How to Claim a Medicare Benefit When Your Provider Has Not Claimed for You
Submit your own Medicare claim when your health provider has not claimed for you. Check invoices, proof of payment, online limits and processing times.
AU Australia
Benefits & Support ~ 8 min read
8 FAQ
Updated 2026-10-02
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If your health provider has not submitted your Medicare claim, you can usually claim through your Medicare online account linked to myGov. You need the service details, invoice and proof of payment if you paid in full. Online claims cannot be made for services more than 2 years old. Online claims usually pay within 7 days; mail and service-centre claims usually pay within 21 days.
What you need
- Be enrolled in Medicare and be entitled to claim for the patient or service concerned.
- Have the invoice for each service you are claiming.
- If you paid the account in full, have proof of payment, such as the paid invoice or receipt.
- For an online claim, have your Medicare online account linked to myGov and make sure the service is not more than 2 years old.
- Have the health professional's provider number, Medicare item number, date of service and amount paid where these details are required for the online claim.
- Make sure Services Australia has your correct bank account details so it can pay your Medicare benefit electronically.
Eligibility
You can submit your own Medicare claim when you received an eligible Medicare service and your health provider has not already submitted the claim for you. You can claim for health care services for people listed on your Medicare card. If you paid for a person who is on another Medicare card, you may also be able to claim for that person, but Services Australia says this type of claim cannot be submitted online. Online claims are not accepted for services more than 2 years old; older claims must be lodged by mail or at a service centre.
How to do it
- Check whether the health professional has already submitted the Medicare claim. If your invoice or receipt says 'Statement of claim and benefit payment', the claim may already be processing.
- Gather the invoice for the service and proof of payment if you paid the account in full.
- Check that the invoice or receipt includes the information needed for the claim, including the provider number, Medicare item number, date of service and charge.
- Make sure your bank account details registered with Medicare are correct.
- For an eligible online claim, sign in to myGov or the myGov app, select Medicare and then select 'Make a Medicare claim'.
- Select the patient, confirm whether the account has been paid in full and upload clear copies or images of the invoice and proof of payment.
- Enter the provider number and each Medicare item, including the date of service and amount paid. Add referral information if the online service asks for it.
- Review the claim carefully, submit it and keep the Claim ID provided after successful submission.
- If you cannot claim online, use Medicare Claim form MS014 and submit the claim by mail or at a service centre. Claims containing an amount of $10,000 or more follow the High Value Medicare Claim Services process.
- Check recent claims in your Medicare online account if you need to follow the progress of an online claim.
When do you need to make the Medicare claim yourself?
The quickest Medicare claiming method is usually for your health professional to submit an electronic claim immediately after you pay. If they do not offer electronic claiming or have not submitted the claim for you, you can make the claim yourself through Medicare online through myGov, or use an alternative mail or service-centre route.
Before submitting another claim, check whether your provider has already lodged it. If your invoice or receipt says Statement of claim and benefit payment, Services Australia says the claim is being automatically processed and you should not submit it again.
What evidence do you need for a Medicare claim?
Services Australia requires supporting documents so it can assess your claim. You need:
- the invoice for the services you are claiming
- proof of payment if you paid the services in full.
For an online claim, scan or photograph the documents before starting. Services Australia accepts PDF, JPG, GIF, PNG and BMP files that are less than 5 MB each. The images need to be clear enough to read.
If you submit a claim by mail or at a service centre, Services Australia requires the original accounts and receipts for the services being claimed.
What details do you enter for an online claim?
The Medicare online service asks for information from the invoice or receipt issued by your health professional. This includes the provider number, Medicare item number, date of service and amount paid for the item.
If your invoice contains several Medicare items, add each item separately. You may also need to enter referral information, including the referring health professional's provider number and the referral date, when this applies to the service.
How do you claim Medicare online through myGov?
To make an online claim, sign in to myGov or the myGov app and select Medicare. From your Medicare account, select Make a Medicare claim.
Before starting, Services Australia recommends checking your claims history or recent claims to make sure the service has not already been claimed.
The online process then asks you to:
- select the person who received the service
- confirm whether the account has been paid in full
- upload your invoice and proof of payment where required
- enter the provider number
- enter each Medicare item, service date and amount paid
- provide referral information if required
- review and submit the claim.
You receive a Claim ID after successfully submitting the claim. Keep this number in case you need to refer to the claim later.
Can you claim for another person?
You can claim for health services provided to people listed on your Medicare card. When submitting an online claim, you select the person who received the service, and you can only make a claim for one person on the card at a time.
Services Australia also states that you can claim for someone who is on another Medicare card if you paid for their service. However, you cannot make that type of claim online, so you need to use an alternative claiming channel.
Can you claim an unpaid medical account?
