Summary. Bulk-billed Medicare services delivered from 5 September 2025 must be claimed within one year of the date of service to be paid automatically, down from two years. The first deadlines fall on 5 September 2026. Health services with aged bulk-bill worklists, held claims or rejected claims should sort them by date of service now, while there is time to act.
Update, 18 October 2026. The first one-year deadlines passed on 5 September 2026, and more bulk-billed services reach their limit every day. If you haven't yet re-sorted your worklists by days remaining, start there.

What changed

From 5 September 2025, bulk-billed services can be paid automatically only if they are claimed within one year of the date of service. Before that, the limit was two years. The change applies to both paper and electronic claims, and was made through amendments to the Health Insurance Act 1973.

Two details matter:

  • Services delivered before 5 September 2025 keep the two-year limit. The new limit depends on the date of service, not the date you lodge the claim.
  • Patients are not affected. The change is about when providers claim, not what patients pay or receive.

Why ageing backlogs matter now

No claim can reach the new limit until 5 September 2026, when services delivered on 5 September 2025 reach their one-year deadline. From then on, more bulk-billed services pass their deadline every day. That leaves only a few weeks to get worklists in order.

In a busy health service, claims don't always go out on the day of service. They wait for missing referral details, a provider number, an item correction, or a clinician to finalise notes. Others are rejected and sit in a queue until someone has time to fix them. Under a two-year limit, a few months' delay rarely cost anything. Under a one-year limit, the same backlog can mean revenue that won't be paid automatically.

There is also a trap in the transition. Because the limit depends on the date of service, the oldest claim in a worklist is not always the most urgent. A service delivered in August 2025 keeps the two-year limit and can be claimed until August 2027. A service delivered in October 2025 has until October 2026. Sorting a worklist by age alone can put the wrong claims first.

What to check

  1. Worklists by date of service. Split every bulk-bill worklist into services delivered before and from 5 September 2025, then sort the second group by days remaining until the one-year limit. That is your working priority list.
  2. Rejected and held claims. Rejections, claims on hold for missing information and claims waiting for a correction often sit outside the main worklist. Bring them into the same view, by date of service.
  3. System queues. Check error queues, unsent batches and interface queues in your patient administration and billing systems. After a system change these can hold claims that nobody is watching.
  4. Unbilled activity. Look for services that were delivered but never turned into a claim at all. They don't appear in any worklist, but the clock is still running on them.
  5. Ownership and reporting. Make sure someone owns the aged-claim position and reports it regularly, with the number and value of claims reaching the limit in the next 30, 60 and 90 days.

Late lodgement exists, but don't rely on it

The existing late-lodgement arrangements remain in place, but they are an exception process, not a way to manage a backlog. Services Australia asks for evidence of why the claim couldn't be submitted within the time limit, and its guidance says it won't accept late claims due to an administrative issue. A backlog caused by staffing gaps or system problems is unlikely to qualify.

If you have claims at or past the limit, contact the Services Australia Provider Enquiry Line (13 21 50) about your circumstances before you assume they can or can't be paid. The better plan is to stop claims getting close to the limit: fix the reasons claims are held or rejected, watch the queues, and report ageing by date of service.

What this means for you

  • Treat one year from the date of service as the working limit for bulk-billed services delivered from 5 September 2025.
  • Re-sort worklists by days remaining, not by age.
  • Bring rejected, held and queued claims into the same view.
  • Look for delivered but unbilled services, not just unclaimed bills.
  • Ask Services Australia about any specific claim before acting on it.

How Nova can help

Nova's billing and claiming diagnostics age your worklists, held claims and rejected claims by date of service, and show how much is at or near the limit, by clinic and queue. This starts as a fixed-fee diagnostic on a sample of your data.

This article is a general guide, not billing or legal advice. Check your own circumstances with Services Australia before acting.

Sam Mackenzie is a director, owner and founder of Nova Consulting, and a co-owner and director of Nova Health. A former palliative care nurse, he leads Nova's health analytics and revenue work. Read Sam's profile

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