> For clean Markdown of any page, append .md to the page URL. > For a complete documentation index, see https://docs.rebateright.com.au/llms.txt. > For AI client integration (Claude Code, Cursor, etc.), connect to the MCP server at https://docs.rebateright.com.au/_mcp/server. # In-patient claims (ECLIPSE) You lodge an in-patient medical claim for the medical services a practitioner gives a patient admitted to a hospital. Medicare assesses the claim. For every claim type except Medicare Only, Medicare then sends the claim to the patient's health fund. Your software retrieves the outcome as a report, and the record of the payment as a remittance advice. Services Australia carries these claims through its Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE). Practice software often calls this ECLIPSE claiming. > **Note** > > Test environment only. Services Australia is certifying this service, and it reaches production once certified. 1 When you lodge Acknowledged Medicare accepts the claim for processing. The acknowledgement carries no assessment. 2 Once assessed Reported The claim's report gives Medicare's assessment, and the health fund's where the claim type has one. 3 Once paid Paid The remittance advice gives the deposit amount and the benefit paid for each claim. A Patient Claim follows steps 1 and 2 only. [Patient Claims](#patient-claims) describes its outcome. | You need to | Go to | | ------------------------------- | ------------------------------------------------------------------------------------------------------------------- | | Choose the claim type | [Which claim type do I send?](#which-claim-type-do-i-send) | | Choose the endpoint | [Specialties](#specialties) | | Build your first claim | [Before the first claim](#before-the-first-claim), then [Lodge a claim](#lodge-a-claim) | | Get the outcome and the payment | [Follow the claim to its outcome](#follow-the-claim-to-its-outcome), then [Reconcile payments](#reconcile-payments) | --- ## Which claim type do I send? The claim type decides who pays whom. Set it in `claimTypeCode`. ![Who pays whom for each claim type. Agreement and Scheme: Medicare pays its benefit to the health fund, and the fund makes one payment to the provider for both benefits. Billing Agent: Medicare and the health fund each pay the billing agent. Medicare Only: Medicare pays the billing agent, and no health fund takes part. Patient Claim with a paid account: Medicare pays the claimant, and the fund pays the patient, its member. Patient Claim with an account not paid in full: Medicare and the fund each pay by a cheque made out to the provider, which the patient passes on.](/_fern-files/rebate-right.docs.buildwithfern.com/ef35271f05951d044c49116f373d192a70717160370dba10c8025e4342f5702a/assets/in-patient-who-pays-light.svg)![Who pays whom for each claim type. Agreement and Scheme: Medicare pays its benefit to the health fund, and the fund makes one payment to the provider for both benefits. Billing Agent: Medicare and the health fund each pay the billing agent. Medicare Only: Medicare pays the billing agent, and no health fund takes part. Patient Claim with a paid account: Medicare pays the claimant, and the fund pays the patient, its member. Patient Claim with an account not paid in full: Medicare and the fund each pay by a cheque made out to the provider, which the patient passes on.](/_fern-files/rebate-right.docs.buildwithfern.com/48068dea5c16d8989ccabc4951b4245d8eecb52bf24c57ec583359385b943709/assets/in-patient-who-pays-dark.svg) | Claim type | `claimTypeCode` | Who pays whom | | ----------------- | --------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Agreement** | `AG` | The provider has an agreement with the patient's health fund. Medicare pays its benefit to the fund, and the fund makes one payment to the provider for both benefits. | | **Scheme** | `SC` | The provider treats the patient under a scheme with the patient's health fund. Medicare pays its benefit to the fund, and the fund makes one payment to the provider for both benefits. | | **Billing Agent** | `MB` | Medicare and the health fund each pay the billing agent named in the claim. | | **Medicare Only** | `MO` | Medicare pays the billing agent named in the claim. No health fund takes part. | | **Patient Claim** | `PC` | The patient is a member of the health fund. For a paid account, Medicare pays the claimant and the fund pays its member. For an account not paid in full, Medicare and the fund each pay by a cheque made out to the provider, which the patient passes on. | ### What each claim type sends These fields change with the claim type. A Patient Claim sends its own set, listed in [Patient Claims](#patient-claims). | Field | `AG` | `SC` | `MB` | `MO` | | ------------------------------------------------------- | --------------- | ---------- | ---------- | ---------- | | `patient.healthFund` | Required | Required | Required | Not sent | | `patient.alsoKnownAs` | Optional | Optional | Optional | Not sent | | `accident.accidentInd` | Required | Required | Required | Not sent | | `billingAgent.providerNumber` | Optional | Optional | Required | Required | | `fundPayeeId` | Optional | Optional | Optional | Not sent | | `benefitAssignmentAuthorisedInd` | `I` or `R` | `I` or `R` | `I` or `R` | `I` or `R` | | `accountPaidInd` | `N` | `N` | `N` | `N` | | `claimant`, `submissionAuthorityInd` | Not sent | Not sent | Not sent | Not sent | | `ifcIssueCode`, on each medical event | `V`, `W` or `X` | `W` or `X` | Optional | Optional | | `financialInterestDisclosureInd`, on each medical event | Optional | `Y` | Optional | Optional | Each claim type's endpoint pages give every field's meaning, format and values. ### Assignment of benefit In every claim type except Patient Claim, the patient's Medicare benefit is assigned to the health fund or the billing agent. `benefitAssignmentAuthorisedInd` declares which pathway applies, and that its legislative requirements are met. For a claim with a service given before 1 July 2026, send `I`. | Pathway | Value | When it applies | What the provider, hospital or organisation does | | ------------------------ | ----- | ------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Implied assignment** | `I` | An insurer arrangement covers the service, such as a gap cover agreement or a medical purchaser provider agreement. | Declares in the claim that the requirements are met, and keeps the assignment records for 7 years. | | **Requested assignment** | `R` | No insurer arrangement covers the service. | Helps the patient request the assignment, and gets the patient's approval for any new or added services. Declares in the claim, keeps the request and any changed request for 7 years, and gives the patient a copy on request. | #### Digital requests, notices and questions * **Digital requests.** Services Australia notes that your software may collect a requested assignment digitally. * **Notifying the patient.** The health fund or billing agent that receives the Medicare benefit notifies the patient within 6 months of receiving it. It keeps its records of the assignment or the notice for 7 years. Services Australia's specification sets this rule beside implied assignment, and does not say whether it also applies to requested assignment. * **Questions.** Send questions about these rules to [AssignmentofBenefit@health.gov.au](mailto:AssignmentofBenefit@health.gov.au). --- ## Specialties Each claim type has a general, a specialist and a pathology endpoint. Send each claim to the endpoint for its services, and set `serviceTypeCode` to match. #### General: O General services need no referral or request. #### Specialist: S Specialist and diagnostic imaging services need a referral, a request, a referral override or a self-deemed service in each medical event. #### Pathology: P Pathology services need a pathology request or a self-deemed service in each medical event. | Claim type | General `O` | Specialist `S` | Pathology `P` | | ---------------------- | --------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------- | | **Agreement** `AG` | [`ag/general`](/api-reference/medicare-claiming/in-patient-claims/in-patient-agreement-general) | [`ag/specialist`](/api-reference/medicare-claiming/in-patient-claims/in-patient-agreement-specialist) | [`ag/pathology`](/api-reference/medicare-claiming/in-patient-claims/in-patient-agreement-pathology) | | **Scheme** `SC` | [`sc/general`](/api-reference/medicare-claiming/in-patient-claims/in-patient-scheme-general) | [`sc/specialist`](/api-reference/medicare-claiming/in-patient-claims/in-patient-scheme-specialist) | [`sc/pathology`](/api-reference/medicare-claiming/in-patient-claims/in-patient-scheme-pathology) | | **Billing Agent** `MB` | [`mb/general`](/api-reference/medicare-claiming/in-patient-claims/in-patient-billing-agent-general) | [`mb/specialist`](/api-reference/medicare-claiming/in-patient-claims/in-patient-billing-agent-specialist) | [`mb/pathology`](/api-reference/medicare-claiming/in-patient-claims/in-patient-billing-agent-pathology) | | **Medicare Only** `MO` | [`mo/general`](/api-reference/medicare-claiming/in-patient-claims/in-patient-medicare-only-general) | [`mo/specialist`](/api-reference/medicare-claiming/in-patient-claims/in-patient-medicare-only-specialist) | [`mo/pathology`](/api-reference/medicare-claiming/in-patient-claims/in-patient-medicare-only-pathology) | | **Patient Claim** `PC` | [`pc/general`](/api-reference/medicare-claiming/in-patient-claims/in-patient-patient-claim-general) | [`pc/specialist`](/api-reference/medicare-claiming/in-patient-claims/in-patient-patient-claim-specialist) | [`pc/pathology`](/api-reference/medicare-claiming/in-patient-claims/in-patient-patient-claim-pathology) | * **The wrong endpoint.** Medicare rejects a claim with `2030` when its `claimTypeCode` or `serviceTypeCode` does not match the endpoint it was sent to. * **Referral fields.** Each specialist and pathology endpoint's page sets out the referral, request, override and self-deemed fields it takes. * **Keep the referral.** Services Australia requires your software to keep a patient's referral details for use at a later consultation. * **Group attendances.