This endpoint retrieves detailed information about a specific MBS item using its item number.
\n🎨 How It Works
\n- \n
Sources data from MBS and enriches it with RebateRight details.
\n \nIncludes MBS notes and additional insights including the limitation period, specifying how often an item can be claimed within a given timeframe (e.g., twice in a 12-month period).
\n \n
🛠️ Example Requests and Responses
\nAt the top-right corner of the Example Request section, select from the available options to view sample requests along with the corresponding responses returned by RebateRight.
\nThis endpoint receives patient details and Medicare items. It verifies patient information with Medicare and calculates rebate amounts.
\n🎨 How It Works
\n- \n
Uses Medicare Patient Verification, Medicare Eligibility Check, and RebateRight Rules Engine services behind the scenes.
\n \nThe response includes enriched data, combining RebateRight insights and MBS item details.
\n \nReturns the rebate amount Medicare will pay for a specific item for a given patient. The reason for the benfit amount is also included in the response.
\n \nIf no rebate is payable, the response includes the reason why (e.g., limitations, ineligibility).
\n \n
In summary, this endpoint performs multiple checks and provides a detailed breakdown of Medicare rebate eligibility and the reasons behind the rebate amount.
\n🛠️ Example Requests and Responses
\nTo explore sample requests and responses, go to the Example Request section and use the options in the top-right corner to view different requests along with their corresponding responses from RebateRight.
\nThis flow contains the core endpoints used to perform a complete eligibility check.
\n- \n
Verifiy patient details against Medicare records.
\n \nGet MBS item information.
\n \nCheck Eligibility based on Medicare rules and RebateRight validation logic.
\n \n
This endpoint retrieves the list of all ~6,000 MBS items.
\n🎨 How It Works
\n- \n
Sources data from MBS and enriches it with RebateRight details.
\n \nEach item includes MBS notes and additional insights including the limitation period, specifying how often an item can be claimed within a given timeframe (e.g., twice in a 12-month period).
\n \n
🛠️ Example Requests and Responses
\nAt the top-right corner of the Example Request section, select from the available options to view sample requests along with the corresponding responses returned by RebateRight.
\nRebateRight maintains comprehensive coverage of the MBS by importing official data published by Medicare upon each release, then enriching it with MBS notes and structured metadata extracted from item descriptions, to support more accurate eligibility checks.
\n","_postman_id":"a6487abb-5aaa-4c82-b72f-8be2f6ed00b8","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"⚖️ Note from Services Australia
\n\n\nServices Australia advises that it is a legislative requirement that the most up to date statements, declarations and privacy notes are used in your software.
\n
- \n
For duplicateServiceOverrideInd, this information plus text detailing the reasoning behind the setting must be displayed on the printed form.
\n- \n
- If set, Medical Event Time or Service text must be set. \n
\nFor multipleProcedureOverrideInd, this information plus text detailing the reasoning behind the setting must be displayed on the printed form.
\n- \n
- If set to Y (Not Multiple), ServiceText (providing the reason for the override) must be set. \n
\nFor restrictiveOverrideCode, this information must be displayed on the printed form.
\n \n
Additionally, any relevant supporting material and /or Text must also appear on the printed statement.
\nWhere a patient claim is being submitted on behalf of a claimant the location must issue either a Statement of Claim & Benefit Payment or Lodgement Advice to the claimant.
\nLodgement Advice
\nThe Lodgement Advice will be issued in the following situation:
\n- \n
- Where the claim has been lodged in real-time and referred to an agency operator for action. \n
The Location must produce a printed copy for the claimant's own record. The location may retain a copy in electronic or hard copy form.
\nInformation in addition to that specified below may be included in the Lodgement Advice.
\nYou can download the template PDF using the link below:
📥Lodgement Advice.pdf
Statement of Claim & Benefit Payment
\nThe Statement of Claim & Benefit Payment is to be issued when a claim has been lodged in real-time, processed by Services Australia and a benefit amount returned to the Location.
\nThe Location must produce a printed copy for the claimant's own record. The Location may retain a copy in electronic or hard copy form.
Information in addition to that specified below may be included in the Statement of Claim & Benefit.
You can download the template PDF using the link below:
📥Statement of Claim Benefit Payment.pdf
Pathology Combined Request Form – Patient Claiming
\nRequesting Practitioner
\n(Prescribed particulars are headings to prompt requesting practitioners to provide necessary information. Necessary particulars can be provided by stamp, sticker label, etc.)
\n- \n
Surname and initials (to distinguish)
\n \nAddress
\n \nProvider number
\n \nPractitioner to date the request form
\n \n
Details of the Person to Whom the Request is Made
\nWhere the person is an Approved Pathology Authority (APA) or Approved Pathology Practitioner (APP):
\n- \n
Full name of APA / surname and initials of APP
\n \nPlace of practice address
\n \nLetters APA / APP shown
\n \n
\n
Patient Details
\n- \n
Name – surname, first name
\n \nAddress
\n \nDate of birth
\n \nSex
\n \nMedicare card number and Individual Reference Number
\n \nHospital status
\n \n
Two acceptable versions are as follows:
\n- \n
- Patient status at the time of the service or when the specimen was collected \n
OR
\n- \n
Was or will the patient be, at the time of the service or when the specimen is obtained:
\n- \n
A private patient in a private hospital or approved day hospital facility
\n \nA private patient in a recognised hospital
\n \nA public patient in a recognised hospital
\n \nAn outpatient of a recognised hospital
\n \n
\n
\n
Tests Requested
\n- \n
An area titled “Tests Requested” is required.
\n \nTerms such as order, require, referred etc. must not be used.
\n \n
\n
Self Determine (SD)
\n- \n
A tick box is required for SD.
\n \nThis is used when the APP determines that pathologist-determinable tests are necessary.
\n \nThe tick box can be placed in the clinical notes area.
\n \n
\n
Privacy Notice
\nThe wording of the note must be:
\n\n\nPrivacy Notice: Your personal information is protected by law, including the Privacy Act 1988, and is collected by Services Australia for the assessment and administration of payments and services. This information is required to process your application or claim.
\n
- \n
Placement of the note is only necessary on the patient’s copy.
\n \nIt may be incorporated into the clinical notes area or placed on the back of the patient copy if more practicable.
\n \n
\n
Combined Online Patient Claiming Authority
\nAuthority for APP/APA to submit an electronic patient claim on behalf of the claimant
\nExample wording:
\n\n\nI authorise the approved pathology practitioner who will render the requested pathology services, and any further pathology services which the practitioner determines to be necessary, to submit my unpaid account to Services Australia, so that Services Australia can assess my claim and issue me a cheque made payable to the practitioner, for the Medicare benefit.
\n
Patient Signature: _____._____._____ Date: _____ /_____ /_____
\nOr:
\nVerbal consent was provided by patient to submit unpaid account to Services Australia. No signature available.
\n\n
Practitioner’s Use Only
\nA text box is required for Practitioner’s Use Only.
This section is used where the patient is unable to sign and an appropriate person endorses on behalf of the patient.
Practitioner’s Use Only:
\n(Reason patient cannot sign)
\n","_postman_id":"6b8a3d8b-e793-4868-a692-dd32e9e04e86","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Patient claim interactive - general
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Patient claim interactive - specialist
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Patient claim interactive - pathology
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Same Day Delete Web Service is a function that provides the Health Care Location with the ability to delete a Patient Claim Interactive Web Service claim that was transmitted earlier on the same day.
This delete request can only be applied to a claim that was successfully processed i.e. the claim status is MEDICARE_ASSESSED.
📑 Request Fields
\n🔸correlationId
\nThe correlationId from the original claim to be deleted.
\n\n
🔸sameDayDelete.reasonCode
\nReason code supporting the same day delete.
\n- \n
Valid values:
\n- \n
\n001– Incorrect Patient Selection \n
\n002– Incorrect Provider Details \n
\n003– Incorrect Date of Service \n
\n004– Incorrect Item Number Claimed \n
\n005– Omitted Text on Original Claim \n
\n006– Incorrect Payment Type (Paid / Unpaid) \n
\n007– Other \n
\n
\n
🔸sameDayDelete.patient.identity.familyName
\nThe patient’s family name.
\n\n
🔸sameDayDelete.patient.identity.givenName
\nThe patient’s first given name.
\n\n
🔸sameDayDelete.patient.medicare.memberNumber
\nThe patient’s Medicare card number.
\n\n
🔸sameDayDelete.patient.medicare.memberRefNumber
\nThe patient’s individual reference number (IRN) on their Medicare card.
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"A Patient Claim Interactive claim may be submitted for a patient who has received professional medical services and has not assigned their right to Medicare benefits to the health professional rendering the service (Patient Claims). The Health Care Location (HCL) lodges the claim on behalf of the patient / or claimant to the agency for processing.
\nPendable Claims
\nPatient Claim Interactive claims requiring further assessment by an operator are returned with claim status of ’MEDICARE_PENDABLE’ in the response.
\nThe client system can request the claim to be pended by resending the claim to the agency using the same transaction id (correlationId) within one hour of submitting the original claim. Once the claim is pended, a lodgement advice is printed and issued to the claimant.
\nServices Australia recommends that you design your software to streamline the process for the end user. Software design such as a tick box or an accept button to accept and trigger the pend, will simplify the process for the user.
\nIf the client system resends the claim using a different transaction id (correlationId), it is processed as a new patient claim.
\nReferred and Requested Services Being Claimed in the Same Voucher
\nSpecialists may submit claims with a mixture of services requiring request and referral information in the same voucher. To do this, the voucher must include referral details along with the relevant service level details.
This only applies to specialist services requiring Referrals and Diagnostic Imaging Requests being submitted together. Pathology Requests need to be submitted separately.
Validations
\n- \n
A Patient Claim can have a maximum of 16 Medical Events.
\n \nOne Medical Event in a Patient Claim can have maximum 14 services.
\n \nA Patient Claim can have a maximum of 16 services.
\n \n
StartFragment
\n📑 Patient Claim Interactive Request Fields
\n🔸patientClaimInteractive.accountPaidInd
\nIndicates whether or not the account has been paid in full.
\n- \n
- Valid values:
Y= Paid in full,N= Not Paid \n
\n
🔸patientClaimInteractive.accountReferenceId (Optional)
\nAccount Reference (ACRF). A reference used by the claim submitter to identify a claim.
\n- \n
Allowed characters:
\n0-9,A-Z,a-z, and@ # $ % + = : ; , . -\nLength:
\n1–9\nFormatting: No leading/trailing spaces
\n \n
\n
🔸patientClaimInteractive.authorisationDate
\nThe date on which the claim was authorised.
\n- \n
- Must not be in the future \n
\n
🔸patientClaimInteractive.referralOverrideCode (Optional)
\nProvides an indication of why services that require a referral/request were provided without a referral.
\n- \n
- Valid values:
E= Emergency,H= Hospital,L= Lost,N= Not required \n
\n
🔸patientClaimInteractive.submissionAuthorityInd
\nIndicates the claimant has authorised the practice location to submit the claim on their behalf.
\n- \n
- Must be
Y(Authorised) to submit the claim \n
\n
🔸patientClaimInteractive.patient.identity.dateOfBirth
\nThe patient’s date of birth.
\n- \n
Must not be in the future
\n \nMust not be more than 130 years in the past
\n \nMust not be after Authorisation Date
\n \n
\n
🔸patientClaimInteractive.patient.identity.familyName
\nThe patient's family name.
\n\n
🔸patientClaimInteractive.patient.identity.givenName
\nThe patient's first given name.
\n\n
🔸patientClaimInteractive.patient.medicare.memberNumber
\nThe patient’s Medicare card number.
\n\n
🔸patientClaimInteractive.patient.medicare.memberRefNumber
\nThe patient’s individual reference number (IRN) on their Medicare card.
\n- \n
Length:
\n1\nValid values: numeric
\n1–9(must not be0) \n
\n
🔸patientClaimInteractive.referral (Optional)
\nConsists of issueDate, typeCode, periodCode, period, provider.providerNumber.
- \n
- If
referralis set, Referral Override Code must not be set \n
\n
🔸patientClaimInteractive.referral.issueDate (Optional)
\nThe date the referral/request was issued.
\n\n
🔸patientClaimInteractive.referral.periodCode (Optional)
\nA code indicating the length/type of the referral period.
\n- \n
Valid values:
\nS= Standard (12 months for GP, 3 months for Specialist),N= Non Standard,I= Indefinite \nIf
\nperiodis supplied,periodCodemust beN\n
\nperiodmay only be set whenperiodCode = N\n
\n
🔸patientClaimInteractive.referral.period (Optional)
\nIndicates the length of the referral period for Non-Standard referrals (in months).
