Interactive Patient Claim — Specialist | RebateRight

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.

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