** In every claim type except Patient Claim, send an item for a group attendance or a home, hospital or institution visit through the general endpoint, with `numberOfPatientsSeen` set. A specialist endpoint assesses the item with no benefit and explanation code `402`. --- ## Validations | Rule | Limit | | ------------------------------------- | ---------------------------------------------------------------------------------------------- | | Patients per claim | One | | Medical events per claim | Maximum **16** | | Services per medical event | Maximum **14** | | Services per Patient Claim | Maximum **16** in total | | Medical event IDs | Start at `01` and increase by one | | Service IDs | 4 digits, such as `0001`, unique within the claim | | Servicing provider in a Patient Claim | The same on every medical event | | Date of service | Not in the future, and less than **2 years** before Medicare receives the claim | | `accountReferenceId` | 1 to 20 letters or digits, or 1 to 9 in a Patient Claim. Every report for the claim carries it | --- ## Patient Claims A Patient Claim (`PC`) has rules of its own: * **Declaration and consent.** Before you lodge, present the Patient Claim consent and declaration to the patient, on screen or printed, and get their verbal consent. Services Australia publishes the current declaration, with its privacy notice, on its Health Systems Developer Portal. Services Australia advises that legislation requires the current version. * **Lodging later.** Services Australia requires your software to be able to create the account now and lodge the claim on a later date. * **Outcome.** Medicare sends the assessment to the patient. The claim's report gives its status only. A Patient Claim sends these fields where they differ from the other claim types: | In a Patient Claim | Fields | | ------------------ | ---------------------------------------------------------------------------------------------------- | | **Required** | `patient.healthFund`, `accident.accidentInd`, `claimant` and `submissionAuthorityInd` | | **Either value** | `accountPaidInd`: `Y` or `N` | | **Optional** | `patient.alsoKnownAs`, and `ifcIssueCode` and `financialInterestDisclosureInd` on each medical event | | **Not sent** | `billingAgent.providerNumber`, `fundPayeeId` and `benefitAssignmentAuthorisedInd` | --- ## Before the first claim #### Get the current fund list Send [Get Participants](/api-reference/health-funds/get-participants) before your first claim, and keep the list current as [Fund codes](/health-fund-checks#fund-codes) sets out. A claim names the patient's health fund by its fund code from that list. #### Verify the patient Check the patient's Medicare details, and their health fund details where the claim type has a fund, as [Patient verification](/health-fund-checks#patient-verification) sets out. Where Medicare returns different details, offer the user an update to the patient's record. #### Check eligibility Check eligibility before you lodge, so the patient can give informed financial consent. * To estimate Medicare's benefit for each service, send [Eligibility Check](/api-reference/medicare-eligibility/eligibility-check) with `InHospitalTreatment` set to `true`. * To estimate what the patient's health fund pays under their cover, send a [health fund eligibility check](/health-fund-checks#eligibility-checks). --- ## Lodge a claim #### Create the correlation ID Create a `correlationId` for the claim, and store it with the claim before you send it. You need it to follow the claim to its report and its payment. [Correlation ID](/claiming#correlation-id) gives the format. #### Send the claim Send the claim to [the endpoint for its claim type and specialty](#specialties). #### Read the acknowledgement | Response | Meaning | What to do | | ----------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | `200`, with a `status` of `SUCCESS` | Medicare has accepted the claim for processing. The acknowledgement returns the claim's `correlationId`, and carries no assessment. | [Follow the claim to its outcome](#follow-the-claim-to-its-outcome). | | `400` | The claim failed validation. | Show each `reason` to the user exactly as returned. Correct the claim, and send it with a new `correlationId`. The endpoint's `400` response lists the codes and what to do. | | `503` | RebateRight got no response from Medicare. | Follow [When a claim gets no response](/claiming#when-a-claim-gets-no-response). | --- ## Follow the claim to its outcome The assessment takes place after the acknowledgement. Your software follows the claim with a status request, then retrieves the report once the status says it is ready. The remittance advice follows the same pattern, once the claim is paid. ![How your software follows an in-patient claim with its transaction ID, which is the claim's correlationId without urn:uuid:. For the report: send the transaction ID to Status Report, and check again later until the status is READY or REPORTED. Then send the transaction ID to In-Patient Claim Report. For the remittance advice: send the transaction ID to Status Report as a remittance advice lookup. When the status is READY or REPORTED, the row gives the remittance advice ID. Send that ID to Remittance Advice.](/_fern-files/rebate-right.docs.buildwithfern.com/7c89d588f3cd956089f95ee9d3f8ba717860e1a5f0e26f2a165f52fa74b806df/assets/in-patient-follow-claim-light.svg)![How your software follows an in-patient claim with its transaction ID, which is the claim's correlationId without urn:uuid:. For the report: send the transaction ID to Status Report, and check again later until the status is READY or REPORTED. Then send the transaction ID to In-Patient Claim Report. For the remittance advice: send the transaction ID to Status Report as a remittance advice lookup. When the status is READY or REPORTED, the row gives the remittance advice ID. Send that ID to Remittance Advice.](/_fern-files/rebate-right.docs.buildwithfern.com/2ad7e2d42358d021b53931e024c6362f4ef51596c8a53de81bc19419f3f52c10/assets/in-patient-follow-claim-dark.svg) * **Transaction ID.