Overseas Visitor Eligibility Check | RebateRight

curl -X POST https://test-api.rebateright.com.au/Medicare/onlineeligibilitycheck/overseas/v2 \
     -H "x-minor-id: <minorId>" \
     -H "x-api-key: <apiKey>" \
     -H "Content-Type: application/json" \
     -d '{
  "claim": {
    "accountReferenceId": "QUOTE0011",
    "claimTypeCode": "AG",
    "compensationClaimInd": "N",
    "hospitalInd": "Y",
    "peaRequestInd": "N",
    "serviceTypeCode": "O",
    "submissionAuthorityInd": "Y",
    "typeCode": "ECO",
    "patient": {
      "identity": {
        "dateOfBirth": "1993-08-14",
        "familyName": "NASH",
        "givenName": "Hazel",
        "sex": "2"
      },
      "healthFund": {
        "memberNumber": "1234567",
        "organisation": "TST",
        "memberRefNumber": "1"
      }
    },
    "principalProvider": {
      "providerNumber": "2447781L"
    },
    "accident": {
      "accidentInd": "N"
    },
    "medicalEvent": [
      {
        "id": "01",
        "serviceProvider": {
          "providerNumber": "2447781L"
        },
        "service": [
          {
            "id": "0001",
            "serviceCodeTypeCode": "C",
            "chargeAmount": "12000",
            "dateOfService": "2027-09-01",
            "itemNumber": "30026"
          }
        ],
        "admissionDate": "2027-09-01"
      }
    ],
    "facilityId": "9988770W",
    "presentingIllnessItemNumber": "30026",
    "sameDayInd": "Y"
  }
}'

{
  "status": "COMPLETE",
  "correlationId": "urn:uuid:MDE00000227d6350388e426a",
  "claimSummary": {
    "accountReferenceId": "QUOTE0011"
  },
  "healthFundStatus": {
    "status": {
      "code": 0,
      "text": "Patient is known to the Health Fund specified in the request."
    }
  },
  "healthFundClaimEstimation": {
    "healthFundTable": {
      "tableName": "Basic Hospital",
      "tableDescription": "Hospital cover only",
      "tableScale": "SINGLE"
    },
    "benefitLimitations": "This is to test a return of 100 character entry in the table description or benefit limitations....",
    "financialStatus": "Y",
    "fundAssessmentCode": "A",
    "fundReferenceId": "STS012102",
    "peaPotentialInd": "N",
    "explanation": [
      {
        "code": "1001",
        "text": "Patient to contact Health Fund"
      }
    ],
    "medicalEvent": [
      {
        "id": "01",
        "service": [
          {
            "id": "0001",
            "benefit": 2000,
            "chargeAmount": "12000",
            "dateOfService": "2027-09-01",
            "fundAssessmentCode": "A",
            "itemNumber": "30026",
            "serviceCodeTypeCode": "C",
            "explanation": [
              {
                "code": "2001",
                "text": "The Fund does not pay for this sort of stuff"
              }
            ]
          }
        ]
      }
    ]
  }
}

What will an overseas visitor’s health fund pay for this treatment?

That is the question this endpoint answers before treatment, in hospital or out of hospital, as an estimate from the visitor’s Australian health fund.

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

Use it when a medical provider treats an overseas visitor who holds cover with an Australian health fund. The check goes to the visitor’s health fund alone, and sends no Medicare details. The fund returns its cover and its benefit for each MBS item, prosthesis or miscellaneous item you send.

Send typeCode as ECO. Send hospitalInd as Y for treatment in hospital, or N for treatment out of hospital. hospitalInd decides which admission fields you send:

Field	In hospital (`Y`)	Out of hospital (`N`)
`facilityId`	Required	Optional
`sameDayInd`	Required	Send `Y`
`lengthOfStay`	Required when `sameDayInd` is `N`	Leave out
`admissionDate`	Required	Leave out
`dischargeDate`	Optional	Leave out

Out of hospital, send sameDayInd as Y, because without it Medicare asks for lengthOfStay.

The estimate supports informed financial consent. The fund assesses the actual claim on the visitor’s cover when the claim is made.

Response `status`

Value	Meaning
`COMPLETE`	The fund answered. `healthFundStatus` and `healthFundClaimEstimation` hold the estimate.
`HEALTH_FUND_REJECTED`	The fund rejected the check
`HEALTH_FUND_UNAVAILABLE`	The fund’s system is unavailable. Check again later.

If the fund takes longer than 30 seconds to answer, the check fails with code 3040. Send it again.

Limits

A request holds up to 16 medical events, numbered from 01 in order. Each medical event holds between 1 and 14 services, and the request holds up to 50.

Validation errors (`400`)

Code	Meaning
`9202`	A submitted field failed its checks. The `reason` in `serviceMessage` names the field and the problem.
`2030`	Two fields conflict, or a date breaks its rule. The `reason` names the rule and, where it applies, the medical event and service.
`9672`	`organisation` is missing from the current fund list. Refresh your list from Get Participants, then check again.
`2025`, `2032`, `2033`	The request is over one of the limits above.
`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.

Showing the result

Give the patient the report sets out what a result shown or printed for the patient must carry.

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.

claimobjectRequired

Response

statusenum

Outcome of the check. The status table at the top of this page explains each value.

Allowed values:

correlationIdstring

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

claimSummaryobjectOptional

healthFundStatusobjectOptional

The fund’s check of the membership. Code 0 means the fund holds the membership.

healthFundClaimEstimationobjectOptional

The fund’s estimate for the treatment. The test environment’s fund returns the fields in the examples. A fund can also return exclusionDescription, patientCoPayment, patientExcessPayment, productTier and additionalClinicalCategories.

Errors

400

Bad Request Error

Response status