\n- \n
Valid values: numeric
\n1–98(must not be0,00or99) \nLeading zeros acceptable (e.g.,
\n01) \nOnly set if
\nperiodCode = N\n
\n
🔸patientClaimInteractive.referral.typeCode
\nA code that indicates the type of service referred/requested (Pathology / Diagnostic / Specialist).
\n- \n
Valid values:
\nP= Pathology,D= Diagnostic Imaging,S= Specialist (including Allied Health) \nIf
\ntypeCode = DorP,periodCodeandperiodmust not be set \nIf
\ntypeCode = S,periodCodemust be supplied \n
\n
🔸patientClaimInteractive.referral.provider.providerNumber
\nReferring provider.
\n- \n
- Referring Provider Number must not be the same as the Servicing Provider Number \n
\n
🔸patientClaimInteractive.claimant.identity.dateOfBirth
\nThe claimant’s Date of Birth (claimant may be the patient or another person).
\n- \n
- Claimant must be at least 14 years old \n
\n
🔸patientClaimInteractive.claimant.identity.familyName
\nThe claimant’s family name (can be patient or other).
\n\n
🔸patientClaimInteractive.claimant.identity.givenName
\nThe claimant’s given name (can be patient or other).
\n\n
🔸patientClaimInteractive.claimant.medicare.memberNumber
\nThe claimant’s Medicare Card number (patient or another person).
\n\n
🔸patientClaimInteractive.claimant.medicare.memberRefNumber
\nThe claimant’s individual Reference Number (IRN).
\n\n
🔸patientClaimInteractive.claimant.eftDetails (Optional)
\nTemporary EFT (bank) details supplied for payment.
\n- \n
If EFT Details is set, Account Paid Indicator must be
\nY\nIf EFT Details is set, Account Name, Account Number and BSB Code must be supplied
\n \n
\n
🔸patientClaimInteractive.claimant.eftDetails.accountName (Optional)
\nUsed for EFT payments — the claimant’s bank/financial institution account name.
\n- \n
Length:
\n1–30\nAllowed characters: letters, numbers, space, apostrophe (
\n'), hyphen (-), ampersand (&) and.,/\nNo leading/trailing spaces
\n \n
\n
🔸patientClaimInteractive.claimant.eftDetails.accountNumber (Optional)
\nUsed for EFT payments — the claimant’s bank/financial institution account number.
\n- \n
Length:
\n1–9\nAllowed characters: numeric and alphabetic as permitted (
\n0-9,A-Z) \n
\n
🔸patientClaimInteractive.claimant.eftDetails.bsbCode (Optional)
\nBSB code for the bank/branch where the account is held.
\n- \n
Length / format:
\n6digits (NNNNNN) \nMust be a valid BSB
\n \n
\n
🔸patientClaimInteractive.claimant.residentialAddress (Optional)
\nClaimant residential address group: addressLineOne, addressLineTwo, locality, postcode.
- \n
- If Residential Address is set then
addressLineOne,localityandpostcodemust be supplied \n
\n
🔸patientClaimInteractive.claimant.residentialAddress.addressLineOne (Optional)
\nFirst line of the residential address.
\n- \n
Length:
\n1–40\nAllowed characters: letters, numbers, spaces, apostrophe (
\n'), hyphen (-), and/ , . : ;\nMust contain at least one alpha or numeric character
\n \nMust not be a PO Box
\n \n
\n
🔸patientClaimInteractive.claimant.residentialAddress.addressLineTwo (Optional)
\nSecond line of the address.
\n- \n
Length:
\n1–40\nAllowed characters: letters, numbers, spaces, apostrophe (
\n'), hyphen (-), and/ , . : ;\nIf
\naddressLineTwois set thenaddressLineOnemust also be set \nMust not be a PO Box
\n \n
\n
🔸patientClaimInteractive.claimant.residentialAddress.locality (Optional)
\nLocality of the residential address.
\n- \n
Length:
\n1–40\nAllowed characters: letters, numbers, spaces, apostrophe (
\n'), hyphen (-), and/ , . : ;\nMust not include a separate State code value (e.g.,
\nPerth WAis invalid) \n
\n
🔸patientClaimInteractive.claimant.residentialAddress.postcode (Optional)
\nPostcode for the residential address.
\n- \n
Length:
\n4digits (NNNN) \nMust not be
\n0000\n
\n
🔸patientClaimInteractive.claimant.contactDetails.phoneNumber (Optional)
\nClaimant phone number for contact about the claim.
\n- \n
Length:
\n8–19\nAllowed characters: numeric
\n0-9, spaces, and()-+\nNo leading/trailing spaces
\n \n
\n
🔸patientClaimInteractive.payeeProvider.providerNumber
\nThe payee health professional.
\n- \n
Length:
\n8characters (no spaces) \nFormat / structure:
\nProvider Stem(6-digit) +Practice Location Character(1) +Check Digit(1) \nMust be filled with leading zeros when needed
\n \n
\n
🔸patientClaimInteractive.serviceProvider.providerNumber
\nServicing health professional.
\n- \n
- Must not be the same person as the Payee Provider. If the servicing and payee are the same person, supply only the Servicing Provider \n
\n
🔸patientClaimInteractive.medicalEvent.id
\nUsed to identify the occurrence of the Medical Event Type.
\n- \n
Length:
\n2characters \nMust be unique within the claim
\n \n
\n
🔸patientClaimInteractive.medicalEvent.medicalEventDate
\nDate the medical event occurred (date of service).
\n- \n
Must not be more than 2 years before the date of transmission
\n \nMust not be before Referral Issue Date (if referral supplied)
\n \nAuthorisation Date must be on or after the Medical Event Date
\n \n
\n
🔸patientClaimInteractive.medicalEvent.medicalEventTime (Optional)
\nTime the medical event occurred.
\n- \n
Must not be in the future (Medical Event Date + Time combined are checked)
\n \nMust reflect the correct Australian time zone
\n \n
PatientClaimInteractive.medicalEvent.service Fields
\n🔸service.id
\nUsed to identify the occurrence of the Service Type.
\n- \n
Format: 4 characters, alphanumeric
\n \nExamples:
\nC001,AC68,0104,4074,ABCD\n
\n
🔸service.accessionDateTime
\nDate/time when the pathology test was performed.
\n- \n
Rules:
\n- \n
Must not be a future date
\n \nMust only be set for Pathology Services
\n \nMust be ≤ Medical Event Date/Time
\n \nMust use a valid Australian timezone (UTC + offset)
\n \nIf set, Collection Date Time must also be set
\n \n
\n
\n
🔸service.aftercareOverrideInd
\nIndicates whether the service was performed as part of normal aftercare.
\n- \n
Valid values:
\n- \n
Y= Not Normal Aftercare \n
\nRules:
\n- \n
- Must only be set for General or Specialist Services \n
\n
\n
🔸service.chargeAmount
\nThe amount charged for the service, in cents.
\n- \n
Format: Numeric, 1–7 digits
\n \nExamples:
\n$1.00 → 100,$10.00 → 1000\nRules:
\n- \n
Must be ≥
\n100(i.e., $1.00) or0\nLeading zeros accepted
\n \n
\n
\n
🔸service.collectionDateTime
\nDate/time when the pathology sample was collected.
\n- \n
Rules:
\n- \n
Must not be after Accession Date Time
\n \nMust only be set for Pathology Services
\n \nIf set, Accession Date Time must also be set
\n \nMust not be before patient Date of Birth
\n \nMust not be before Referral Issue Date
\n \nMust use valid Australian timezone
\n \n
\n
\n
🔸service.duplicateServiceOverrideInd
\nIndicates whether multiple services on the same day by the same provider should be treated separately.
\n- \n
Valid values:
\n- \n
Y= Not Duplicate \n
\nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nIf set, Medical Event Time or Service Text must also be set
\n \n
\n
\n
🔸service.facilityId
\nThe Commonwealth Hospital Facility Provider Number.
\n- \n
Format:
\nNNNNNNA(6-digit stem + 1 numeric location + 1 check digit) \nRules:
\n- \n
Must be set if Referral Override Code =
\nH\nMust be set if Hospital Indicator =
\nY\n
\n
\n
🔸service.fieldQuantity
\nNumber of fields irradiated or time blocks (e.g., radiotherapy, infusions).
\n- \n
Format: Numeric
\n1–99(leading zeros allowed) \nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nCannot be set with
\nnumberOfPatientsSeen\nCannot be set with
\ntimeDuration\n
\n
\n
🔸service.hospitalInd
\nIndicates whether the service was rendered to an admitted patient.
\n- \n
Valid values:
\n- \n
Y= In Hospital \n
\nRules:
\n- \n
Must be set if
\nReferral Override Code = H\nMust be set if
\nS4b3ExemptInd = Y\n
\n
\n
🔸service.itemNumber
\nMBS item number identifying the service.
\n\n
🔸service.lspNumber
\nLocation Specific Practice Number (LSPN) for diagnostic/radiation oncology.
\n- \n
Format: Numeric
\n1–999999(leading zeros allowed) \nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nCannot be set with
\nnumberOfPatientsSeen\nCannot be set with
\ntimeDuration\n
\n
\n
🔸service.multipleProcedureOverrideInd
\nIndicates whether the multiple services rule applies.
\n- \n
Valid values:
\n- \n
Y= Not Multiple \n
\nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nIf set,
\nservice.text(reason) must also be provided \n
\n
\n
🔸service.numberOfPatientsSeen
\nThe number of patients seen (group attendance, home/hospital visits).
\n- \n
Format: Numeric
\n1–99(leading zeros allowed) \nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nCannot be set with
\ntimeDuration\n
\n
\n
🔸service.patientContribAmount
\nAmount paid by the patient towards the service (in cents).
\n- \n
Format: Numeric, 3–7 digits
\n \nExamples:
\n$1.00 → 100\nRules:
\n- \n
Must be <
\nchargeAmount\nCannot be set if Account Paid Indicator =
\nY\n
\n
\n
🔸service.restrictiveOverrideCode
\nUsed to allow payment where a service is not restrictive with another service.
\n- \n
Valid values:
\n- \n
\nSP= Separate Sites \n
\nNR= Not Related to consult \n
\nNC= Not for Comparison (bilateral) \n
\nRules:
\n- \n
- Must only be set for General or Specialist Services \n
\n
\n
🔸service.rule3ExemptInd
\nIndicates whether the pathology service is exempt from Rule 3 (MBS).
\n- \n
Valid values:
\n- \n
Y= Exempt \n
\nRules:
\n- \n
Must only be set for Pathology Services
\n \nIf set,
\nmedicalEvent.timemust also be set \nIf set, must align with one of:
\n- \n
\nselfDeemedCode = SD\nReferral Type =
\nP+ Referrer details \nReferral Override Code =
\nN\n
\n
\n
\n
🔸service.s4b3ExemptInd
\nIndicates whether the service is exempt from S4b3 MBS requirements.
\n- \n
Valid values:
\n- \n
Y= Exempt \n
\nRules:
\n- \n
Must only be set for Pathology Services
\n \nCannot be set if
\nrule3ExemptIndis set \nIf set, must align with one of:
\n- \n
\nselfDeemedCode = SD\nReferral Type =
\nP+ Referrer details \nReferral Override Code =
\nN\n
\n
\n
\n
🔸service.scpId
\nSpecimen Collection Point identifier.
\n- \n
Format: 3–5 characters (alpha/numeric, not
\n0) \nExamples:
\n001,0001,00001\nRules:
\n- \n
Must only be set for Pathology Services
\n \nIf set, must align with one of:
\n- \n
Referral Type =
\nP\n
\nselfDeemedCode = SD\nReferral Override Code =
\nN\n
\n
\n
\n
🔸service.selfDeemedCode
\nIndicates additional or substituted service.
\n- \n
Valid values:
\n- \n
\nSD= Self Deemed \n
\nSS= Substituted Service \n
\nRules:
\n- \n
Cannot be set if Referral Override Code is set
\n \nCannot be set if Referral Type =
\nP\n
\n
\n
🔸service.text
\nFree text providing additional information to assist with assessment.
\n- \n
Format: Max 50 characters
\n \nAllowed chars: Alphanumeric, space,
\n@ # $ % + = : ; , . -\nRules:
\n- \n
- Cannot exceed 50 characters \n
\n
\n
🔸service.timeDuration
\nThe duration of the service in minutes.
\n- \n
Format: Numeric
\n001–999\nRules:
\n- \n
Must only be set for General or Specialist Services
\n \nCannot be set with
\nnumberOfPatientsSeen\nCannot be set with
\nfieldQuantity\n
\nExamples:
\n030= 30 minutes \n
Resubmitting Rejected Patient Claims in RebateRight
\nOverview
\nPatient Claim Interactive (PCI) claims allow patients to claim Medicare benefits for services where they haven't assigned their benefits to the healthcare provider. Understanding how to handle rejected patient claims is essential for efficient practice operations and positive patient experiences.
