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RebateRight APIMedicare ClaimingIN Patient Claims

In-Patient Agreement — Specialist

Beta

How do I lodge an in-patient Agreement claim for specialist or diagnostic imaging services?

Use this endpoint when the provider has an agreement with the patient’s health fund, for specialist and diagnostic imaging services.

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

You sendYou getThen
An Agreement claim (AG) for the medical services an admitted patient received in hospitalAn acknowledgement: status SUCCESS and the claim’s correlationId, with no assessmentStatus Report says when the claim’s report is ready, and In-Patient Claim Report retrieves it

Which claim type do I send? defines each claim type and who it pays. In-patient claims (ECLIPSE) sets out the rules the claim types share.

Referral requirement

Send specialist and diagnostic imaging services with serviceTypeCode set to S. Every medical event needs one of the following, or Medicare rejects the claim with 2030:

OptionHow to send it
A specialist referralreferral with typeCode S and a periodCode
A diagnostic imaging requestreferral with typeCode D
No referral documentreferralOverrideCode of E, H, L or N
A self-deemed serviceselfDeemedCode of SD or SS on at least one service

Send referralOverrideCode on its own. With referral or a selfDeemedCode, it is rejected with 2030.

Send each item to the endpoint for its specialty. Send general services to In-Patient Agreement — General, and pathology services to In-Patient Agreement — Pathology.

Claim limits. Validations gives the limits for each claim type.

Responses

ResponseMeaning
200Medicare has received the claim for processing, and status is SUCCESS.
400Medicare or RebateRight rejected the request, and nothing is lodged. The 400 response of In-Patient Agreement — General lists the codes and what to do.
503RebateRight got no response from Medicare, so Medicare may or may not hold the claim. Follow When a claim gets no response.

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.

Headers

x-minor-idstringRequired

The Minor ID of the clinic you act for. See Keys, Minor ID and environments.

Request

This endpoint expects an object.
claimobjectRequired

The in-patient claim. One claim covers one patient.

correlationIdstringOptionalformat: "^urn:uuid:[A-Z]{3}[0-9]{5}[A-Za-z0-9]{16}$"=33 characters

Your identifier for this claim, 33 characters: urn:uuid:, then the Minor ID you send in x-minor-id, then 16 letters or digits, as in urn:uuid:MDE00000a1b2c3d4e5f6a7b8.

Send your own on every claim, and store it before you send. You request the claim’s status and report by its transaction ID, which is this value without urn:uuid:. If you omit it, RebateRight generates one and returns it on the response. When to use a new value and when to reuse one is set out in Correlation ID.

Response

Medicare has received the claim for processing.
statusstring

SUCCESS means Medicare has received the claim for processing. It is not an assessment, and its report can still show the claim as rejected.

correlationIdstring

The correlationId you sent, or the one RebateRight generated. Store it with the claim, because you request the claim’s status and report by it.

Errors

400
Bad Request Error