55
8 Excess on Serv Nil benefit – excess on service applied
9 Excess on Serv Reduced benefit – excess on service applied
0 Quote Required Nil benefit – quote required prior to service
Quote Required Reduced benefit – quote required prior
to service
Exceeds Quote Nil benefit – claim exceeds quote
Exceeds Quote Reduced benefit – claim exceeds quote
4 Age Restriction Nil benefit – Age restriction applies
5 Age Restriction Reduced benefit – Age restriction applies
6 Gender Restrict Nil benefit – Gender restriction applies
7 Gender Restrict Reduced benefit – Gender restriction applies
8 Invalid Charge Nil benefit – Amount charged is invalid
9 Notional Charge Notional Charge
40 Converted Item Converted item
4 Refer to Health Fund Refer to fund
4 System Problem System Problem
4 Tran Declined Transaction Declined – Refer Tran
to Resp Code
50 Prov Not Appro Provider not approved by Fund
(at date of service)
5 Prov Not Appro Provider not approved by Fund for this
service at DOS
5 Tooth id Reqd Tooth ID Number Required
5 DOS before Injury Service Date Before Injury Date
54 Submitted Transaction Submitted for Processing
P0-PZ Refer to Fund Refer Health Fund – note
Note 1: Item codes in the range P0 – P9 and PA – PZ indicate that an item has been
declined by the Health Fund for a specific reason. These items must be followed up
directly with the Fund.
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