Bulk Bill Claim | RebateRight

A Bulk Bill claim is submitted when a patient assigns their right to Medicare benefits to the health professional who provided the service. Services Australia assesses the claim and pays the benefit directly to the provider via EFT.

Bulk billing requires the patient to assign their Medicare benefit to the provider. RebateRight can render that signable agreement from this claim. See Assignment of Benefit, in particular Post-assignment, which is built from the bulk bill claim.

Confirming the assignment

Every voucher carries submissionAuthorityInd, which must be Y. It confirms the patient has assigned their Medicare benefit to the provider, through pre-assignment or post-assignment, the precondition for bulk billing. A claim that doesn’t assert it is not accepted. Set it once the patient has agreed to the assignment; RebateRight renders the signable agreement from the same claim.

Claim Types

RebateRight supports three Bulk Bill service types:

General Services

Standard GP and general practitioner consultations.

Specialist Services

Specialist, Allied Health, and Diagnostic Imaging services.

Pathology Services

Pathology services subject to a pathology request.

All vouchers in a single claim must use the same serviceTypeCode. You cannot mix General, Specialist, and Pathology services in one claim.

Claim Structure

Each Bulk Bill claim contains:

One servicing provider and one payee provider (where applicable, they cannot be the same)
Up to 80 Medical Events (Vouchers)
A consistent serviceTypeCode across all vouchers

Each voucher contains:

One patient
A date of service
Up to 14 services (MBS items)
Referral details (where applicable)

For an in-hospital service, set hospitalInd to Y and supply the 8-character facilityId. In-hospital claim IDs come back with a # prefix instead of a letter.

Mixed Referral and Request Services

Specialists may submit claims with a mixture of services requiring both referral and request information in the same voucher. To do this, include referral details at the voucher level alongside the relevant service-level request details.

This only applies to specialist services combining Referrals and Diagnostic Imaging Requests in the same voucher. Pathology Requests must be submitted separately.

Validations

Rule	Limit
Medical Events per claim	Maximum 80
Services per Medical Event	Maximum 14
Medical Event IDs	Must start at `01` and increment by one
Service IDs	Must be unique within the claim
Date of Service	Within 1 year of submission, and not in the future
Daily claim volume	More than 2,500 BBSW claims from the same Payee Provider and Location ID per day will be rejected

How a Failure is Scoped

A claim passes through two stages, and they fail differently. The distinction decides how many patients you should batch into one claim.

Stage	When	Scope of a failure
Validation	Synchronously, in the response to your submission	The whole claim. Nothing is lodged and no `claimId` is issued
Assessment	Later, retrieved through the processing report	The individual voucher or service

Validation covers field shapes, field-to-field consistency, and claim structure. One malformed value anywhere rejects every voucher in the claim: a Medicare card number that fails the check digit routine in voucher 02 takes the rest of the claim with it. The 400 response returns one serviceMessage per failed check, each naming the voucher it came from, so you can correct them all in one pass rather than one submission at a time.

Assessment is where Medicare resolves patients, providers, and item eligibility. A card number that is well formed but does not match a patient passes validation and lodges with the rest of the claim. The processing report then reports benefitPaid and an assessmentCode per voucher and per service, so an outcome at this stage belongs to the voucher or service it came from.

Batching a day’s consults into one claim per provider is exposed to the errors your own software could have caught, and safe against the ones only Medicare can resolve. Validate field shapes before you submit and the all-or-nothing stage stops being a batching risk.

EFT Payment Details

Services Australia no longer issues cheques for Bulk Bill payments. Health professionals must register their bank details with Services Australia to receive payments via EFT.

If a health professional practises at more than one location, bank details must be registered for each location separately.

To register EFT details, refer health professionals to: Claim Bulk Bill Payments (Services Australia)

Resubmitting Rejected Claims

If a claim is rejected, you can resubmit it after correcting the errors. Key rules:

Use the same correlationId to resubmit a corrected version of the same claim
Use a new correlationId if you are submitting a different claim
Review the error messages in the response

If the patient’s Medicare details differ from Medicare’s records, the corrected values come back on the processing report. Reconcile against those before resubmitting.