API ReferenceMedicare Eligibility

Patient Verification

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Verify that the patient details you hold (name, date of birth, sex, Medicare card number and IRN) match Medicare's records. RebateRight runs its own field-format checks first, then calls Medicare's **Patient Verification Check** service. When Medicare accepts the check but some details differ, the corrected value is echoed on the matching **`Correct…`** field so you can propose an update to the patient's record. Every `Reason` string is prefixed with **`[Medicare]`** (passthrough from Medicare) or **`[RebateRight]`** (RebateRight-side validation) so each sentence can be attributed to its source. ## 📑 How Medicare handles individual fields | Field | Behaviour when only this field is wrong | Behaviour when another field is also wrong | |---|---|---| | **Medicare Card Number** | Fails. No correction provided. | Fails. No correction provided. | | **Date of Birth** | Accepted with a prompt to confirm DOB. No correction provided. | Fails. No correction provided. | | **Medicare Reference Number (IRN)** | Accepted with the correct IRN in `CorrectMedicareReferenceNumber`. | Fails. No correction provided. | | **Given Name** | First 5 characters must match (so `ELIZA` vs `ELIZABETH` passes). If only the given name differs, the correct value is returned in `CorrectGivenName`. | Fails. No correction provided. | | **Family Name / Sex** | Ignored — verification still passes with no correction reported. | Does not by itself cause failure. | | **New Medicare card issued** | `Verified: false`; Medicare supplies `CorrectMedicareNumber`, `CorrectMedicareReferenceNumber`, and `CorrectGivenName` so you can update the patient's record. | | ## 👤 Patients with a single name For single-name patients, submit the single name as **`PatientFamilyName`** and set **`PatientGivenName`** to the literal string **`ONLYNAME`**.

Authentication

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

Request

This endpoint expects an object.
PatientDateOfBirthdateRequired

Patient date of birth (YYYY-MM-DD). Cannot be a future date or more than 130 years in the past.

PatientFamilyNamestringRequired

Patient family name as it appears on the Medicare card. For single-name patients, put the single name here.

PatientGivenNamestringRequired

Patient first given name as it appears on the Medicare card. Medicare matches on the first 5 characters, so ELIZA is accepted against a record of ELIZABETH. For single-name patients, set this to the literal string ONLYNAME.

PatientSexenumRequired
Patient sex (Services Australia coding). Medicare does not fail verification on a sex mismatch alone and does not report a correction for this field. | Code | Meaning | |---|---| | `1` | Male | | `2` | Female | | `3` | Other | | `9` | Not stated / inadequately described |
Allowed values:
PatientMedicareNumberstringRequired

Patient’s 10-digit Medicare card number. Must pass the Medicare card check-digit routine — RebateRight validates this before calling Medicare.

PatientMedicareRefNumberstringRequired

Individual Reference Number (IRN) from the patient’s Medicare card — a single digit identifying the family member.

Response

OK
Verifiedboolean or null

Tri-state verification outcome. true means Medicare confirms an exact match, false means Medicare accepted the check with corrections or returned a mismatch, and a null value means the check did not run (the request failed RebateRight-side validation). Always check Reason for the full explanation.

Reasonstring

Human-readable explanation of the outcome, prefixed with [Medicare] (passthrough from Medicare) or [RebateRight] (RebateRight-side validation).

CorrectSexstring or null

Always null — Medicare does not report corrections to sex.

CorrectGivenNamestring or null

Corrected given name when Medicare’s records differ and the given name is the only field wrong; null otherwise.

CorrectFamilyNamestring or null

Always null — Medicare does not report corrections to family name.

CorrectDateOfBirthstring or null

Always null — Medicare signals a DOB mismatch in Reason but does not return the correct value.

CorrectMedicareNumberstring or null

Corrected 10-digit Medicare card number when Medicare has re-issued the card; null otherwise.

CorrectMedicareReferenceNumberstring or null

Corrected IRN when the IRN was the only field wrong, or when a new Medicare card has been issued; null otherwise.