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API ReferenceMedicare ClaimingInteractive Patient Claims

Interactive Patient Claim — Specialist

||View as Markdown|
POST
/Medicare/patientclaiminteractive/specialist/v1
POST
/Medicare/patientclaiminteractive/specialist/v1
$curl -X POST https://api.rebateright.com.au/Medicare/patientclaiminteractive/specialist/v1 \
>     -H "x-api-key: <apiKey>" \
>     -H "Content-Type: application/json" \
>     -d '{
>  "patientClaimInteractive": {
>    "accountPaidInd": "N",
>    "authorisationDate": "2026-04-13",
>    "submissionAuthorityInd": "Y",
>    "serviceProvider": {
>      "providerNumber": "2447781L"
>    },
>    "patient": {
>      "identity": {
>        "givenName": "Edmond",
>        "familyName": "FLETCHER",
>        "dateOfBirth": "1986-12-18"
>      },
>      "medicare": {
>        "memberNumber": "4951525561",
>        "memberRefNumber": "2"
>      }
>    },
>    "medicalEvent": [
>      {
>        "id": "01",
>        "medicalEventDate": "2026-04-01",
>        "service": [
>          {
>            "id": "1001",
>            "itemNumber": "104",
>            "chargeAmount": "25000"
>          }
>        ]
>      }
>    ],
>    "claimant": {
>      "identity": {
>        "givenName": "Edmond",
>        "familyName": "FLETCHER",
>        "dateOfBirth": "1986-12-18"
>      },
>      "medicare": {
>        "memberNumber": "4951525561",
>        "memberRefNumber": "2"
>      }
>    },
>    "referralOverrideCode": "H"
>  }
>}'
1{
2  "status": "MEDICARE_PENDED",
3  "correlationId": "urn:uuid:MDE00000e714ca2feb1742a2",
4  "claimAssessment": {
5    "claimId": "MDE0000004042619464403",
6    "medicalEvent": [
7      {
8        "id": "01",
9        "eventDate": "2026-04-01",
10        "service": [
11          {
12            "id": "1001",
13            "itemNumber": "104",
14            "chargeAmount": "25000"
15          }
16        ]
17      }
18    ]
19  }
20}
The **specialist** interactive patient claim endpoint submits a Medicare patient claim for specialist or diagnostic imaging services. ### Referral requirement One of the following must hold, otherwise Medicare rejects the claim: - `referral.typeCode` is `D` (diagnostic imaging) or `S` (specialist), or - `referralOverrideCode` is `H`, `L`, `E`, or `N`, or - at least one service has `selfDeemedCode` `SD` or `SS`. ### Response handling The `200` response shape is shared with the **general** endpoint — see that endpoint's response schema for the full `status` and `assessmentCode` handling tables. ### Error codes Medicare reason codes on `error.code` (claim- or service-level) and `serviceMessage[].code` map to user-facing descriptions via the [Services Australia reason-code lookup](https://www.servicesaustralia.gov.au/look-up-medicare-reason-code).
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Interactive Patient Claim — General

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Interactive Patient Claim — Pathology

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The specialist interactive patient claim endpoint submits a Medicare patient claim for specialist or diagnostic imaging services.

Referral requirement

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

  • referral.typeCode is D (diagnostic imaging) or S (specialist), or
  • referralOverrideCode is H, L, E, or N, or
  • at least one service has selfDeemedCode SD or SS.

Response handling

The 200 response shape is shared with the general endpoint — see that endpoint’s response schema for the full status and assessmentCode handling tables.

Error codes

Medicare reason codes on error.code (claim- or service-level) and serviceMessage[].code map to user-facing descriptions via the Services Australia reason-code lookup.

Authentication

x-api-keystring
API Key authentication via header
x-minor-idstring
API Key authentication via header

Request

Specialist / diagnostic imaging request fields (combined with the general interactive claim payload via allOf).

patientClaimInteractiveobjectRequired
correlationIdstringOptional

Optional. Supply a unique transaction ID in the format urn:uuid:{MinorId}{16 hex chars}. If omitted, RebateRight generates one automatically.

Response headers

Request-Contextstring

Response

OK
statusenum

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

StatusMeaningTypical handling
MEDICARE_ASSESSEDClaim assessed by Medicare. One or more services have a benefitPaid and an assessmentCode of ASSESSED.Treat as paid; payment is in progress to the claimant.
MEDICARE_PENDABLEClaim held by your software; Medicare has not yet received it for assessment. Typically triggered by a service returning ACCEPTABLE_ERROR (e.g. possible duplicate).Surface the reason to the claimant. Within 60 minutes, resubmit with the same correlationId to either (a) send it to a Medicare operator for manual assessment (→ MEDICARE_PENDED), or (b) auto-resolve it by adding the appropriate override indicator or service text (→ may go to MEDICARE_ASSESSED).
MEDICARE_PENDEDClaim accepted by Medicare and queued for manual operator assessment. No assessmentCode or benefitPaid will follow via the API.Record the claimId for reconciliation and issue the claimant a printed Lodgement Advice (legislatively required). Medicare notifies the claimant directly of the outcome — no downstream API notification is sent.
MEDICARE_REJECTEDClaim rejected outright. Check claimAssessment.error (claim-level) or per-service error for the reason.Do not resubmit without correcting the underlying issue.
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