Skip to navigation
RebateRight APIMedicare ClaimingInteractive Patient Claims

Statement of Claim and Benefit Payment (PDF)

Beta

What do I give the claimant when Medicare assesses a patient claim?

The claimant gets the Statement of Claim and Benefit Payment. This endpoint produces it as a PDF, in the wording Services Australia sets, with the claim’s details filled in.

Test environment only. Services Australia is certifying this service, and it reaches production once certified.

Services Australia requires the location to give the claimant a printed statement for each interactive patient claim. This statement is for a claim that comes back MEDICARE_ASSESSED. Printed statements says which statement each outcome needs.

You sendYou getThen
The claim you lodged, Medicare’s response, and the names the claim does not carryThe Statement of Claim and Benefit Payment as a PDFPrint it for the claimant. The location may keep its own copy.

What the PDF carries

The PDF carries the header Services Australia sets, the Location ID and claim reference, the location, the patient and claimant, the providers and referral, each service with its charge and benefit, the Medicare reason codes, the payment details, the claimant declaration and the privacy notice. The static wording follows the Patient Claim Interactive specification word for word, with the Acts in italics. When the claimant has eftDetails, the PDF also carries their authority to pay the benefit into that account. The footer on each page records the date and time RebateRight made the PDF.

Claim reference. The PDF prints Medicare’s claimId as the Claim Reference. The claimId is the Location ID followed by the date and time of lodgement, which is how Services Australia defines the claim reference.

Request body

Send the request you lodged at an Interactive Patient Claim endpoint, with the status and claimAssessment from Medicare’s response beside patientClaimInteractive. Add statementDetails for the location and the names the claim does not carry. This endpoint reads the fields below and ignores the rest. It sends nothing to Medicare.

status must be MEDICARE_ASSESSED. For a pended claim, use Lodgement Advice (PDF).

Location on the PDF

The PDF prints the x-minor-id request header as its Location ID.

Response

StatusContent typeMeaning
200application/pdfThe statement, offered as the download PatientClaimStatement.pdf.
400text/plainThe JSON is invalid, a field has the wrong type or value, a required field or the x-minor-id header is missing, or status is not MEDICARE_ASSESSED. The body names the problem.

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 Keys, Minor ID and environments.

Request

This endpoint expects an object.
patientClaimInteractivemap from strings to anyRequired

The patientClaimInteractive object you lodged, unchanged. medicalEvent needs at least 1 medical event. Most fields print as you sent them. These print in their own form:

FieldOn the PDF
chargeAmount and patientContribAmountIn dollars, such as $25.05
hospitalInd Y* after the item number
numberOfPatientsSeenAfter the item number, as 23/2
medicalEventTimeUnder the date of service
referral.periodCodeN prints period in months, I prints Indefinite, and S prints statementDetails.referralPeriodMonths in months
referralOverrideCodeE prints Emergency referral, L prints Lost referral, and H prints Referral within, then statementDetails.hospitalName, or the facility ID when you leave the name out
accountPaidIndThe account is fully paid: YES or NO
claimant.residentialAddressUnder the claimant’s details. Correspondence goes to the ABOVE ADDRESS when you send it, and to the ADDRESS HELD BY MEDICARE when you do not
claimant.eftDetailsThe claimant’s authority to pay into that account, with its BSB, number and name

Each service’s notations print in its Description of Service, in Services Australia’s form: aftercareOverrideInd as NNAC, accessionDateTime as A-, collectionDateTime as C-, duplicateServiceOverrideInd as NDS, fieldQuantity as FQty-, lspNumber as LSPNum-, multipleProcedureOverrideInd as MPO, rule3ExemptInd as R3Ex, restrictiveOverrideCode as its meaning, selfDeemedCode as sent, s4b3ExemptInd as S4b3Ex, scpId as SCPId-, and text and timeDuration as sent.

When the claimant is the patient, the claimant’s name, date of birth and card print blank, because Services Australia asks for them only when the patient is not the claimant.

statusenumRequired

The status from Medicare’s response. It must be MEDICARE_ASSESSED.

Allowed values:
claimAssessmentmap from strings to anyRequired

The claimAssessment object from Medicare’s response, unchanged. The PDF prints claimId as the Claim Reference. It matches each service’s assessmentCode and benefitPaid to the service you sent by its id, and prints benefitPaid in dollars as the Benefit. A 3-digit assessmentCode prints as the RSN Code. A claim-level error prints under Medicare Reason Codes with its text.

statementDetailsobjectOptional
Details Services Australia requires on the statement that the claim does not carry. Send them so the statement names the location and each provider. A field you leave out prints as a blank.

Response

The Statement of Claim and Benefit Payment as a PDF, named PatientClaimStatement.pdf.