Health Fund Verification | RebateRight

Does the patient’s health fund hold this membership?

That is the question this endpoint answers, from the patient’s details and their health fund membership card.

Test environment only. Services Australia is certifying this service, and it reaches production once certified.

The patient’s health fund checks the membership as at dateOfService.

Send typeCode as PVF. To check Medicare and the health fund in one request, use Medicare and Health Fund Verification.

organisation is the patient’s fund code from Get Participants. A code missing from the current fund list returns code 9672.

Health fund status codes (`healthFundStatus.status.code`)

Code	Meaning
`0`	The fund holds the membership
`8007`	Membership matched. The patient must contact the fund.
`8008`	Membership matched. The provider must contact the fund.
`9662`	The provider must contact the fund
`9663`	Check the fund and the membership card details
`9664`	Check the patient’s details, then the fund and card details. If they are correct, the fund may hold a different name. Send it in `alsoKnownAs`, or send `memberRefNumber`.
`9665`	The fund cannot identify one patient from the details sent. Send more details, or confirm them with the patient.
`9666`	The patient must contact the fund
`9667`	The membership is suspended or cancelled
`9668`	The membership does not cover medical claims. The patient must contact the fund.
`9669`	Membership matched, but the fund cannot take claims for this patient online at present. The patient must contact the fund.
`9671`	The fund does not accept this check at present
`9672`	`organisation` is missing from the current fund list. Refresh your list from Get Participants, then check again.
`9686`	The fund does not hold the baby on the membership
`9687`	The fund holds no bank details for this provider or facility. Contact the fund before you send claims.
`3040`	The fund’s system is unavailable. Check again later.

Validation errors (`400`)

Code	Meaning
`9202`	A submitted field failed its checks. The `reason` in `serviceMessage` names the field and the problem.
`2030`	The request does not fit this check. `typeCode` is not `PVF`, a `medicare` object was sent, or `dateOfService` is before the patient’s date of birth.
`5`, with `codeType` `DHSEIN`	The request does not match the expected structure, such as a missing required field or a number sent as a string. `message` names the problem.

Using this check

Patient verification sets out the hospital cover rule, and how Services Australia requires software to use this check.

Display text exactly as supplied. Services Australia requires its messages to be shown to the end user exactly as supplied in the response, without truncating, transforming or changing them in any way. The wording can change at any time, so branch on code, never on text.

Authentication

x-api-keystring

API Key authentication via header

x-minor-idstring

Your Minor ID is 3 uppercase letters followed by 5 digits, such as MDE00000. Send the Minor ID exactly as issued. A malformed value returns 400 with the text The Minor ID is not valid. on every endpoint.

Request

This endpoint expects an object.

patientobjectRequired

typeCodeenumRequired

Must be PVF on this endpoint. Any other value returns 400 with code 2030.

Code	Meaning
`PVF`	Health fund only

Allowed values:

dateOfServicedateOptional

Optional. The date the fund checks the membership against. Defaults to today when omitted. It cannot be in the future, 2 years or more in the past, or before the patient's date of birth.

Response

correlationIdstring

Unique identifier for this transaction. Use it for tracing and support.

healthFundStatusobject

The fund's answer.

Errors

400

Bad Request Error

Health fund status codes (healthFundStatus.status.code)

Validation errors (400)