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Medicare claiming troubleshooting

Certification in progress

Praxi is completing Services Australia conformance testing for Medicare Online Claiming. Production claiming becomes available once Services Australia grants the Notice of Integration (NOI). This page describes how the workflow operates so your practice can prepare; we will update it when certification completes.

This guide covers common issues you may encounter when submitting Medicare claims through Praxi, along with step-by-step resolution instructions.

PRODA connection issues​

First check Settings > Medicare > PRODA & claiming > How claims are sent. If you use Praxi's PRODA, Praxi manages the device: review your setup status and contact Praxi Support if the connection remains blocked. The device checks below apply when you have chosen Your own PRODA. For Tyro, follow Tyro setup.

"PRODA connection failed"​

Your practice cannot authenticate with Services Australia.

Steps to resolve:

  1. Check your internet connection — PRODA requires a stable connection to Services Australia's servers
  2. Go to Settings > Medicare and check the connection status
  3. Select Test PRODA connection in PRODA & claiming to read the result
  4. Check the authentication failure count — if there have been multiple failures, your device may be approaching lockout
  5. Verify your PRODA device is still active in the PRODA portal
  6. If the key has expired, contact your Praxi support team to rotate the device key — key rotation is normally automatic; manual rotation is performed by Praxi support, not from the tenant Medicare settings page
  7. If the issue persists after these steps, check the Services Australia system status page for planned outages
info

Services Australia performs scheduled maintenance, typically on weekends. During these windows, PRODA authentication may be temporarily unavailable. Check the system status page if you experience connection issues outside business hours.

"authentication failure count exceeded"​

Too many failed authentication attempts have occurred in a short period.

Steps to resolve:

  1. Stop attempting to submit claims — further failures will lock the device
  2. Go to Settings > Medicare and click Test Connection
  3. If the test succeeds, resume claiming
  4. If the test fails, your device may be locked — see "Device locked" below

Provider issues​

"claim rejected: invalid provider"​

The provider number used in the claim is not valid for the claiming location.

Steps to resolve:

  1. Go to Settings > Medicare and select the claiming practitioner's provider number record
  2. Verify the provider number is correct
  3. Confirm the location stem matches the practice location where the service was delivered
  4. Provider numbers are location-specific — if the practitioner works across multiple sites, each site needs its own provider number registered with Services Australia
  5. If the practitioner recently changed locations or registered a new provider number, ensure it has been updated in Praxi
tip

You can check a practitioner's provider number details in the Health Professional Online Services (HPOS) portal.

Claim processing issues​

"pendable claim expired"​

A PCI claim with PENDABLE status was not confirmed within the 1-hour window.

Steps to resolve:

  1. The original claim has expired and cannot be confirmed
  2. Go to Finance > Claims and find the expired claim
  3. Click Resubmit to create a new claim with the same details
  4. When the new claim returns PENDABLE, confirm it within 1 hour
  5. To avoid this in future, check the claiming queue regularly for PENDABLE claims — Praxi displays a countdown timer and sends notifications
warning

PENDABLE claims must be confirmed before the deadline SA sets on the pendable response (typically one hour from submission). Use Confirm — Praxi then re-sends the same logical claim for you. If you resubmit instead, Praxi creates a brand-new claim and the original PENDABLE window simply expires.

"same-day delete failed"​

You attempted to delete a claim but the deletion was rejected.

Steps to resolve:

  1. Verify the claim was submitted today (same business day) — same-day delete is only available for claims submitted earlier the same business day
  2. Check the claim status — claims with a status of PAID cannot be deleted
  3. If the claim was submitted on a previous day, you must use the standard adjustment process instead (contact Services Australia if needed)
  4. If the claim is from today and is not PAID but deletion still fails, try again after a few minutes — there may be a brief processing delay

"processing report empty"​

After submitting Bulk Bill claims, the processing report shows no results.

Steps to resolve:

  1. Wait — Bulk Bill claims are processed asynchronously (store-and-forward). Results may take from a few minutes to several hours
  2. Praxi polls for processing reports every 15 minutes automatically
  3. Check back in Finance > Claims after 30–60 minutes
  4. If no results appear after several hours:
    • Verify the claims were actually submitted (check for a "Submitted" status)
    • Check the PRODA connection status — if authentication failed, claims may not have been sent
    • Contact Praxi Support if claims show as submitted but no report arrives within 24 hours

Medicare number issues​

"Medicare number validation failed"​

The client's Medicare details did not pass validation.

Steps to resolve:

  1. Open the client record and go to Medicare Details
  2. Verify the Medicare card number — must be exactly 10 digits
  3. Verify the IRN (Individual Reference Number) — a single digit from 1 to 9, identifying which person on the card
  4. Verify the card issue number — printed below the expiry date on the physical card
  5. Check the card expiry date — expired cards may still be valid for claiming, but the issue number must be current
  6. If the client has recently received a new Medicare card, update all fields to match the new card
tip

Ask clients to bring their Medicare card to each appointment. Card details change when cards are reissued (e.g., after adding a dependant or changing name). The issue number is the most commonly outdated field.

"patient not eligible"​

The Medicare eligibility check indicates the client is not currently eligible.

Steps to resolve:

  1. Ask the client to confirm their Medicare eligibility status — they may need to contact Services Australia
  2. Check if the client has a temporary visa — some visa types do not include Medicare
  3. Check if the client's reciprocal healthcare agreement coverage has expired
  4. If the client has recently become an Australian citizen or permanent resident, they may need to register for Medicare
  5. Consider billing via an alternative funding source (private billing) if the client is not eligible

Session and referral issues​

"session limit exceeded"​

The client has used all allocated Medicare sessions.

Steps to resolve:

  1. Check the session count on the client record — Praxi tracks sessions automatically
  2. Under Better Access, clients receive 10 individual sessions per calendar year (1 January – 31 December)
  3. If sessions are exhausted for this calendar year:
    • Discuss alternative funding with the client (private, NDIS, EAP, WorkCover)
    • New sessions become available on 1 January of the next calendar year
    • The client will need a new Mental Health Treatment Plan from their GP
  4. If you believe the count is incorrect, check whether other providers have submitted claims for this client — the session count is shared across all providers

"referral required"​

The claim was rejected because no valid referral is on file.

Steps to resolve:

  1. Open the client record and go to Referrals
  2. Check if a GP referral (Mental Health Treatment Plan) is recorded
  3. Verify the referral has not expired
  4. If the referral has expired, the client needs to return to their GP for a new referral
  5. Once the new referral is recorded in Praxi, resubmit the claim

When to contact Praxi support​

Contact Praxi Support if:

  • You have followed the troubleshooting steps but the issue persists
  • You encounter an error code not covered in the error codes reference
  • Claims are stuck in a "Submitted" status for more than 24 hours
  • The PRODA connection test passes but claims are still failing
  • You suspect a bug or system issue

When to contact Services Australia​

Contact Services Australia on 1800 700 199 (Health Professional line) if:

  • Your PRODA device is locked and needs to be unlocked
  • You need to verify a patient's Medicare eligibility directly
  • You need to dispute a claim assessment or request a review
  • You have questions about MBS item eligibility for your provider type
  • Your HW027 form has not been processed after 10 business days

When PRODA is locked or the key is lost​

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Verified against the current Praxi product surface on 2026-05-14. For wire-level error semantics see Medicare Error Codes.