** A claim's transaction ID is its `correlationId` without the `urn:uuid:` prefix, such as `MDE00000b896820b03e348a5`. Every status request and report request names the claim by it. A remittance advice has its own ID, the remittance advice ID, which a status request returns. * **Same Minor ID.** Send every request with the `x-minor-id` that lodged the claim. * **For 6 months.** For 6 months from lodgement, you may check a claim's status and retrieve its report and remittance advice as many times as you need. #### Request the status Send the claim's transaction ID to [Status Report](/api-reference/medicare-claiming/in-patient-claims/status-report), or send a range of lodgement dates to list your claims. #### Read the status Each claim's row gives a `reportStatus` and a `processStatus`. [Status Report](/api-reference/medicare-claiming/in-patient-claims/status-report) explains each value. | `reportStatus` | What to do | | --------------------- | ------------------------------- | | `PROCESSING` | Request the status again later. | | `READY` or `REPORTED` | Retrieve the report. | Services Australia asks that you retrieve a report only once its status is `READY` or `REPORTED`. Your software may send both requests automatically. #### Retrieve the report Send the transaction IDs of claims whose report is ready to [In-Patient Claim Report](/api-reference/medicare-claiming/in-patient-claims/in-patient-claim-report). An entry with a `status` of `SUCCESS` carries the claim's `report`. Services Australia requires your software to be able to retrieve an available report more than once. #### Read the report The report gives Medicare's assessment of each service, then the health fund's. Show each `status.text` and each explanation's `text` to the user exactly as returned. Where Medicare returns different details in `medicareAssessment.currentPatient`, offer the user an update to the patient's record. [In-Patient Claim Report](/api-reference/medicare-claiming/in-patient-claims/in-patient-claim-report) describes every field, and the claims whose report has no health fund assessment. --- ## Reconcile payments A remittance advice records a payment for in-patient claims: the amount deposited, the reference on the bank statement, and the benefit paid for each claim. Services Australia calls it an ECLIPSE Remittance Advice. | Claim type | Remittance advice | | ---------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------- | | **Agreement** and **Scheme** | One, from the health fund. Each claim's `benefit` is the Medicare and fund benefits together. | | **Billing Agent** | Two, each with its own remittance advice ID: one from Services Australia for the Medicare benefit, and one from the health fund for the fund benefit. | | **Medicare Only** | One, from Services Australia, for the Medicare benefit. | | **Patient Claim** | None. | #### Request the remittance advice status Once the claim's `processStatus` is `COMPLETE`, send its transaction ID to [Status Report](/api-reference/medicare-claiming/in-patient-claims/status-report), with `requestTransmissionType` set to `mcp-eclipse-remittance-advice`. #### Read each row When a row's `reportStatus` is `READY` or `REPORTED`, its `transactionId` is the remittance advice ID. Store it. A Billing Agent claim returns a transaction ID for each of its 2 remittance advices once each is ready. [Status Report](/api-reference/medicare-claiming/in-patient-claims/status-report) explains each `reportStatus`. #### Retrieve the remittance advice Send the remittance advice's transaction ID to [Remittance Advice](/api-reference/medicare-claiming/in-patient-claims/remittance-advice). That page also says when a remittance advice is ready. #### Record the request Store the date of your last successful remittance advice status request, as Services Australia requires. Show the user that request's details, including its `toDateTime`. #### Match the payment Match the remittance advice to your bank statement by its `paymentInfo.paymentReference` and `paymentInfo.depositAmount`. Then match each `claimSummary` entry to your claim by its `accountReferenceId`. [Remittance Advice](/api-reference/medicare-claiming/in-patient-claims/remittance-advice) describes every field. --- ## In the test environment * **Assessed claims.** [Claiming in the test environment](/test-data#claiming-in-the-test-environment) says how the test environment handles in-patient claims. * **Test data.** Use the fund code, facility ID and billing agent in [Hospital, fund, and billing IDs](/test-data#hospital-fund-and-billing-ids), with the Medicare test patients and providers on the same page. --- ## What Services Australia requires Each rule Services Australia sets for in-patient claims appears at the step it applies to. [What Services Australia requires of your software](/services-australia-requirements#in-patient-claims) lists the rules that apply across every step.