\nThis guide will help you navigate the resubmission process for rejected Patient Claim Interactive Web Service (PCIW) claims in RebateRight.
\nUnderstanding Patient Claim Rejections
\nClaim Assessment Outcomes
\nWhen you submit a patient claim, Medicare returns one of four status responses:
\n- \n
MEDICARE_ASSESSED - Claim successfully processed and benefit calculated
\n \nMEDICARE_REJECTED - Claim contains unacceptable errors and cannot be processed
\n \nMEDICARE_PENDABLE - Claim contains acceptable errors and can be pended for manual assessment
\n \nMEDICARE_PENDED - Claim successfully sent to Medicare for manual review
\n \n
When Claims Are Rejected
\nPatient claims are rejected when:
\n- \n
YAML Interface Validation fails - Technical format errors detected immediately
\n \nBusiness Rules Validation fails - Clinical or administrative rule violations identified
\n \nUnacceptable errors exist - Issues that prevent automatic assessment
\n \n
Important: If a claim is rejected, the claim will be returned with status MEDICARE_REJECTED and no benefit amount will be calculated.
Pendable vs Rejected Claims
\nPendable Claims (Acceptable Errors)
\n- \n
Contain issues that can be reviewed by a Medicare operator
\n \nReturn status:
\nMEDICARE_PENDABLE\nCan be pended for manual assessment within 1 hour
\n \nExamples: Restrictive conditions, complex referral scenarios
\n \n
Rejected Claims (Unacceptable Errors)
\n- \n
Contain critical issues that prevent processing
\n \nReturn status:
\nMEDICARE_REJECTED\nMust be corrected and resubmitted with new Transaction ID
\n \nExamples: Invalid patient details, missing referrals, invalid provider numbers
\n \n
Common Rejection Reasons
\nPatient Details Errors
\n- \n
Invalid Medicare Card Details
\n- \n
Medicare card number doesn't conform to check digit routine
\n \nCard issue number (10th digit) set to zero
\n \nIndividual Reference Number (IRN) invalid or set to zero
\n \n
\nPatient Name Issues
\n- \n
Missing family name or given name
\n \nInvalid characters in name fields
\n \nIncorrect handling of single-name patients
\n \n
\nDate of Birth Errors
\n- \n
Date of birth in the future
\n \nDate of birth more than 130 years ago
\n \nDate of birth after authorisation date
\n \n
\n
Claimant Details Errors
\n- \n
Claimant Age Restriction
\n- \n
Claimant must be at least 14 years old
\n \nDate of birth calculation error
\n \n
\nClaimant Address Issues (when provided)
\n- \n
PO Box addresses not accepted for residential address
\n \nMissing required address components (Line 1, Locality, Postcode)
\n \nInvalid postcode (0000) or incorrect format
\n \nState code incorrectly included in locality field
\n \n
\nBank Account Details (for EFT payments)
\n- \n
Incomplete EFT details (missing account name, number, or BSB)
\n \nInvalid BSB code
\n \nEFT details supplied for unpaid claim (Account Paid Indicator = N)
\n \n
\n
Service Information Errors
\n- \n
Charge Amount Issues
\n- \n
At least one service in each Medical Event must have charge ≥ $1.00 (100 cents)
\n \nCharge amount exceeds maximum ($9999.99)
\n \nPatient contribution amount equals or exceeds charge amount
\n \n
\nService Date Errors
\n- \n
Medical Event Date more than 2 years old
\n \nMedical Event Date in the future
\n \nMedical Event Date before patient's date of birth
\n \nMedical Event Date before referral issue date
\n \n
\nHospital Service Errors
\n- \n
Hospital Indicator set to Y but Facility ID missing
\n \nFacility ID provided but Hospital Indicator not set
\n \nInvalid Facility ID format
\n \n
\n
Referral/Request Errors
\n- \n
Missing Referral Information
\n- \n
Specialist service without referral, override code, or self-deemed code
\n \nPathology service without request, override code (N), or self-deemed code (SD)
\n \nReferral details incomplete (missing provider number or issue date)
\n \n
\nReferral Date Issues
\n- \n
Referral issue date in the future
\n \nReferral issue date before patient date of birth
\n \nReferral issue date after service date
\n \n
\nReferral Period Errors
\n- \n
Referral Period Code set to N but period not provided
\n \nReferral period provided but code not set to N
\n \nPeriod/Period Code provided for Pathology or Diagnostic requests
\n \n
\n
Provider Information Errors
\n- \n
Invalid Provider Numbers
\n- \n
Incorrect format (must be 6-digit stem + 1 location char + 1 check digit)
\n \nServicing provider same as payee provider
\n \nReferring provider same as servicing provider
\n \n
\n
Service Type Validation Errors
\n- \n
General Claims (mcp.patient.claim.interactive.general)
\n- \n
- Referral details, Referral Override Code, or Self Deemed Code incorrectly included \n
\nSpecialist Claims (mcp.patient.claim.interactive.specialist)
\n- \n
- Must have one of: Diagnostic/Specialist Referral, Referral Override Code (H/L/E/N), or Self Deemed Code (SD/SS) \n
\nPathology Claims (mcp.patient.claim.interactive.pathology)
\n- \n
Must have one of: Pathology Request, Referral Override Code (N), or Self Deemed Code (SD)
\n \nSelf Deemed Code SS not allowed for pathology
\n \n
\n
Reading Error Messages
\nError Message Format
\nMedicare error messages for patient claims follow this structure:
\n[Error Code] [Error Message Text]. Error located in Medical Event {m}, Service {s}.\n\nError Response Types
\n1. Claim Level Errors (Rejection)
\n{\n \"claimAssessment\": {\n \"error\": {\n \"code\": 9602,\n \"text\": \"This claim cannot be lodged through this channel...\"\n },\n \"claimId\": \"AAA5555509122010321519\"\n },\n \"status\": \"MEDICARE_REJECTED\"\n}\n\n2. Service Level Acceptable Errors (Pendable)
\n{\n \"claimAssessment\": {\n \"medicalEvent\": [{\n \"service\": [{\n \"error\": {\n \"code\": 9641,\n \"text\": \"A restrictive condition exists.\"\n },\n \"id\": \"C002\",\n \"assessmentCode\": \"ACCEPTABLE_ERROR\",\n \"chargeAmount\": \"5000\",\n \"itemNumber\": \"30071\"\n }]\n }]\n },\n \"status\": \"MEDICARE_PENDABLE\"\n}\n\n3. Service Level Unacceptable Errors (Rejection)
\n{\n \"claimAssessment\": {\n \"medicalEvent\": [{\n \"service\": [{\n \"error\": {\n \"code\": 9628,\n \"text\": \"Referral or request required.\"\n },\n \"id\": \"C001\",\n \"assessmentCode\": \"UNACCEPTABLE_ERROR\"\n }]\n }]\n },\n \"status\": \"MEDICARE_REJECTED\"\n}\n\nAssessment Codes
\nThe assessmentCode field indicates the outcome for each service:
Important: Display all error messages exactly as provided by Medicare - do not truncate, transform, or modify them.
\nHandling Pendable Claims
\nWhat Are Pendable Claims?
\nPendable claims contain acceptable errors that require manual review by a Medicare operator but don't prevent the claim from being submitted for assessment.
\nWhen to Pend a Claim
\nConsider pending when:
\n- \n
Restrictive conditions need operator review (error 9641)
\n \nComplex service combinations require assessment (error 9601)
\n \nStatus returned is
\nMEDICARE_PENDABLE\n
How to Pend a Claim
\n- \n
Receive Pendable Response: Claim returns with status:
\nMEDICARE_PENDABLE\nMake Decision Within 1 Hour: You have 1 hour from original submission to pend the claim, After 1 hour, you must resubmit with a new Correlation ID
\n \nPend the Claim: Resubmit using the same CorrelationId ID you received in the response of the pendable claim. Please note, no other fields needs to be changed
\n \nIssue Lodgement Advice
\n- \n
Print and provide Lodgement Advice to patient/claimant
\n \nKeep electronic or hard copy for records
\n \nPatient will receive payment notification when assessed
\n \n
\n
Automatic Pend Workflow (Recommended)
\nDesign your workflow to streamline pending:
\nClaim Submitted → MEDICARE_PENDABLE response received\n ↓\n Display: \"Claim requires manual review\"\n ↓\n [Accept and Pend] button\n ↓\n Auto-resubmit with same Correlation ID\n ↓\n Print Lodgement Advice for patient\n\nResubmission Process
\nStep 1: Identify the Rejection Type
\nFor MEDICARE_REJECTED:
\n- \n
Review error code and message
\n \nIdentify which level contains the error (claim, medical event, or service)
\n \nNote all errors that need correction
\n \n
For MEDICARE_PENDABLE:
\n- \n
Decide whether to pend or correct and resubmit
\n \nIf pending, resubmit within 1 hour with same Correlation ID
\n \nIf correcting, treat as rejected claim
\n \n
Step 2: Correct the Errors
\nFor Patient Details Errors (9202):
\n- \n
Verify Medicare card number using Patient Verification Web Service
\n \nConfirm card issue number is not zero
\n \nCheck patient name format and special characters
\n \nValidate date of birth is reasonable and not in future
\n \n
For Claimant Details Errors:
\n- \n
Verify claimant is at least 14 years old
\n \nIf providing address, ensure it's residential (not PO Box)
\n \nInclude all required address fields (Line 1, Locality, Postcode)
\n \nIf providing EFT details, ensure all three fields are complete (account name, number, BSB)
\n \n
For Service Information Errors (2030):
\n- \n
Ensure at least one service per Medical Event has charge ≥ $1.00
\n \nVerify service dates are within 2-year window
\n \nCheck hospital services have both Hospital Indicator and Facility ID
\n \nConfirm patient contribution is less than charge amount
\n \n
For Referral Errors (9202, 2030):
\n- \n
Include complete referral details (provider number, issue date)
\n \nFor specialist referrals, include period code and period (if non-standard)
\n \nEnsure referral date is before service date
\n \nUse correct override codes when applicable
\n \n
For Service Type Errors (2030):
\n- \n
Match service type to correct web service endpoint
\n \nGeneral claims: Remove any referral/request information
\n \nSpecialist claims: Include referral OR override code OR self-deemed code
\n \nPathology claims: Include request OR override code (N) OR self-deemed code (SD)
\n \n
Step 3: Validate Before Resubmission
\nComplete this checklist:
\nPatient/Claimant Details
\n- \n
✓ Patient Medicare card number is valid (checked with OPVW)
\n \n✓ Patient name correctly formatted
\n \n✓ Patient date of birth is valid
\n \n✓ Claimant is at least 14 years old
\n \n✓ Claimant details complete and valid
\n \n✓ Address is residential (if provided)
\n \n✓ EFT details complete (if provided and account paid)
\n \n
Service Details
\n- \n
✓ At least one service per Medical Event ≥ $1.00
\n \n✓ All Medical Event dates within 2 years
\n \n✓ Medical Event dates not in future
\n \n✓ Hospital services have Facility ID and Hospital Indicator
\n \n✓ Patient contribution < charge amount
\n \n
Referral/Request Details
\n- \n
✓ Referral complete for specialist/pathology services (or valid override)
\n \n✓ Referral dates valid and logical
\n \n✓ Referring provider different from servicing provider
\n \n✓ Referral period included for specialist referrals (if non-standard)
\n \n
Provider Details
\n- \n
✓ All provider numbers correctly formatted
\n \n✓ Servicing provider ≠ payee provider
\n \n✓ Referring provider ≠ servicing provider
\n \n
Other Requirements
\n- \n
✓ Submission Authority Indicator set to Y
\n \n✓ Account Paid Indicator correctly set
\n \n✓ Maximum limits not exceeded (16 Medical Events, 14 services per event, 16 total services)
\n \n
Step 4: Resubmit the Claim
\nGenerate New Transaction ID
\n- \n
Critical: Never reuse the Transaction ID from a rejected claim
\n \nReusing Transaction ID results in error 9777
\n \nRebateRight automatically generates unique Transaction IDs
\n \n
Resubmit Through Correct Web Service
\n- \n
General claims:
\nmcp.patient.claim.interactive.general\nSpecialist claims:
\nmcp.patient.claim.interactive.specialist\nPathology claims:
\nmcp.patient.claim.interactive.pathology\n
Monitor Response
\n- \n
Review response status (ASSESSED, REJECTED, or PENDABLE)
\n \nCheck assessment codes for each service
\n \nVerify benefit amounts calculated
\n \nPrint appropriate statement for patient
\n \n
Important Resubmission Rules
\nTransaction ID Management
\nFor Rejected Claims:
\n- \n
Always generate a new Transaction ID
\n \nNever reuse Transaction ID from rejected claim
\n \nError 9777 occurs if Transaction ID duplicated
\n \n
For Pendable Claims:
\n- \n
Use the same Transaction ID to pend within 1 hour
\n \nAfter 1 hour, must use new Transaction ID
\n \n
Claim Structure Limits
\nMaximum limits per patient claim:
\n- \n
16 Medical Events per claim (Error 2025 if exceeded)
\n \n14 Services per Medical Event (Error 2032 if exceeded)
\n \n16 Total Services per claim (Error 2033 if exceeded)
\n \n
If you exceed these limits, split into multiple claims.
