Medicare and Health Fund Verification | RebateRight

Does this patient match Medicare and their health fund?

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

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

Medicare checks the patient first. The health fund checks the membership only when Medicare returns code 0. Any other Medicare code, including a partial match such as a corrected Individual Reference Number (IRN), skips the fund check and returns health fund code 9674.

The fund checks the membership as at dateOfService.

Send typeCode as OPV. To check the health fund alone, use Health Fund Verification. To check Medicare alone, use Patient Verification.

Common Medicare status codes (`medicareStatus.status.code`)

Code	Meaning
`0`	Patient matched on Medicare
`8015` to `8022`	Accepted, but not an exact match. `text` names the detail to check. For a wrong IRN (`8016`), `currentMembership` holds the correct value.
`9633`	A new Medicare card has been issued, so the details differ from Medicare’s records
`9650`	The card number or the patient details did not match Medicare

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

0 means the fund holds the membership. 9674 means the fund check was skipped, because Medicare returned a code other than 0. Health Fund Verification lists the other codes a fund returns.

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 `OPV`, `medicare` or `healthFund` is missing, 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 OPV on this endpoint. Any other value returns 400 with code 2030.

Code	Meaning
`OPV`	Medicare and health fund

Allowed values:

dateOfServicedateOptional

Optional. The date Medicare and the fund check the details 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.

medicareStatusobject

The outcome of the Medicare check.

healthFundStatusobject

The outcome of the health fund check. It carries code 9674 when the fund check was skipped.

Errors

400

Bad Request Error

Common Medicare status codes (medicareStatus.status.code)

Health fund status codes (healthFundStatus.status.code)

Validation errors (400)