Any fields not required for the particular claim being lodged will be greyed out.
 Patient Names
Family Name - As per the Medicare Card. Maximum of 40 characters long
First Name - Where a patient has only one name, that name should appear in the Family Name field and the word "Onlyname" be entered in the First Name field. Maximum of 40 characters long
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 Date of Birth and Gender
The options for Gender are:
1: Male
2: Female
3: Indeterminate
9: Unknown or inadequately described
M: Male
F: Female
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 Medicare Details
Medicare Number - this is the patients Medicare Card Number. Maximum of 10 characters maximum.
Medicare Ref No. - this is the patients Medicare Reference Number. This number appears to the left of the patients name on their Medicare card. It is one (1) character and can not be a zero (0)
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 Alias
Alias First Name - Is the patient's First Name as known to the Provider for DVA if different to that known by Medicare (or DVA). Maximum of 40 characters long
Alias Family Name - Is the patient's Family Name as known to the Provider for DVA if different to that known by Medicare (or DVA). Maximum of 40 characters long
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 Lodge ClaimTo enable the Lodge Claim button to be enabled the user must type CONFIRM
This is a requirement to have the claim be lodged akin to having to sign it. It is a way of acknowledging that this claim has been purposely put through. This can be done on any of the claim screens.
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