\nTiming Considerations
\n- \n
Do not submit more than one claim per second
\n \nPend window: 1 hour from original submission for pendable claims
\n \nService date limit: Services cannot be more than 2 years old
\n \n
Same Day Deletion
\nIf you need to delete a claim submitted today:
\n- \n
Use Same Day Delete Web Service (SDDW)
\n \nMust be same day as original submission
\n \nClaim cannot already be paid
\n \nCorrected claim can then be resubmitted
\n \n
Special Cases
\nMultiple Errors in One Claim
\nWhen a claim has multiple errors:
\n- \n
Claim Level Error Present
\n- \n
Only claim level objects returned in response
\n \nFix claim level error first
\n \nResubmit with new Transaction ID
\n \n
\nService Level Errors Only
\n- \n
All levels of objects returned
\n \nFix all service level errors
\n \nResubmit with new Transaction ID
\n \n
\nMix of Acceptable and Unacceptable Errors
\n- \n
If ANY unacceptable error exists, claim is rejected
\n \nMust fix all unacceptable errors before resubmission
\n \nCannot pend if any unacceptable errors present
\n \n
\n
Exceeding Claim Structure Limits
\nToo Many Medical Events (Error 2025):
\nMaximum 16 Medical Events per claim exceeded\n\nSolution:
\n- \n
Split claim into multiple submissions
\n \nGroup related services logically
\n \nSubmit separate claims with new Transaction IDs
\n \n
Too Many Services per Medical Event (Error 2032):
\nMaximum 14 Services per Medical Event exceeded\n\nSolution:
\n- \n
Split Medical Event into separate Medical Events
\n \nEach new Medical Event can have up to 14 services
\n \nKeep same date of service for related services
\n \n
Too Many Total Services (Error 2033):
\nMaximum 16 Services per claim exceeded\n\nSolution:
\n- \n
Split into multiple claims
\n \nEach claim can have maximum 16 services total
\n \n
Claimant Without Bank Details
\nIf claim assessed successfully but claimant has no bank details:
\nResponse Received:
\n{\n \"claimAssessment\": {\n \"error\": {\n \"code\": 9783,\n \"text\": \"The claimant will need to update their bank details...\"\n }\n },\n \"status\": \"MEDICARE_ASSESSED\"\n}\n\nAction Required:
\n- \n
Inform patient/claimant that benefit was calculated
\n \nPatient must update bank details with Medicare:
\n- \n
Through Medicare online account
\n \nBy calling Medicare
\n \nBy visiting a Service Centre
\n \n
\nPayment will be released once bank details updated
\n \nNo resubmission needed
\n \n
Service Type Mismatch
\nError 2030 for Service Type:
\nThe details in this claim are inconsistent with the service called\n\nSolution:
\n- \n
Verify service type:
\n- \n
General practitioners →
\nmcp.patient.claim.interactive.general\nSpecialists/Allied Health/Diagnostic Imaging →
\nmcp.patient.claim.interactive.specialist\nPathology →
\nmcp.patient.claim.interactive.pathology\n
\nEnsure referral/request details match service type:
\n- \n
General: No referral/request details
\n \nSpecialist: Referral OR override OR self-deemed
\n \nPathology: Request OR override (N) OR self-deemed (SD only)
\n \n
\nResubmit to correct web service endpoint
\n \n
Assessment Codes with Zero Benefits
\nSome services may be assessed with zero benefit due to MBS conditions:
\nExample Response:
\n{\n \"service\": [{\n \"assessmentCode\": \"556\",\n \"benefitPaid\": 0,\n \"chargeAmount\": \"40000\",\n \"itemNumber\": \"20560\"\n }]\n}\n\nUnderstanding 3-Digit Codes:
\n- \n
These are Medicare reason codes
\n \nIndicate why benefit was zero or reduced
\n \nClaim is not rejected - it was assessed
\n \nReview MBS Schedule for item-specific conditions
\n \n
Common Reason Codes:
\n- \n
242: Multiple operation rule applied
\n \n556: Service not eligible for benefit
\n \n154: Benefit reduced due to conditions
\n \n
Action: Explain outcome to patient and why benefit differs from expected amount.
\nBest Practices to Minimize Rejections
\n1. Always Use Patient Verification and Eligibility Check First
\nBefore submitting any patient claim:
\n- \n
Use Online Patient Verification Web Service (OPVW)
\n \nConfirm patient's Medicare eligibility
\n \nVerify claimant details if different from patient
\n \nCheck current Medicare card number and IRN
\n \n
2. Validate Claimant Eligibility
\n- \n
Confirm claimant is at least 14 years old
\n \nIf patient is under 14, claimant must be parent/guardian
\n \nVerify claimant has valid Medicare card
\n \n
3. Complete All Required Information
\nFor All Claims:
\n- \n
Submission Authority Indicator must be Y
\n \nAccount Paid Indicator correctly set (Y or N)
\n \nAuthorisation date not in future
\n \nAll provider numbers valid and correctly formatted
\n \n
For Specialist/Pathology Claims:
\n- \n
Include complete referral/request details OR
\n \nInclude valid override code OR
\n \nInclude appropriate self-deemed code
\n \n
For Hospital Services:
\n- \n
Set Hospital Indicator to Y
\n \nProvide valid Facility ID
\n \nBoth must be present together
\n \n
4. Verify EFT Details (If Provided)
\nIf providing temporary bank details for claimant:
\n- \n
Account Paid Indicator must be Y
\n \nInclude all three EFT fields:
\n- \n
Account Name (1-30 characters)
\n \nAccount Number (1-9 characters)
\n \nBSB Code (6 digits, valid BSB)
\n \n
\nValidate BSB code is valid for Medicare payments
\n \n
5. Check Service Dates and Amounts
\n- \n
Services cannot be more than 2 years old
\n \nAt least one service per Medical Event must be ≥ $1.00
\n \nPatient contribution must be less than charge amount
\n \nMedical Event Date must be after patient's date of birth
\n \n
6. Validate Address Information (If Provided)
\n- \n
Use residential address (not PO Box)
\n \nInclude all required components (Line 1, Locality, Postcode)
\n \nPostcode cannot be 0000
\n \nDon't include state code as separate value in locality
\n \n
7. Use RebateRight Calculate Rebate
\nBefore submitting:
\n- \n
Run RebateRight's pre-submission Calculate Rebate checks
\n \nReview all warnings and errors
\n \nConfirm all conditional fields are complete
\n \nVerify claim structure limits not exceeded
\n \n
8. Monitor Submission Rate
\n- \n
Maximum 1 claim per second
\n \nBatch submissions appropriately
\n \nAllow processing time between submissions
\n \n
Printed Statements for Patients
\nWhen to Issue Statements
\nLodgement Advice:
\n- \n
Issued when claim pended for manual assessment
\n \nStatus: MEDICARE_PENDABLE → MEDICARE_PENDED
\n \nStates claim already submitted, not for claiming
\n \n
Statement of Claim & Benefit Payment:
\n- \n
Issued when claim successfully assessed
\n \nStatus: MEDICARE_ASSESSED
\n \nShows benefit amount calculated
\n \nIncludes Medicare reason codes (if any)
\n \n
Critical Statement Requirements
\nBoth statements must include:
\n- \n
Claimant Declaration - Legal authorisation wording (exact text required)
\n \nPrivacy Notice - Services Australia privacy statement (exact text required)
\n \nAll Service Details - Including any override indicators or additional information
\n \nPayment Information - How benefit will be paid (EFT or to stored bank details)
\n \n
Important: Use exact wording as specified in Medicare documentation. Do not modify, shorten, or paraphrase required text.
\nValues to Display on Statements
\nEssential information to include:
\nQuick Reference: Common Error Codes
\nKey Differences: Patient Claims vs Bulk Bill Claims
\n\n
Remember: Patient claims require additional validation for claimant details and have different structure limits than bulk bill claims. Always use Patient Verification before submitting, and monitor the response status to determine if the claim was assessed, rejected, or requires pending for manual review.
\n","_postman_id":"06cf1b32-c016-4607-8472-2fa8a01c0271","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"The Claiming services provide health professionals and healthcare locations with the ability to lodge Medicare claims electronically with Services Australia.
\nThere are two main claim types supported by RebateRight:
\n- \n
Bulk Bill Claim – where the patient assigns their right to Medicare benefits to the health professional, and the claim is lodged on their behalf.
\n \nPatient Claim Interactive – where the patient retains their right to Medicare benefits, and the claim is lodged on their behalf for direct payment to the patient.
\n \n
Both claim types share common concepts such as vouchers, services, referrals, and requests, but differ in processing rules, payment flow, and responsibilities for assignment of benefits.
\nUse the specific claim type folder for detailed information about structures, requirements, and response handling.
\n","_postman_id":"dbde0d90-3052-4b88-bfca-3696b29580f2","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"🛡️ Security, Privacy, Data Residency
\nAt RebateRight, security and privacy are fundamental to everything we build. Our platform is architected from the ground up to protect your data while ensuring full compliance with Australian healthcare regulations.
\n⚡Zero Data Persistence Architecture
\nReal-time processing only — Patient data flows through our system without ever being stored. Each request is processed immediately and discarded, ensuring no sensitive information remains in our infrastructure.
\nStateless serverless design — Every request is handled independently with no session persistence. Once your request is complete, no trace of the transaction remains in our systems.
\n📍Australian Data Sovereignty & Compliance
\nComplete geographic containment — Your data never crosses Australian borders. Our entire infrastructure operates within Microsoft Azure's Australia East region, ensuring data sovereignty from ingestion to response.
\nGovernment-grade security — Microsoft Azure has completed an IRAP (Information Security Registered Assessors Program) assessment for Australian government data processing, supporting workloads up to and including the PROTECTED classification level in Australian regions.
\nEnterprise compliance framework — Azure provides compliance with ISO 27001, SOC 2, HIPAA, GDPR, and numerous other global security standards, giving you confidence in our underlying infrastructure's security posture. (Microsoft Azure Compliance).
\n🔐 Your Keys, Your Control
\nClient-managed authentication — RebateRight never stores, accesses, or manages your API credentials. You maintain complete control over your authentication tokens.
\n🏗️ Enterprise-Grade Infrastructure
\nAzure reliability — Leveraging Microsoft Azure's enterprise infrastructure ensures high availability, automatic scaling during peak periods, and built-in redundancy across multiple availability zones.
\nSecurity by design — Every component follows security best practices including TLS 1.2/1.3 encrypted transit, minimal attack surface, secure development lifecycle with vulnerability scanning, and continuous monitoring for threats.
\nGovernment-standard integration — Our communications with Services Australia including Medicare use PRODA (Provider Digital Access), Services Australia's secure authentication mechanism, ensuring authentication meet official security requirements.
\n📊 Usage Data We Store
\nTo keep billing accurate and provide you with usage insights, RebateRight stores a minimal set of operational metadata about requests.
Examples of this metadata include:
- \n
The total number of times RebateRight endpoints were used
\n \nWhich API endpoints were called
\n \nWhich MBS item numbers were requested
\n \nThe outcome of the operation (e.g., whether an eligibility check returned eligible or not eligible)
\n \n
This metadata never includes personally identifiable information (PII), patient details, or provider information. It is retained solely for billing and reporting purposes, ensuring transparency without compromising privacy.
\n","_postman_id":"720954ec-4441-4bf6-9d4b-9a700ca01391","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"📍 Minor IDs
\nIf you use Claiming endpoints or AIR through RebateRight, You should notify Services Australia of your assigned Minor ID for linking purposes by following the steps outlined below. If you are only using Patient Verification and Eligibility Check, you may not need to complete these steps, as RebateRight will handle the necessary registrations.
