--- title: "Claim response code reference" description: "Look up what a private health claim response code means, the message HaltH shows, and what to do next." url: https://support.halth.com/en/articles/13711517-claim-response-code-reference collection: "Troubleshooting" updated: 2026-11-04 language: en --- # Claim response code reference Look up what a private health claim response code means, the message HaltH shows, and what to do next. 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. ## Claim codes

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42	This membership is suspended or no longer active.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.

## Item codes: member and membership

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.

## Item codes: item and service

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.

## Item codes: benefits and limits

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.

## Item codes: dates

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.

## Item codes: billing and charges

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.

## Item codes: admin and system

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.

## Related - [Make a private health claim at checkout](https://support.halth.com/en/articles/10575207.md) - [Step 2: Add your providers](https://support.halth.com/en/articles/13711527.md)