Interactive Patient Claim — Specialist | RebateRight

curl -X POST https://api.rebateright.com.au/Medicare/patientclaiminteractive/specialist/v1 \
     -H "x-api-key: <apiKey>" \
     -H "Content-Type: application/json" \
     -d '{
  "patientClaimInteractive": {
    "medicalEvent": [
      {
        "service": [
          {
            "id": "1001",
            "itemNumber": "104",
            "chargeAmount": "25000"
          }
        ],
        "id": "01",
        "medicalEventDate": "2026-04-01"
      }
    ],
    "referralOverrideCode": "H",
    "accountPaidInd": "N",
    "authorisationDate": "2026-04-13",
    "submissionAuthorityInd": "Y",
    "serviceProvider": {
      "providerNumber": "2447781L"
    },
    "patient": {
      "identity": {
        "dateOfBirth": "1986-12-18",
        "familyName": "FLETCHER",
        "givenName": "Edmond"
      },
      "medicare": {
        "memberNumber": "4951525561",
        "memberRefNumber": "2"
      }
    },
    "claimant": {
      "identity": {
        "dateOfBirth": "1986-12-18",
        "familyName": "FLETCHER",
        "givenName": "Edmond"
      },
      "medicare": {
        "memberNumber": "4951525561",
        "memberRefNumber": "2"
      }
    }
  }
}'

{
  "status": "MEDICARE_PENDED",
  "correlationId": "urn:uuid:MDE00000e714ca2feb1742a2",
  "claimAssessment": {
    "claimId": "MDE0000004042619464403",
    "medicalEvent": [
      {
        "id": "01",
        "eventDate": "2026-04-01",
        "service": [
          {
            "id": "1001",
            "itemNumber": "104",
            "chargeAmount": "25000"
          }
        ]
      }
    ]
  }
}

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

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.

Request and successful 200 payloads reuse the same schemas as the general endpoint in components.schemas in this file (PciwPatientClaimInteractiveRequestBody, PciwPatientClaimInteractiveSuccessResponse). Specialist-only fields are the second branch of the request allOf below (hospital / facility / LSP on services are already defined on the general request schema). 400 uses PciwMedicareServiceMessageError.

The **specialist** interactive patient claim endpoint submits a Medicare patient claim for specialist or diagnostic imaging services. 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`. **Request** and successful **`200`** payloads reuse the same schemas as the **general** endpoint in **`components.schemas`** in this file (`PciwPatientClaimInteractiveRequestBody`, `PciwPatientClaimInteractiveSuccessResponse`). Specialist-only fields are the second branch of the request `allOf` below (hospital / facility / LSP on services are already defined on the general request schema). **`400`** uses `PciwMedicareServiceMessageError`.

Authentication

x-api-keystring

API Key authentication via header

x-minor-idstring

API Key authentication via header

Request

This endpoint expects an object.

correlationIdstringOptional

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

patientClaimInteractiveobjectOptional

Response headers

Request-Contextstring

Response

statusstring

correlationIdstring

claimAssessmentobject

Errors

400

Bad Request Error