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": {
    "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"
  }
}'

{
  "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.

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.

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).

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

statusenum

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

Status	Meaning	Typical handling
`MEDICARE_ASSESSED`	Claim 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_PENDABLE`	Claim 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_PENDED`	Claim 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_REJECTED`	Claim rejected outright. Check `claimAssessment.error` (claim-level) or per-service `error` for the reason.	Do not resubmit without correcting the underlying issue.

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