\nStep 1: Get your Minor ID
\nRebateRight will issue and provide your organisation with its unique Minor ID(s)—also known as Location IDs or Software Site IDs. Each physical location of your business requires its own Minor ID so that Services Australia can accurately identify where each request originates. This ensures compliance with Services Australia standards, which rely on Minor ID + provider number combinations being unique and location-specific. When you open a new site, you must request a new Minor ID from RebateRight before submitting claims for that location
\nStep 2: Complete the Form
\nDownload and complete the following form: ➡️ HW027
\nThis form allows Services Australia to associate your organisation with the provided Minor ID(s).
\nNote:
\n- \n
The HW027 form only needs to be completed once per organisation, not per practitioner.
\n \nIf you prefer, you may use the ➡️ HW052 form to register up to six practitioners at the same time.
\n \n
Step 3: Submit the Form
\nFollow the submission instructions included in the form.
\nOnce Services Australia approves the form, your organisation will be able to use these services through RebateRight.
\nStep 4: Link All Other Practitioners in Your Organisation
\nFor every practitioner who will be claiming:
\n- \n
They must log in to PRODA and confirm their bank account details match your organisation's bank account details.
\n \nThen call Medicare eBusiness: 1800 700 199 and request that the Minor ID be linked to their provider number.
\n \n
Or
\nA representative from your organisation may call Medicare to link all provider numbers to the Minor ID/s.
\nNote:
\n- \n
The practitioner’s bank details in PRODA must match the organisation’s bank details.
\n \nIf any practitioner’s bank details are not current, that practitioner will be required to submit their own HW027 form.
\n \n
🔧 Troubleshooting
\n⛔ \"Unauthorized access.\" Response
\nThis indicates that a valid API Key was not provided in your request.
\nResolution
Refer to the 🔓 Authentication section for resolution details.
\n
⛔ The '...' field is not provided.
\nWhen a required field for an endpoint is missing, the reason field provides exact details about the missing field, including the expected field name enclosed in single quotes.
\nFor instance: \"Reason\": \"The 'PrincipalProviderNumber' field is not provided.\"
Resolution
\nTo resolve this error, ensure that the missing field (in this case, PrincipalProviderNumber) is included in your request and try again.
\n
⛔ \"Referral details and referral override code both provided.\"
\nThis occurs when both referral details (such as referring provider number) and a referral override code (e.g. N – Not required) are included in the same request. Medicare only allows one of these to be provided.
Resolution
\nInclude either referral details or a referral override code — not both.
\n\n
⛔ Invalid Referral Type or Service Type combination.
\nThis indicates that the combination of Referral Type Code and Service Type Code in the request does not meet Medicare’s validation rules.
\nResolution
\n- \n
If
\nReferralTypeCodeisSorD, thenServiceTypeCodemust beS(Specialist). \nIf
\nReferralTypeCodeisP, thenServiceTypeCodemust beP(Pathology). \nConfirm both values exactly match one of the valid MBS combinations.
\n \n
\n
⛔ \"Invalid or inconsistent Referral Issue Date.\"
\nThe Referral Issue Date provided is invalid. This can happen when the date is in the future, after the service date, or before the patient’s date of birth.
\nResolution
\nEnsure the referral issue date:
\n- \n
Is not in the future
\n \nIs on or before the service date
\n \nIs after the patient’s date of birth
\n \n
\n
⛔ \"Invalid Provider Number format.\"
\nThe provider number does not follow the required Medicare format.
\nResolution
\nProvider numbers must contain 8 characters in the format:
\n6-digit stem + 1 location character + 1 check digit.
\nExample: 123456A7
\n
⛔ \"Referrer and servicing provider cannot be the same.\"
\nThis occurs when the referring provider number matches the servicing provider number. Medicare requires different provider stems for each.
\nResolution
\nUse a referring provider number with a different 6-digit stem from the servicing provider’s number.
\n\n
⛔ \"Hospital indicator or Facility ID missing.\"
\nA hospital-related referral override code (H) was provided, but required hospital fields were not included.
Resolution
\nIf ReferralOverrideCode is H:
- \n
Set HospitalIndicator to
\nY, and \nProvide a valid FacilityID.
\n \n
\n
⛔ \"Invalid or inconsistent service date.\"
\nThe Service Date is invalid. This occurs when the service date is in the future or outside Medicare’s permitted timeframe.
\nResolution
\nEnsure the service date:
\n- \n
Is not in the future
\n \nIs within 2 years of the transmission date
\n \n
\n
⛔ \"Invalid Medicare card number or IRN.\"
\nThe Medicare card number or IRN (Individual Reference Number) provided is invalid.
\nResolution
\n- \n
The Medicare card number must be 10 digits, with a valid check digit.
\n \nThe 10th digit must not be 0.
\n \nThe IRN must be a single digit from 1 to 9 (not 0).
\n \n
\n
⛔ \"Incomplete collection or accession date/time (pathology).\"
\nA Collection or Accession timestamp was provided without its corresponding value.
\nResolution
\nIf either CollectionDateTime or AccessionDateTime is provided, both must be included.
- \n
Both must use valid Australian time zones.
\n \nThe order must be Collection ≤ Accession ≤ ServiceDate.
\n \n
\n
⛔ \"Medicare rejected the request.\" or \"Response incomplete.\"
\nThis indicates that Medicare rejected the transaction due to missing or invalid dependent fields, or incomplete data required for claim validation.
\nResolution
\nReview the reason or errorDescription field in the response for details.
⛔ \"Too many Medical Events in claim.\"
\nA Patient Claim contains more than 16 Medical Events.
\nResolution
\n- \n
Limit each claim to 16 Medical Events.
\n \nIf more events exist, split into separate claims.
\n \n
\n
⛔ \"Too many services in a Medical Event.\"
\nA Medical Event contains more than 14 services.
\nResolution
\n- \n
Limit each Medical Event to 14 services.
\n \nIf more services exist, split into separate Medical Events.
\n \n
\n
⛔ \"Too many services in a Patient Claim.\"
\nThe Patient Claim contains more than 16 services overall.
\nResolution
\n- \n
Limit the claim to 16 services total.
\n \nSplit additional services into separate claims.
\n \n
\n
⛔ \"Duplicate or out-of-sequence Medical Event ID.\"
\nOne or more Medical Event IDs are either duplicated or not in the correct sequence (01–16).
\nResolution
\n- \n
Ensure Medical Event IDs are unique.
\n \nIDs must start at 01 and increment by one sequentially.
\n \n
\n
⛔ \"Duplicate Service ID in claim.\"
\nA Service ID is repeated within the same Patient Claim.
\nResolution
\n- \n
- Ensure all Service IDs are unique within the claim. \n
\n
⛔ \"Invalid Account Paid Indicator.\"
\nThe Account Paid Indicator is not Y or N, or inconsistent with EFT details.
Resolution
\n- \n
Must be
\nY(paid) orN(not paid). \nIf EFT details are supplied, set Account Paid Indicator = Y.
\n \n
\n
⛔ \"Invalid Account Reference ID.\"
\nThe Account Reference ID contains invalid characters or length.
\nResolution
\n- \n
Must be 1–9 characters.
\n \nAllowed:
\n0-9, A-Z, a-z, @ # $ % + = : ; , . -\nNo leading or trailing spaces.
\n \n
\n
⛔ \"Invalid Referral Period or Type.\"
\nReferral PeriodCode, Period, or TypeCode is missing or inconsistent.
\nResolution
\n- \n
TypeCode:
\nS(Specialist),P(Pathology),D(Diagnostic). \nPeriod/PeriodCode only set if TypeCode = S.
\n \nNon-standard referrals (
\nN) must supply Period 1–98, not 0, 00, or 99. \n
\n
⛔ \"Submission Authority not set.\"
\nThe claim cannot be submitted digitally because SubmissionAuthorityInd is missing or invalid.
\nResolution
\n- \n
- Set SubmissionAuthorityInd = Y to indicate claimant authorised digital submission. \n
🧩 Diagrams
\nHigh-level Overview
\nThe diagram below provides a simplified, high-level overview of how your application interacts with RebateRight. The Calculate Rebate endpoint is just an example and one of many possibilities.
\n1️⃣ Calculate Rebate Request
\n- \n
The request includes your Location Minor ID, Patient Details, List of MBS Item Numbers and Provider numbers. Essentially, all the information that determine the patient's eligibility for a Medicare Rebate.
\n \nRebateRight works behind the scenes with PRODA, Medicare, the Provider Directory, and the MBS Item Catalogue to determine eligibility and calculate applicable rebates.
\n \nYour Api Key is included in the request header.
\n \nUpon receiving a request, RebateRight will initiate internal processes and external API calls to gather the result.
\n \n
2️⃣ Rebate Response
\n- \n
- The response will indicate the rebate amount Medicare will pay for each of the requested MBS items. \n
RebateRight External Interactions
\nThis diagram offers a more detailed view of RebateRight’s interactions with external systems and services.
\n1️⃣ RebateRight Rules Engine
\n- \n
RebateRight has a growing set of internal rules to assess patient eligibility, including checks for age, referrer specialty, and in-hospital or out-of-hospital restrictions.
\n \nThese rules serve as the first layer of eligibility checks before any external validation is performed.
\n \n
2️⃣PRODA
\n- \n
PRODA is the authentication mechanism that enables secure communication between RebateRight and Medicare.
\n \nOur organization and B2B device are registered in PRODA.
\n \nOperations such as Activate Device, Refresh Token, and Get Authetication Token take place with PRODA.
\n \n
3️⃣Medicare
\n- \n
RebateRight securely connects to Medicare to perform advanced verification, eligibility, and claiming operations.
\n \nPatient Demographic Verification: Ensures that patient details — such as name, date of birth, and Medicare number — match official Medicare records for accurate identification.
\n \nEligibility Checks: Determines whether a patient is eligible for rebates for specific MBS item numbers, applying the latest Medicare rules and taking into account the patient’s claim history.
\n \nClaiming: Enables seamless submission and tracking of Medicare claims directly through RebateRight, ensuring fast and accurate processing of rebates.
\n \nNote: All related information, including Medicare reason codes, is automatically updated within RebateRight. No manual action is required from users
\n \n
4️⃣ Providers Directory
\n- \n
RebateRight automatically connects to a nationwide provider directory to retrieve the latest information on all registered healthcare providers in Australia.
\n \nThis service allows searching by provider number to obtain specialty details, which are used for referrer specialty validation during eligibility checks.
\n \nNote: The provider data is imported automatically by RebateRight. No manual updates or user actions are required.
\n \n
5️⃣ MBS Items
\n- \n
RebateRight has access to the complete list of ~6,000 MBS items, including descriptions, rebate values, and usage rules.
\n \nAlways up to date with the latest MBS releases
\n
RebateRight automatically applies the latest Medicare Benefits Schedule (MBS) updates to ensure all eligibility checks and rebate calculations remain accurate and compliant, no manual updates required. \n
Provider Digital Access (PRODA)\n🔔 Note:
\n\n\nThis section is provided for your information only — no action is required from you regarding PRODA. For Medicare integrations (excluding claiming), RebateRight manages all required setup and maintenance internally, including generating and registering Minor IDs, managing and activating the PRODA device, refreshing keys, and related configuration processes.
\n
PRODA is the authentication mechanism that enables secure communication between RebateRight and Medicare. It allows RebateRight to access Medicare, AIR and other government services securely. Our organization and B2B device are registered in the PRODA environment, which lays the foundation for authentication.
\n🔗For more information please visit: servicesaustralia.gov.au/proda
For each request sent to Medicare or AIR, RebateRight requires an authentication token from PRODA. These tokens are cached and reused for about an hour, after which they are refreshed automatically.
\n","_postman_id":"cc4eda3a-905a-4e6d-a9a1-e758f535da85","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"💉 AIR Integration Overview
\nThe Australian Immunisation Register (AIR) is a national register that records all vaccinations given to individuals of all ages living in Australia. This includes people who are non-eligible for Medicare with no Medicare card number i.e., newborns, newly arrived immigrants, student visas.
\nRebateRight integrates with the AIR to support secure, compliant, and streamlined healthcare transactions.
\n","_postman_id":"ec830578-697a-452d-9d47-4ce8a24329c4","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"This endpoint provides a report that serves as a record of the eligibility quote provided by the health professional to the patient.
\n🎨How It Works
\n- \n
Generates a PDF file containing the required quote record.
\n \nThe request structure is identical to the
\n/CalculateRebateendpoint. \n
⚖️ Note from Services Australia:
\n\n\nServices Australia advises that it is a legislative requirement that the most up to date statements, declarations and privacy notes are used in your software.
\n
Bulk Bill Assignment Advice
\nThe Location must issue the patient with a Bulk Bill Assignment of benefit form detailing services provided, except in the case of pathology services subject to a request which contains an appropriately completed \"offer to assign\".
