A rejected claim is not lost money - it's money with a deadline. Medicare tells you why a claim bounced, most rejections are administrative and fixable, and a corrected claim can be resubmitted. The same goes for NDIS payment requests. What turns a rejection into a write-off is silence: nobody notices, nobody fixes it, and the lodgement window - now as short as one year for bulk-billed Medicare services and 90 days for NDIS payment requests - quietly closes.
Medicare: why claims bounce
When a bulk bill or patient claim is rejected through your claiming channel, it comes back with a reason code. The usual suspects in allied health are mundane:
- Patient detail mismatches - an expired Medicare card, a name spelled differently, a transposed digit.
- Referral problems - the referral lapsed, its details weren't included, or the item billed doesn't match what the referral supports.
- Session limits reached - the patient has used their allocation for the calendar year under their plan or program, so the item isn't payable again.
- Item number errors - a wrong or outdated item, or a service combination Medicare won't pay together.
- Duplicate claims - the claim (or something that looks like it) was already submitted.
Every one of these is correctable. The routine is unglamorous: read the reason code, fix the underlying detail, resubmit. What matters is that someone actually does it the week the rejection lands, not at tax time.
The deadline just halved
For services provided on or after 5 September 2025, bulk-billed Medicare claims must be lodged within one year of the date of service (services before that date kept the old two-year window). Miss it and you're into the late-lodgement application process - paperwork, a Services Australia assessment, and no guarantee. A rejected claim that sits unfixed is running down that clock the whole time, which is why "we'll sort the bounced ones later" is more expensive advice than it used to be.
NDIS: who you chase depends on how the plan is managed
An unpaid NDIS invoice has three different owners, and the first step is knowing which one you're dealing with:
- NDIA-managed (agency-managed): you claim through the provider portal. Rejections show up there with a reason - commonly a price above the current pricing schedule cap, wrong dates, a duplicate request, missing bank or ABN details, or claiming outside the participant's plan dates. Most are correctable in the portal, and payment requests are expected within 90 days of the service.
- Plan-managed: your invoice goes to the plan manager, and the chase is with them - a business-to-business follow-up like any other overdue invoice, except the plan manager is themselves waiting on the portal. Polite, specific, persistent.
- Self-managed: the participant pays you and claims back. Your follow-up is with the person, which is exactly the conversation clinics find hardest - we've written about why those invoices pile up and the structures that help.
Since the NDIA's move to its new PACE system, providers claiming for agency-managed participants may also need the participant to have endorsed them as a "my provider" for some supports - if requests suddenly started bouncing after a participant's plan moved, that's worth checking before assuming a billing error.
The real problem: rejections that go quiet
In a busy practice the failure mode is rarely "we couldn't fix it". It's that the rejection landed in a portal or an inbox, the day moved on, and the claim silently joined a pile with no owner. US healthcare data suggests as much as two-thirds of denied claims are never reworked at all - and the research on revenue leakage in private practice says small clinics are most exposed, because nobody's job is to watch the pile.
The fix is a standing habit, not heroics: once a month, list every claim and third-party invoice with no recorded outcome, and work the list oldest-first. It's step four of our end-of-month billing checklist, and an hour a month is enough to keep the pile at zero while the money is still claimable.
Where RIFT fits (and where it doesn't)
RIFT won't resubmit a Medicare claim for you, and on Cliniko it can't see claim outcomes at all - claim results live in your claiming terminal, not the practice management system, and we'd rather tell you that plainly than imply otherwise. What RIFT does watch, continuously, is the layer where rejected-and-forgotten money eventually shows up: invoices that stay unpaid past your terms, sessions that never got invoiced at all, and cancellation fees never raised. It drafts the follow-ups and tracks each item until it's resolved, so the pile with no owner gets one. The first leak report is free and covers your last 12 months.