When you submit a private health claim, the fund sends back a response code for the claim and for each item. HaltH shows a plain-English message for each code. Use this page to look up what a code means and what to do next.
Claim codes are 2 digits and apply to the whole claim. Item codes are 4 digits and apply to a single item.
Code | What HaltH shows | What to do |
|---|---|---|
00 | Claim approved. | No action needed. |
01 | This provider isn’t yet approved by the fund. | Check the provider's registration for this fund and location. See Provider not approved or not found for a fund or location. |
02 | Please contact the health fund for help. | Ask the client to contact their fund. |
03 | The provider number doesn’t appear to be valid. | Check the provider number in the provider's funding registrations. |
04 | Please keep the card — it may need review. | Don't resubmit. Ask the client to contact their fund. |
10 | The fund needs to review this claim. | Wait for the fund to review it. |
12 | The claim wasn’t accepted. Please check and try again. | Check the member number, that the name matches the card exactly, and the items. Repeated declines can block the card for 12 hours. |
14 | The card number seems invalid. Double-check and retry. | Check the membership number and card details, then retry. |
15 | Some claim items weren’t accepted by the fund. | Check the item codes below for each item. |
19 | Please add at least one item to submit the claim. | Add an item and resubmit. |
21 | Please contact support for assistance. | Chat with HaltH support. |
25 | We couldn’t locate this claim. Please check the details. | Check the transaction in Transactions before trying again. |
30 | Something didn’t go through correctly. Please try again. | Try again. Chat with support if it keeps happening. |
32 | Claim submitted — some items were only partially processed. | Check the item codes. The client pays the difference as their gap. |
40 | The membership doesn’t cover this service. | The client pays in full. They can check their cover with the fund. |
42 | This membership is suspended or no longer active. | Ask the client to contact their fund. |
51 | The membership isn’t up to date with payments. | Ask the client to contact their fund. |
54 | The member’s card has expired. Please update the details. | Update the card details from the client's current card. |
56 | The membership number doesn’t match any record. | Check the member number and that the name matches the card exactly. |
57 | The member doesn’t have ancillary cover for this service. | The client pays in full. |
58 | This type of claim can’t be processed. | Ask the client to contact their fund. |
60 | The fund doesn’t recognise this provider. | Check the provider's registration for this fund and location. |
61 | The benefit limit for this service has been reached. | The client has used their limit. They pay in full. |
69 | No benefit is payable for this claim. | The client pays in full. |
76 | The service date must match the claim date. | Private health claims must be made on the day of the appointment. The client can claim directly with their fund. |
80 | This claim must be processed through the employer. | Ask the client to contact their fund. |
81 | We couldn’t locate this claim record. | Check the transaction in Transactions before trying again. |
82 | This claim has already been processed. | Don't resubmit. Check Transactions. |
83 | Too many patients listed — please review. | Check the claim is for one patient and resubmit. |
84 | This claim needs to be submitted manually. | Take full payment. The client claims directly with their fund using the receipt. |
91 | The system is busy — please try again shortly. | Wait a minute and try again. |
92 | The system is temporarily unavailable — try again soon. | Wait a few minutes and try again. |
93 | A system issue occurred — please try again later. | Wait a few minutes and try again. Chat with support if it keeps happening. |
94 | This claim looks like a duplicate submission. | Check Transactions. The first claim may have gone through. |
Code | What HaltH shows | What to do |
|---|---|---|
0000 | Item approved. | No action needed. |
0007 | The member is still within their waiting period. | Ask the client to check with their fund when their cover starts. |
0009 | Not payable due to a pre-existing condition. | The client pays for this item. |
0019 | The patient isn’t covered for this service. | Check the right patient (cardholder) is selected. |
0020 | The dependent status isn’t valid for this member. | Check the cardholder details. The client may need to contact their fund. |
0021 | The patient number isn’t valid. | Check the patient (reference) number on the card and resubmit. |
0022 | The membership doesn’t cover this service. | The client pays for this item. |
0023 | The membership is suspended or no longer active. | Ask the client to contact their fund. |
0024 | The membership isn’t up to date with payments. | Ask the client to contact their fund. |
0025 | This membership doesn’t include ancillary cover. | The client pays for this item. |
0034, 0035 | The member’s age doesn’t meet the requirements for this service. | The client pays for this item. |
0036, 0037 | The member’s policy restricts this service by gender. | The client pays for this item. |
Code | What HaltH shows | What to do |
|---|---|---|
0002, 0003 | This item has restrictions under the member’s policy. | Ask the client to check their policy before resubmitting. |
0008 | Another service must be claimed first. | Check which service must be claimed first (often an initial consult). |
0010 | The item number isn’t valid. Please check and retry. | Check the item code and resubmit. |
0011 | This item number is no longer in use. | Use the current item code instead. |
0012, 0013 | This item isn’t approved for this provider. | Check the item code matches the provider's profession and registration. |
0014 | The maximum number of uses for this item has been reached. | The client pays for this item. |
0018 | Please include the relevant body part for this service. | Add the body part and resubmit. |
0040 | The item has been converted to a different code. | No action needed. Check the new code on the response. |
0051 | This item isn’t available for this provider type. | Use an item code for the provider's profession. |
0052 | Please include the relevant tooth number. | Add the tooth number and resubmit. |
0055 | Please provide an ICD-10 code. | Add the ICD-10 code and resubmit. |
0058 | This item can’t be used for telehealth claims. | Use the telehealth item code instead. |
Code | What HaltH shows | What to do |
|---|---|---|
0001 | No benefit is payable for this item. | The client pays for this item. |
0005, 0006 | The benefit limit for this service has been reached. | The client has used their limit for this period and pays for this item. |
0026 | The fund doesn’t cover this item. | The client pays for this item. |
Code | What HaltH shows | What to do |
|---|---|---|
0016 | The service date appears invalid. | Check the appointment date and resubmit. |
0017 | The service date is too far in the past. | The client can claim directly with their fund. Chat with support if you think this is wrong. |
0053 | The date of service is before the recorded injury date. | Check the dates and resubmit. |
Code | What HaltH shows | What to do |
|---|---|---|
0004 | This item has already been paid. | Check Transactions before resubmitting. |
0015 | Please enter a service fee to proceed. | Enter a price for the item and resubmit. |
0027 | This item appears to have already been submitted. | Check Transactions before resubmitting. |
0028, 0029 | An excess applies — benefit reduced accordingly. | No action needed. The client pays the difference. |
0032, 0033 | The item exceeds the approved quotation amount. | Lower the amount or get a new quotation. |
0038 | The charge entered isn’t valid. | Check the price and resubmit. |
0039 | Benefit calculated on a notional charge. | No action needed. The fund used its own charge, not the price entered. |
0056 | The charge exceeds the fund’s maximum payable amount. | Lower the price and resubmit. |
0057 | The item amount has been adjusted. | No action needed. Check the adjusted amount on the response. |
Code | What HaltH shows | What to do |
|---|---|---|
0030, 0031 | A quotation is required before this item can be paid. | Get a quote from the fund first. |
0041 | The fund needs to review this item manually. | Wait for the fund's response. |
0042 | A system issue occurred — please try again later. | Wait a moment and try again. Chat with support if it keeps happening. |
0044 | A medical certificate is required for this item. | The client claims directly with their fund and provides the certificate. |
0050 | The fund doesn’t recognise this provider. | Check the provider's registration for this fund and location. |
0054 | The item has been sent for manual processing. | No action needed for now. |