\nThe assignment of benefit form must be printed, provided to the patient to review and sign and offered to the patient to retain for their records.
\nProviders are no longer required to retain a copy of the assignment of benefit form for a period of two years. Should Services Australia need to confirm that a service was provided to a patient, evidence demonstrating that the service was provided will be sought from the service provider. The evidence of service may be demonstrated through records such as electronic billing information, notes in practice software, appointment records and, if the practice chooses to retain them, a copy of the assignment of benefit form.
\nInformation in addition to that specified below may be included in the Bulk Bill Assignment of benefit form. The form submitted for approval must not contain any variable data.
\nThe assignment of benefit form must be compliant with the guidelines provided by services Australia.
\n🔔 Note:
\n\n\nThe wording appearing on your form must be the same as that set out in the template below. You can arrange the fields to suit your needs however if the wording changes, the form does not meet the guidelines and is not an approved form.
\n
You can download the template PDF using the link below:
📥Bulk Bill Assignment of Benefit Form (DB4).pdf
Pathology Combined Request Assignment Advice – Bulk Bill
\nThe Pathology Combined Request Assignment Advice for bulk billing may be used as an alternative to the Bulk Bill Assignment of Benefit Form (DB4) in scenarios where:
\n- \n
The treating practitioner (e.g., GP) requests pathology services
\n \nThe patient does not physically attend the Approved Pathology Practitioner (APP)
\n \n
In this case:
\n- \n
The patient may complete an assignment voucher (Pathology Combined Request Assignment Advice form) at the time of the visit to the requesting practitioner, offering to assign benefits for the APP’s services.
\n \nThe DB4 form must also be signed by the patient for the assignment of benefit to the requesting practitioner/GP (if they are bulk billing the patient).
\n \n
🔔 Note:
\n\n\nThe wording appearing on your form must be the same as that set out in the template. You can arrange the fields to suit your needs, however if the wording changes, the form does not meet the guidelines and is not an approved form.
\n
\n
Requesting Practitioner
\n(Prescribed particulars are headings to prompt requesting practitioners to provide necessary information. Necessary particulars can be provided by stamp, sticker label, etc.)
\n- \n
Surname and initials (to distinguish)
\n \nAddress
\n \nProvider number
\n \nPractitioner to date the request form
\n \n
\n
Details of the Person to Whom the Request is Made
\nWhere the person is an Approved Pathology Authority (APA) or Approved Pathology Practitioner (APP):
\n- \n
Full name of APA / surname and initials of APP
\n \nPlace of practice address
\n \nLetters APA / APP shown
\n \n
\n
Patient Details
\n- \n
Name – surname, first name
\n \nAddress
\n \nDate of birth
\n \nSex
\n \nMedicare card number and Individual Reference Number
\n \nHospital status
\n \n
Two acceptable versions are as follows:
\n- \n
- Patient status at the time of the service or when the specimen was collected \n
OR
\n- \n
Was or will the patient be, at the time of the service or when the specimen is obtained:
\n- \n
A private patient in a private hospital or approved day hospital facility
\n \nA private patient in a recognised hospital
\n \nA public patient in a recognised hospital
\n \nAn outpatient of a recognised hospital
\n \n
\n
\n
Tests Requested
\n- \n
An area titled “Tests Requested” is required.
\n \nTerms such as order, require, referred etc. must not be used.
\n \n
\n
Self Determine (SD)
\n- \n
A tick box is required for SD.
\n \nThis is used when the APP determines that pathologist-determinable tests are necessary.
\n \nThe tick box can be placed in the clinical notes area.
\n \n
\n
Privacy Notice
\nThe wording of the notice must be:
\n\n\nPrivacy Notice: Your personal information is protected by law, including the Privacy Act 1988, and is collected by Services Australia for the assessment and administration of payments and services. This information is required to process your application or claim.
\n
- \n
Placement of the notice is only necessary on the patient’s copy.
\n \nIt may be incorporated into the clinical notes area or placed on the back of the patient copy if more practicable.
\n \n
\n
Combined Request / Assignment Form Only
\nOffer to Assign and Reference to Section 20A
\nExample of Section 20A Offer to Assign:
\n\n\nMedicare Assignment (Section 20A of the Health Insurance Act 1973)
\n
I offer to assign my right to benefits to the Approved Pathology Practitioner who will render the requested pathology service(s) and any eligible pathologist determinable service(s) established as necessary by the practitioner.
Patient Signature: _____._____._____ Date: _____ /_____ /_____
\n","_postman_id":"d5ff8d2f-4f6b-4438-b1bd-148ed3808c6f","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"General services claim
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Specialist services claim
\nThis is including Allied Health & Diagnostic services claim
\nOne of the below conditions must be satisfied for each medical event within a Specialist claim. If one of the below conditions is not met for each medical event within a Specialist claim, an error will be returned and no further processing will occur.
\n- \n
If referral is set and referral>Type Code is set to S or ‘D’ perform validation checks and continue processing. If referral is set and referral>Type Code is not set to S or D, an error will be returned and processing will stop.
\n \nIf Referral Override Code is set to either H, L, E or N, perform validation checks and continue processing. If Referral Override Code is not set to either H, L, E or N, an error will be returned and processing will stop.
\n \nIf Self Deemed Code is set to either SD or SS for at least one service per medical event, perform validation checks and continue processing. If Self Deemed Code is not set to either SD or SS for at least one service per medical event, an error will be returned and processing will stop.
\n \n
Pathology services claim
\nOne of the below conditions must be satisfied for each medical event within a Pathology claim. If one of the below conditions is not met for each medical event within a Pathology claim, an error will be returned and no further processing will occur.
\n- \n
If referral is set and referral>Type Code is set to P perform validation checks and continue processing. If referral is set and referral>Type Code is not set to P, an error will be returned and processing will stop.
\n \nIf Referral Override Code is set to N, perform validation checks and continue processing. If Referral Override Code is not set to N, an error will be returned and processing will stop.
\n \nIf Self Deemed Code is set to SD for at least one service per medical event and no service has Self Deemed Code set to SS, perform validation checks and continue processing. If Self Deemed Code is not set to SD for at least one service per medical event, or service has Self Deemed Code set to SS, an error will be returned and processing will stop.
\n \n
Bulk Bill Processing Report Web Service (BPRW) is used to retrieve a processing report for a Bulk Bill claim/s, which details processing information (including changes and exception situations) for each medical event and associated service/s within the original BBSW claim.
\nThis report is available for six months after its initial generation (date of lodgement for claim) and can be retrieved in real time as many times as required.
\nThe report can only be requested by the same transmitting location that submitted the claim.
\n📑 Request Fields
\n🔸correlationId
\nThe correlationId from the original Bulk Bill claim.
\n\n
🔸payeeProvider.providerNumber
\nDetails of the health professional to whom the Medicare benefit is to be paid, as submitted in the original claim transmission.
\n- \n
- Must be filled with leading zeros if the provider number is greater than 2 characters but less than 8 characters \n
\n
📑 Bulk Bill Report Response Fields
\n🔸status
\nIndicates the status of the report being requested.
\n- \n
Valid values:
\n- \n
\nCOMPLETE\n
\nREPORT_NOT_READY\n
\nREPORT_NOT_FOUND\n
\nREPORT_EXPIRED\n
\n
When status = COMPLETE, the following objects/values may be returned:
\n
🔸claimAssessment.benefitPaid
\nThe total amount of Medicare benefit paid for all services in the claim, returned in cents.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸claimAssessment.chargeAmount
\nThe total amount charged for all services in the claim, returned in cents.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸claimAssessment.claimId
\nA unique identifier generated by the practice management software for DBS claims, or by the agency for BBSW claims.
\n\n
medicalEvent – up to 80 per claim
\n🔸medicalEvent.eventDate
\nThe date of service applicable to the medical event, as submitted in the original Bulk Bill claim.
\n\n
🔸medicalEvent.id
\nAn identifier used to define the occurrence of the medical event.
\n\n
🔸medicalEvent.patient.status.code
\nA code which identifies the problem with the Medicare card details supplied.
\n\n
🔸medicalEvent.patient.status.text
\nText explaining the patient status code. Provides additional information to assist with service assessment and can be used to suggest changes to the Medicare patient record.
\n- \n
Values:
\n- \n
\n8023= Patient identification amended \n
\n8024= Patient Medicare Issue number changed \n
\n8025= Patient Medicare Number changed \n
\n8026= Patient card used will expire shortly \n
\n8027= Patient card expired. Future services may be rejected \n
\n8028= Old Medicare issue number for patient. Future services may be rejected \n
\n
\n
🔸medicalEvent.patient.currentMembership.memberNumber
\nThe patient's Medicare Card Number as recorded with Medicare at the time of the claim.
\n🔸medicalEvent.patient.currentMembership.memberRefNumber
\nThe patient’s Medicare Reference Number (IRN) as recorded with Medicare in the original claim.
\n\n
🔸medicalEvent.patient.currentMember.familyName
\nThe patient's family name as identified or corrected at the time of assessment.
\n\n
🔸medicalEvent.patient.currentMember.givenName
\nThe patient's first given name as recorded with Medicare.
\n\n
medicalEvent.service – up to 14 per medical event
\n🔸medicalEvent.service.assessmentCode
\nMedicare assessment result explanation code (Medicare Reason Code).
\n\n
🔸medicalEvent.service.benefitPaid
\nThe amount of benefit assessed as payable for the service, returned in cents.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸medicalEvent.service.chargeAmount
\nThe amount charged for the service in cents, as submitted in the original claim.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸medicalEvent.service.id
\nUnique identifier used to define the occurrence of the service within the claim.
\n\n
🔸medicalEvent.service.itemNumber
\nThe MBS item number against which the Medicare benefit was assessed.
\n\n
🔸medicalEvent.service.numberOfPatientsSeen
\nThe number of patients seen for the service in a group attendance scenario.
\n- \n
- Valid values:
1–99\n
\n
🔸serviceProvider.providerNumber
\nService provider.
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"Bulk Bill Payment Report Web Service (BPYW) is used to retrieve a payment report, providing payment information relating to Bulk Bill claims including the payment deposited, the bank account details the deposit was made to, and the list of claims covered by the payment run.
\nThis report is available for six months after its initial generation (date of lodgement for claim) and can be retrieved in real time as many times as required.
\nThe report can only be requested by the same transmitting location that submitted the claim.
\n📑 Request Fields
\n🔸correlationId
\nThe correlationId from the original Bulk Bill claim.
\n\n
🔸payeeProvider.providerNumber
\nDetails of the health professional to whom the Medicare benefit is to be paid, as submitted in the original claim transmission.
\n- \n
- Must be filled with leading zeros if the provider number is greater than 2 characters but less than 8 characters \n
\n
📑 Response Fields
\n🔸status
\nIndicates the status of the report being requested.
\n- \n
Valid values:
\n- \n
\nCOMPLETE\n
\nREPORT_NOT_AVAILABLE\n
\nREPORT_NOT_READY\n
\nREPORT_NOT_FOUND\n
\nREPORT_EXPIRED\n
\n
When status = COMPLETE, the following values may be returned:
\n
🔸paymentRun.runDate
\nThe date on which the agency is requesting the RBA to make the payment.
\n\n
🔸paymentRun.runNumber
\nA unique identifier for the payment run.
\n\n
🔸paymentInfo.depositAmount
\nThe total amount of Medicare benefit to be deposited into the payee provider's account for the claims detailed in the payment run.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸paymentInfo.accountInfo.accountName
\nThe payee provider's financial institution account name.
\n\n
🔸paymentInfo.accountInfo.accountNumber
\nThe payee provider's financial institution account number.
\n- \n
- Note: Only the last 4 digits are returned and prefixed with asterisks, e.g.,
\\\\\\*1234. \n
\n
🔸paymentInfo.accountInfo.bsbCode
\nThe branch identifier (BSB) for where the payee provider's account is held.
\n\n
🔸claimSummary.benefit
\nThe total amount of Medicare benefit paid for all services in the claim.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸claimSummary.chargeAmount
\nThe total amount charged for all services in the claim.
\n- \n
- Format: Numeric cents (e.g., $1.00 →
100) \n
\n
🔸claimSummary.claimId
\nThe unique identifier that is generated by Medicare for the original Bulk Bill claim.
\n\n
🔸claimSummary.lodgementDate
\nThe date when Medicare received the original claim.
\n\n
🔸claimSummary.transactionId
\nThe unique identifier of the claim request maintained throughout the life of a claim.
\n","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"This is the bulk claiming process that allows health professionals to claim Medicare benefits directly from Services Australia.
