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RebateRight APIMedicare ClaimingInteractive Patient Claims

Interactive Patient Claim — Pathology

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How do I lodge a Medicare patient claim for pathology services?

Use this endpoint. The referral requirement is below, and Medicare’s outcome comes back in the response.

The pathology interactive patient claim endpoint submits a Medicare patient claim for pathology services.

Referral requirement

One of the following must hold, or Medicare rejects the claim:

  • referral.typeCode = P (pathology request), or
  • referralOverrideCode = N (not required), or
  • selfDeemedCode = SD on at least one service and no service uses SS.

Response handling

The 200 response has the same shape as the general endpoint’s. The response schema below has the full status and assessmentCode handling tables.

Error codes

Medicare’s 4-digit return codes on error.code (claim- or service-level) and serviceMessage[].code are in the Services Australia return-code lookup. The general endpoint lists how to handle 9777 and 3004.

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 Required headers and hosts.

Request

Pathology-only request fields, combined with the general interactive claim payload through allOf.

patientClaimInteractiveobjectRequired
correlationIdstringOptional

Your identifier for this claim: the prefix urn:uuid:, then the Minor ID you send in the x-minor-id header, then 16 letters or digits, as in urn:uuid:MDE00000dd434adf401e4ee3.

Send your own on every claim, and store it before you send. Use a new value for every new claim. Correlation ID has the rules for reusing one, including the resend that pends a pendable claim. If you omit it, RebateRight generates one, which you see only in a response.

Response

OK
statusenum

Overall claim outcome. The value drives response handling on your side:

StatusMeaningTypical handling
MEDICARE_ASSESSEDClaim assessed by Medicare. Each service has an assessmentCode, and benefitPaid holds the benefit per service, which can be zero.Show the benefit per service. Check the claim-level error: 9783 means Medicare holds the payment until the claimant updates their bank details. On an unpaid claim, the benefit is paid by a cheque made out to the provider.
MEDICARE_PENDABLEMedicare received and checked the claim, and found an issue only a Medicare operator can resolve. The claim is not queued for an operator. A service with ACCEPTABLE_ERROR gives the reason, such as a possible duplicate.Show the reason to the claimant. Then pend the claim or correct it, as Pendable Claims describes.
MEDICARE_PENDEDMedicare accepted the claim and queued it for manual assessment by an operator. The API returns no later assessmentCode or benefitPaid for it.Record the claimId for reconciliation, and give the claimant a printed Lodgement Advice, which the law requires. Medicare tells the claimant the outcome directly, and the API sends no notification.
MEDICARE_REJECTEDClaim rejected outright. Check claimAssessment.error (claim-level) or per-service error for the reason.Correct the issue, then send the claim with a new correlationId.
Allowed values:
correlationIdstring

Echo of the request correlationId (or the one generated by RebateRight when the request omitted it).

claimAssessmentobject
Medicare's assessment of the submitted claim.

Errors

400
Bad Request Error