Yes. Medicare Claim form MS014 can be used for paid and unpaid accounts. The online claiming process also asks whether the services have been paid in full.
If an online claim concerns an unpaid account, Services Australia says it will mail a cheque made payable to the health professional. If you state that the service was paid in full, you need proof of payment before completing the online claim.
Can you claim a service from more than 2 years ago?
Services Australia does not accept online Medicare claims for services that are more than 2 years old.
If the service is more than 2 years old, you can instead submit the claim by mail or at a service centre. This is an online-channel restriction rather than a statement that every older service will necessarily qualify for a Medicare benefit.
What if you cannot make the claim online?
If you cannot claim through your health professional or online, complete the Medicare Claim form (MS014). Services Australia provides this form for Medicare claims submitted by mail or at a service centre.
The form can be used for both paid and unpaid accounts. Include the required original supporting documents. For a mail claim, send the completed form to the address specified on the form.
You can also submit a claim at a service centre. Services Australia confirms your bank account details when you make the claim because Medicare benefits are paid electronically into your registered bank account.
What if the claim includes an amount of $10,000 or more?
If your Medicare claim contains an amount of $10,000 or more, Services Australia requires you to complete Medicare Claim form MS014 and use its High Value Medicare Claim Services process.
The completed form can be sent to High Value Medicare Claim Services by the official email or mail channel specified by Services Australia, or the claim can be submitted at a service centre.
Where does Medicare pay the benefit?
For a paid claim, Medicare benefits are normally paid electronically into the bank account you have registered with Services Australia. Make sure your Medicare bank details are correct before submitting the claim.
If Services Australia does not have your bank details, it can hold the benefit until you provide them. You can manage Medicare details through your Medicare online account.
How long does a Medicare claim take?
Services Australia says that when you submit an eligible claim online, you will usually get your benefit within 7 days.
For a claim submitted by mail, you will usually get the benefit within 21 days from when Services Australia receives it. Claims submitted at a service centre also usually pay within 21 days.
These are Services Australia's usual payment timeframes, not guarantees that every claim will be completed within that period. A claim may require additional assessment or information.
How do you check whether your claim has been processed?
After submitting an online claim, you can use your Medicare online account to view recent Medicare claims. Services Australia shows recent claim information for up to 30 days after a claim is completed, including the date submitted, status, patient, provider, claiming method and Claim ID.
Your Medicare online account also lets you make and track claims, view claims history and manage your Medicare details.
What if you have high out-of-pocket medical costs?
Eligible out-of-hospital Medicare services can count towards the Medicare Safety Net. Once the applicable threshold is reached, the Medicare Safety Net can increase the amount Medicare pays for certain eligible services for the rest of the calendar year.
If you are part of a couple or family, registration can be important so your eligible costs are combined. See the separate Helpydo procedure on how to register your family or couple for the Medicare Safety Net.
If you are not yet enrolled in Medicare, claiming is a later step. Start with the separate guide on how to enrol in Medicare for the first time.
Frequently asked questions
Can I claim Medicare myself if my doctor did not submit the claim?
Yes. If your health professional has not claimed for you, you can usually submit the claim through your Medicare online account linked to myGov. Mail and service-centre options are also available.
What documents do I need to make my own Medicare claim?
You need invoices for the services being claimed and proof of payment if you paid the services in full. Online claims require clear uploaded copies or images of the supporting documents.
How long does an online Medicare claim take?
Services Australia says you will usually receive your Medicare benefit within 7 days after submitting an online claim.
Can I submit a Medicare claim more than 2 years after the service?
You cannot claim a service more than 2 years old through the online service. Services Australia directs older claims to the mail or service-centre claiming channels.
Can I claim Medicare if I have not paid the doctor yet?
Medicare Claim form MS014 can be used for paid or unpaid accounts. In the online process, if the service has not been paid in full, Services Australia says it will mail a cheque made payable to the health professional.
Can I claim for someone who is not on my Medicare card?
Services Australia says you can claim for someone on another Medicare card if you paid for the service, but you cannot submit that type of claim online.
How do I know if my doctor already submitted the Medicare claim?
Check your recent claims and your invoice or receipt. If it says 'Statement of claim and benefit payment', Services Australia says the claim is being automatically processed and you should not submit it again.
What happens if my Medicare claim is $10,000 or more?
If the claim contains an amount of $10,000 or more, complete Medicare Claim form MS014 and use the High Value Medicare Claim Services process or submit the claim at a service centre.
Official sources
Services Australia - Medicare claimsServices Australia - Medicare online account help: Make a Medicare claimServices Australia - Proof of payment for a Medicare claimServices Australia - Medicare Claim form (MS014)Services Australia - What you can do with your Medicare online accountRelated procedures
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