\nThis service allows claims where patients who have received professional medical services, and have assigned their right to Medicare benefits to the health professional who provided the service, to be transmitted to Services Australia and assessed at a later time.
\nThe Health Care Location submits the claim on behalf of a patient to Medicare.
\nThere are three Bulk Bill claim types:
\n- \n
General services claim
\n \nSpecialist services claim, including Allied Health & Diagnostic services claim
\n \nPathology services claim
\n \n
A Bulk Bill claim contains information about:
\n- \n
one servicing provider, and one payee provider, where applicable (the servicing provider and payee provider cannot be the same)
\n \none or more Medical Events (Vouchers - up to a maximum of 80)
\n \na consistent ServiceTypeCode eg. All Specialist, General or Pathology
\n \n
Each voucher (Medical Event) consists of:
\n- \n
a Patient
\n \none or more services (up to a maximum of 14)
\n \na Date of Service
\n \nReferral details, where applicable
\n \n
Once a claim has been successfully submitted, you will receive a response to indicate success of the transmission.
\nReferred and Requested services being claimed in the same voucher
\nSpecialists may submit claims with a mixture of services requiring request and referral information in the same voucher. To do this, the voucher must include referral details along with the relevant service level details.
\nThis only applies to specialist services requiring Referrals and Diagnostic Imaging Requests being submitted together.
\nPathology Requests need to be submitted separately.
\nBulk Bill Assignment Advice (DB4)
\nThe Location must issue the patient with a Bulk Bill Assignment of benefit form detailing services provided, except in the case of pathology services subject to a request which contains an appropriately completed \"offer to assign\".
\nThe assignment of benefit form must be printed, provided to the patient to review and sign and offered to the patient to retain for their records.
\nProviders are no longer required to retain a copy of the assignment of benefit form for a period of two years. Should Services Australia need to confirm that a service was provided to a patient, evidence demonstrating that the service was provided will be sought from the service provider. The evidence of service may be demonstrated through records such as electronic billing information, notes in practice software, appointment records and, if the practice chooses to retain them, a copy of the assignment of benefit form.
\nEFT details
\nServices Australia no longer sends cheques for bulk bill and Department of Veterans' Affairs (DVA) payments to health professionals.
\nHealth professionals must provide their bank details to the agency to have their bulk bill and DVA claims paid through Electronic Funds Transfer (EFT).
If they practise at more than one location, a health professional must submit bank details for each location.
To register EFT details for bulk bill and DVA payments, refer health professionals to the Services Australia website: Claim bulk bill payments
\n🔔 Note:
\n\n\nClaims with a DateOfService greater than 2 years in the past will not be accepted by Medicare.
\n
👩💻 Implementation Note:
\n\n\nIt is a requirement by Services Australia that error messages are displayed to the end user as supplied in the response, and not truncated, transformed or changed in any way. This will ensure that the correct message is received by the end user, as they may be updated at any time.
\n
Validations
\n- \n
A maximum of 80 Medical Events are allowed per Bulk Bill Claim.
\n \nA maximum of 14 Services are allowed per Medical Event.
\n \nMedical Event Ids must begin with 01 and increase by one as each Medical Event is added.
\n \nService Ids must be unique within the claim.
\n \nWhen the number of Bulk Bill Claims received from the same Payee Provider and Location Id exceeds 2500 per day,
\n
Subsequent BBSW claims will be rejected. \n
📑 Request Fields
\n🔸claim.facilityId
\nThe Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility. If Hospital Indicator is set to Y (In Hospital) then Facility Id must be supplied.
\n
🔸claim.hospitalInd
\nIndicates the service(s) was rendered to an admitted patient for in-patient services provided within a hospital facility.
\nValid Values:
\n- \n
Y= In Hospital (In-patient) \n
\n
🔸claim.serviceTypeCode
\nIndicates the type of services that make up the claim.
\nValid Values:
\n- \n
\nP= Pathology \n
\nS= Specialist \n
\nO= General \n
\n
🔸claim.serviceProvider.providerNumber
\n- \n
The health professional providing the service.
\n \nThe Servicing Provider must not be the same person as the Payee Provider. If they are the same person only supply the Servicing Provider.
\n \n
\n
🔸claim.payeeProvider.providerNumber (Optional)
\nA Payee Provider Number is issued by Medicare for each clinician who wants to bill for services. It identifies the bank account where Medicare payments should be made. In most cases, it is the same as the clinician’s Provider Number.
\n- \n
- The Servicing Provider must not be the same person as the Payee Provider. If they are the same person only supply the Servicing Provider. \n
\n
🔸claim.medicalEvent.id
\nUsed to identify the occurrence of the Medical Event Type. (01–80)
\n
🔸claim.medicalEvent.authorisationDate
\nThe date on which the claim was authorised.
\n- \n
Must not be in the future
\n \nMust not be earlier than the Medical Event Date
\n \n
\n
🔸claim.medicalEvent.createDateTime
\nUsed to record the date and time that the medical event record was created.
\n- \n
Must not be in the future
\n \nMust not be earlier than the Medical Event Date and Medical Event Time (if supplied)
\n \nMust reflect the correct Australian time zone.
\n \n
\n
🔸claim.medicalEvent.medicalEventDate
\nUsed to record the date that the medical event occurred (Date of Service).
\n- \n
Must not be in the future
\n \nMust not be more than 2 years before the date of transmission
\n \n
\n
🔸claim.medicalEvent.medicalEventTime (Optional)
\nUsed to record the time that the medical event occurred (Time of Service).
\n- \n
Must not be in the future
\n \nMust reflect the correct Australian time zone
\n \n
\n
🔸claim.medicalEvent.referralOverrideCode (Optional)
\nProvides an indication of why services that require a referral were provided without a referral from another health professional.
\nValid Values:
\n- \n
\nE= Emergency \n
\nH= Hospital \n
\nL= Lost \n
\nN= Not required (Non-Referred) \n
Additional Rules:
\n- \n
If set to
\nH(Hospital), Hospital Indicator must be set toY\nIf set to
\nH(Hospital), Facility Id must be supplied \nMust not be suplied for general services.
\n \n
\n
🔸claim.medicalEvent.submissionAuthorityInd
\nIndicates that the Medicare benefit was assigned by the patient, who retained a copy of the DB4 form.
\nValid Values:
\n- \n
- Must be set to
Y(Authorised) to submit the claim \n
\n
🔸claim.medicalEvent.referral (Optional)
\n- \n
If referral is set, Referral Override Code must not be set
\n \nReferral must not be set when Service Type Code is
\nO(general services) \n
\n
🔸claim.medicalEvent.referral.issueDate (Optional)
\nThe date the referral/request was issued.
\nValid Values:
\n- \n
Must not be in the future
\n \nMust not be after the Medical Event Date
\n \nMust not be set when Service Type Code is
\nO(general services) \nMust not be before the Patient’s Date of Birth
\n \n
\n
🔸claim.medicalEvent.referral.period (Optional)
\nIndicates the length of the referral period for Non Standard referrals (in months).
\nValid Values:
\n- \n
Must be numeric (
\n1–98) \nMust only be set if Referral Period Code is
\nN(Non Standard) \n
\n
🔸claim.medicalEvent.referral.periodCode (Optional)
\nA code indicating the length of the referral period.
\nValid Values:
\n- \n
\nS= Standard (12 months for a GP, 3 months for a Specialist) \n
\nN= Non Standard \n
\nI= Indefinite \n
Must only be set to N if Referral Period is set.
\n
🔸claim.medicalEvent.referral.typeCode (Optional)
\nA code that indicates the type of referral/request (i.e., Pathology, Diagnostic, Specialist).
\nValid Values:
\n- \n
\nP= Pathology \n
\nD= Diagnostic Imaging \n
\nS= Specialist (Including Allied Health) \n
Rules:
\n- \n
Must not be set when Service Type Code is
\nO(general services) \nIf set to
\nDorP, Referral Period Code and Referral Period must not be set \nIf set to
\nS, Referral Period Code must be supplied \nIf set to
\nP, Service Type Code must beP\nIf set to
\nDorS, Service Type Code must beS\n
\n
🔸claim.medicalEvent.referral.provider.providerNumber (Optional)
\nReferrer provider number.
\nRules:
\n- \n
Must not be set when Service Type Code is
\nO(general services) \nReferring Provider Number must not be the same as the Servicing Provider Number.
\n \n
\n
🔸claim.medicalEvent.patient.identity.dateOfBirth
\nThe patient’s date of birth.
\n- \n
Must not be in the future
\n \nMust not be more than 130 years in the past
\n \nMust not be after the Medical Event Date
\n \n
\n
🔸claim.medicalEvent.patient.identity.familyName
\nThe patient’s family name.
\n- \n
Must be between
\n1and40characters long \nWhere a patient has only one name, that name must appear in this field and the word
\nOnlynamemust be entered in the given name field \n
\n
🔸claim.medicalEvent.patient.identity.givenName
\nThe patient’s first given name.
\n- \n
Must be between
\n1and40characters long \nWhere a patient has only one name, that name must appear in the family name field and the word
\nOnlynamemust be provided in this field \n
\n
🔸claim.medicalEvent.patient.medicare.memberNumber
\nThe patient’s Medicare card number.
\n- \n
- Must be
10characters long \n
\n
🔸claim.medicalEvent.patient.medicare.memberRefNumber
\nThe patient’s individual reference number on their Medicare card.
\n- \n
Must be
\n1character long \nMust be numeric (
\n1–9) \nMust not be zero
\n \n
\n
🔸claim.medicalEvent.service.id
\nUsed to identify the occurrence of the Service Type.
\n- \n
Must be set
\n \nMust be
\n4characters long \nMust be alphanumeric (
\nA–Z,0–9) \nExample valid values:
\nC001,AC68,0104,4074,ABCD\n
\n
🔸claim.medicalEvent.service.accessionDateTime
\nThe date/time the pathology test was performed.
\n- \n
Must not be in the future
\n \nMust only be set when Service Type Code is
\nP(Pathology) and must not be set when Service Type Code isO(General) orS(Specialist) \nMust be equal to or earlier than Medical Event Date and Time (if present)
\n \nMust be equal to or earlier than Medical Event Creation Date Time
\n \nMust reflect the correct Australian time zone
\n \n
\n
🔸claim.medicalEvent.service.aftercareOverrideInd (Optional)
\nIndicates whether the service was performed as part of normal aftercare.
\n- \n
Valid value:
\nY= Not Normal Aftercare \nIf set, Service Type Code must not be
\nP(Pathology) \nMust only be set when Service Type Code is
\nS(Specialist) orO(General) and must not be set for Pathology. \n
\n
🔸claim.medicalEvent.service.chargeAmount
\nThe amount charged for the service in cents. For Bulk Bill claims, this is the benefit assigned.
\n- \n
Minimum amount:
\n100cents ($1.00) \nMaximum amount:
\n9,999,999cents ($99,999.99) \nLeading zeros allowed for amounts less than
\n7characters (e.g.,100,0100,00100) \n
\n
🔸claim.medicalEvent.service.collectionDateTime (Optional)
\nThe date/time the pathology sample was taken/extracted from the patient.
\n- \n
Must only be set when Service Type Code is
\nP(Pathology) and must not be set when Service Type Code isO(General) orS(Specialist) \nMust not be after Accession Date Time
\n \nIf either Collection Date Time or Accession Date Time is set, both must be supplied.
\n \nMust not be before Patient Date of Birth
\n \nMust not be before Referral Issue Date
\n \nMust reflect the correct Australian time zone
\n \n
\n
🔸claim.medicalEvent.service.duplicateServiceOverrideInd (Optional)
\nIndicates whether multiple services performed on the same day by the same service provider should be treated as separate services.
\n- \n
Valid value:
\nY= Not Duplicate \nMust not be set when Service Type Code is
\nP(Pathology) and Must only be set when Service Type Code isS(Specialist) orO(General) \nIf set, either Medical Event Time or additional information in Service Text must be provided to support the override.
\n \n
\n
🔸claim.medicalEvent.service.itemNumber
\nA number from the Medicare Benefits Schedule (MBS) that identifies the service(s) provided. Used to enable a claim for a Medicare benefit.
\n- \n
Must be numeric (
\n1–99999) \nLeading zeros are acceptable e.g., item
\n3can be transmitted as3,03,003,0003, or00003\n
\n
🔸claim.medicalEvent.service.lspNumber (Optional)
\nLocation Specific Practice Number for diagnostic and radiation oncology that is specific to an individual location for the purpose of claiming a Medicare benefit.
\n- \n
Must be numeric (
\n1–999999) \nLeading zeros are acceptable (e.g.,
\n4can be transmitted as4,04,004, etc.) \nMust only be set when Service Type Code is
\nS(Specialist) orO(General) \nMust not be set when Service Type Code is
\nP\nMust not be set with Number of Patients Seen
\n \nMust not be set with Time Duration
\n \n
\n
🔸claim.medicalEvent.service.multipleProcedureOverrideInd (Optional)
\nIndicates whether the multiple services rule should or shouldn’t be applied to the services being claimed.
\n- \n
Value must be
\nY(Not Multiple) \nMust only be set when Service Type Code is
\nS(Specialist) orO(General) \nMust not be set when Service Type Code is
\nP\nIf set to
\nY, Service Text (reason for the override) must also be supplied \n
\n
🔸claim.medicalEvent.service.numberOfPatientsSeen (Optional)
\nThe number of patients seen. Must be set for group attendance items (e.g. counselling) or visits (home, hospital, or institution) to ensure the correct payment is made.
\n- \n
Value must be numeric (
\n1–99) \nLeading zeros are acceptable (e.g.
\n1may be transmitted as1or01) \nMust only be set when Service Type Code is
\nS(Specialist) orO(General) \nMust not be set when Service Type Code is
\nP\nMust not be set with Time Duration
\n \n
\n
🔸claim.medicalEvent.service.restrictiveOverrideCode (Optional)
\nThis code allows payment for services where the account indicates the service is not restrictive with another service either within the same claim or on the patient’s history.
\n- \n
Value must be one of:
\n- \n
\nSP= Separate Sites \n
\nNR= Not Related to consult \n
\nNC= Not for Comparison (Bilateral) \n
\nMust only be set when Service Type Code is
\nS(Specialist) orO(General) \nMust not be set when Service Type Code is
\nP\n
\n
🔸claim.medicalEvent.service.rule3ExemptInd (Optional)
\nIndicates if the pathology service is exempt from Rule 3 in the Medicare Benefits Schedule (MBS).
\n- \n
Value must be:
\nY= Exempt \nMust only be set when Service Type Code is
\nP(Pathology) \nMust not be set when Service Type Code is
\nO(General) orS(Specialist) \nIf set, Medical Event Time must also be supplied
\n \n
\n
🔸claim.medicalEvent.service.s4b3ExemptInd (Optional)
\nIndicates if the pathology service is exempt from assessment in accordance with S4b3 requirements in the Medicare Benefits Schedule (MBS).
\n- \n
Value must be:
\nY= Exempt \nMust only be set when Service Type Code is
\nP(Pathology) \nMust not be set when Service Type Code is
\nO(General) orS(Specialist) \nMust not be set if Rule 3 Exempt Indicator is set
\n \nIf set:
\n- \n
Self Deemed Code must be
\nSD, OR \nReferral Override Code must be
\nN, OR \nPathology Referred must be supplied (Referral Type Code =
\nP, with Referring Provider Number and Referral Issue Date set) \nHospital Indicator must be
\nY(service must be rendered in hospital) \n
\n
\n
🔸claim.medicalEvent.service.scpId (Optional)
\nThe Specimen Collection Point (SCP Id) identifies the site where the pathology specimen was collected.
\n- \n
Format rules:
\n- \n
\n3–5characters in length \nCharacters must be alphanumeric (
\nA–Z,0–9) \nMust not be all zero (
\n0,00,000, etc.) \nSpaces are not allowed
\n \nLeading zeros are allowed for shorter values (e.g.
\n001,0001,00001) \n
\nBusiness rules:
\n- \n
Must only be set when Service Type Code =
\nP(Pathology) \nMust not be set when Service Type Code =
\nO(General) orS(Specialist) \nIf set, at least one of the following must be true:
\n- \n
Referral Type Code =
\nP\nReferral Override Code =
\nN\nSelf Deemed Code =
\nSD\n
\n
\n
\n
🔸claim.medicalEvent.service.selfDeemedCode (Optional)
\nIndicates if the service is Self Deemed or a Substituted Service.
\n- \n
Valid values
\n- \n
\nSD– Self Deemed \n
\nSS– Substituted Service \n
\nBusiness rules
\n- \n
\nSSmust only be set when Service Type Code =S(Specialist) \nMust not be set when Service Type Code =
\nO(General) \nMust not be set if Referral Override Code is set
\n \nIf Rule 3 Exempt Indicator is set, Self Deemed Code must be
\nSD\nFor pathology, at least one of the following must apply if set:
\n- \n
- Referral Type Code =
Pand Referring Provider Number & Referral Issue Date are set \n
\n- Referral Type Code =
\n
\n
🔸claim.medicalEvent.service.text (Optional)
\nFree text used to provide additional information to assist with the assessment of the service.
\n- \n
Length:
\n1–50characters \nValid characters:
\n- \n
Alpha (
\nA–Z,a–z) \nNumeric (
\n0–9) \nSpace ( )
\n \nSpecial characters:
\n@ # $ % + = : ; , . -\n
\nFormatting rules:
\n- \n
- Spaces must not appear before or after other spaces or at the start/end of the value \n
\n
\n
🔸claim.medicalEvent.service.timeDuration (Optional)
\nThe duration of a service in minutes.
\n- \n
Length:
\n3characters \nValid values: Numeric,
\n001–999(represents time in minutes) \nService Type restriction: Only set when Service Type Code is
\nS(Specialist) orO(General) \n
Resubmitting Rejected Claims in RebateRight
\nOverview
\nWhen a Bulk Bill claim is rejected by Medicare, it's important to understand why the rejection occurred and how to correct and resubmit the claim properly. This guide will help you navigate the resubmission process in RebateRight.
\nUnderstanding Claim Rejections
\nWhen Claims Are Rejected
\nClaims can be rejected at two stages:
\n- \n
YAML Interface Validation - Technical format errors detected immediately
\n \nBusiness Rules Validation - Clinical or administrative rule violations identified during processing
\n \n
If a claim is rejected, no Claim ID will be generated and the claim will not be submitted to Medicare for assessment.
\nCommon Rejection Reasons
\nBased on Medicare's validation rules, claims are commonly rejected for:
\n- \n
Patient Details Errors
\n- \n
Invalid Medicare card number or IRN
\n \nPatient date of birth in the future or more than 130 years ago
\n \nMissing or incorrectly formatted patient names
\n \n
\nService Information Errors
\n- \n
Invalid MBS item numbers
\n \nCharge amounts below minimum ($1.00) or incorrectly formatted
\n \nMissing required fields for specific service types
\n \n
\nReferral/Request Issues
\n- \n
Referral issue date after service date
\n \nMissing referral details for specialist services
\n \nIncorrect referral period codes
\n \n
\nProvider Information Errors
\n- \n
Invalid provider number format
\n \nServicing provider same as payee provider
\n \nReferring provider same as servicing provider
\n \n
\nDate and Time Errors
\n- \n
Service date more than 2 years in the past
\n \nAuthorisation date before service date
\n \nFuture dates for services or authorisations
\n \n
\n
Reading Error Messages
\nMedicare error messages follow this format:
\n[Error Code] [Error Message Text]. Error located in Medical Event {m}, Service {s}.
\nExample:
\n9202 Invalid value of [12345] supplied for Patient Medicare Card Number. The value supplied must be numeric and conform to the Medicare Card check digit routine. Error located in Medical Event 01, Service C001.
\nKey Elements:
\n- \n
Error Code: Identifies the type of error (e.g., 9202 for format errors, 2030 for missing information)
\n \nError Message: Describes what's wrong and what's required
\n \nLocation: Shows which Medical Event (voucher) and Service contains the error
\n \n
Important: Display all error messages exactly as provided by Medicare - do not truncate, transform, or modify them.
\nResubmission Process
\nStep 1: Review the Rejection
\n- \n
Open the rejected claim in RebateRight
\n \nLocate the error message(s) in the claim details
\n \nIdentify which Medical Event(s) and Service(s) are affected
\n \nNote the specific validation rule that failed
\n \n
Step 2: Correct the Errors
\nBased on the error code and message:
\n- \n
For Format Errors (9202)
\n- \n
Verify the data format matches Medicare requirements
\n \nCheck for special characters, spacing, or length issues
\n \nEnsure dates are valid and in correct format
\n \n
\nFor Missing Information (2030)
\n- \n
Add the required fields specified in the error message
\n \nEnsure all conditional requirements are met
\n \nVerify related fields are consistent
\n \n
\nFor Structural Errors (2025, 2032)
\n- \n
Check Medical Event and Service counts don't exceed limits
\n \nEnsure IDs are unique and sequential
\n \nVerify Medical Event structure is valid
\n \n
\n
Step 3: Validate Before Resubmission
\nBefore resubmitting:
\n- \n
✓ All error messages have been addressed
\n \n✓ Patient details are correct and verified
\n \n✓ Provider numbers are valid and correctly formatted
\n \n✓ Service dates are within acceptable range (not more than 2 years old)
\n \n✓ Referral details are complete (for specialist/pathology services)
\n \n
Step 4: Resubmit the Claim
\n- \n
Generate a new Transaction ID for the resubmission. When you leave the field empty RebateRight automatically generates a new TransactionId for you.
\n \nReview the corrected claim details one final time
\n \nSubmit the claim through RebateRight.
\n \n
Important Resubmission Rules
\nTransaction IDs
\n- \n
Always use a new Transaction ID for resubmissions
\n \nReusing a Transaction ID will result in error 9777: \"Transaction Id submitted for this claim has already been received\"
\n \nRebateRight automatically generates unique Transaction IDs for each submission
\n \n
Submission Limits
\n- \n
Maximum 2500 BBSW claims per day per Payee Provider and Location ID
\n \nExceeding this limit results in error 3004
\n \nPlan your resubmissions to stay within daily limits
\n \n
Timing Considerations
\n- \n
Do not submit more than one claim per second to ensure proper processing
\n \nAllow time between resubmission attempts for system processing
\n \nIf multiple claims need correction, prioritize by service date
\n \n
Special Cases
\nMultiple Errors in One Claim
\nIf a claim has multiple errors:
\n- \n
Review all error messages before making corrections
\n \nAddress errors systematically (patient details first, then services)
\n \nFix related errors together (e.g., referral date and referral period)
\n \nResubmit once all errors are corrected
\n \n
Claim Structure Errors
\nIf you receive errors 2025 or 2032:
\n- \n
Error 2025: Too many Medical Events (maximum 80)
\n- \n
Split the claim into multiple submissions
\n \nEach submission should have 80 or fewer Medical Events
\n \n
\nError 2032: Too many Services per Medical Event (maximum 14)
\n- \n
Split the Medical Event into separate Medical Events
\n \nEach Medical Event should have 14 or fewer Services
\n \n
\n
Service Type Mismatches (Error 2030)
\nIf the service type doesn't match the web service called:
\n- \n
Verify you're using the correct web service:
\n- \n
\nmcp.bulk.bill.store.forward.generalfor General services \n
\nmcp.bulk.bill.store.forward.specialistfor Specialist services \n
\nmcp.bulk.bill.store.forward.pathologyfor Pathology services \n
\nEnsure referral/request details match the service type
\n \nCannot mix service types in a single claim
\n \n
Best Practices
\nTo Minimize Rejections:
\n- \n
Validate Patient Details First
\n- \n
Use Patient Verification and Calculate Rebate before submitting claims
\n \nConfirm Medicare card details are current and accurate
\n \n
\nCheck Provider Numbers
\n- \n
Ensure all provider numbers are valid and correctly formatted
\n \nVerify provider numbers conform to check digit routine
\n \nDon't use same provider number for different roles (servicing/payee/referring)
\n \n
\nVerify Service Dates
\n- \n
Services cannot be more than 2 years old
\n \nService dates cannot be in the future
\n \nEnsure date sequence is logical (referral before service, service before authorisation)
\n \n
\nComplete All Required Fields
\n- \n
For specialist services: Include referral details OR override code OR self-deemed code
\n \nFor pathology services: Include request details OR override code (N) OR self-deemed code (SD)
\n \nFor in-hospital services: Include facility ID and hospital indicator
\n \n
\nReview Before Submission
\n- \n
Use RebateRight's validation checks before submitting
\n \nConfirm all conditional requirements are met
\n \n
\n
This endpoint provides a report that serves as a record of the eligibility quote provided by the health professional to the patient.
\n🎨How It Works
\n- \n
Generates a PDF file containing the required quote record.
\n \nThe request structure is identical to the
\n/CalculateRebateendpoint. \n
The following sections provide detailed information on specific topics. Each folder focuses on a particular aspect and contains guidance relevant to that area.
\n","_postman_id":"83789c2e-8fd0-41dc-8e57-42d9ec81eb20","auth":{"type":"apikey","apikey":{"value":"{{ApiKey}}","key":"