***
title: Interactive patient claims
subtitle: Lodge claims where the patient retains their Medicare benefits
slug: patient-claim-interactive
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An **interactive patient claim** is submitted when a patient has received professional medical services and has **not** assigned their right to Medicare benefits to the health professional. The healthcare location lodges the claim on behalf of the patient or claimant, and Medicare pays the benefit directly to the patient.
***
## Validations
| Rule | Limit |
| -------------------------- | -------------------- |
| Medical Events per claim | Maximum **16** |
| Services per Medical Event | Maximum **14** |
| Services per claim | Maximum **16** total |
***
## Pendable Claims
Some interactive patient claim submissions require further assessment by a Services Australia operator. These are returned with a claim status of `MEDICARE_PENDABLE`.
Your system receives a response indicating the claim requires operator review.
Display the pendable status to the end user. Services Australia recommends designing your software to streamline this — for example, a checkbox or accept button.
Resend the claim using the **same `correlationId`** within **one hour** of the original submission to request that the claim be pended.
Once pended, a lodgement advice is printed and issued to the claimant.
If you resend the claim using a **different `correlationId`**, it is treated as a new patient claim — not a resubmission of the pending claim.
***
## Mixed Referral and Request Services
Specialists may submit claims with a mixture of services requiring both referral and request information in the same voucher. 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.
***
## Printed Statements
Services Australia advises that using the most up-to-date statements, declarations, and privacy notes in your software is a **legislative requirement**.
When an interactive patient claim is lodged, the location must issue the claimant with a printed statement. Which one depends on the claim outcome:
Issued when the claim is processed in real-time and Services Australia returns a benefit amount.
[Download template PDF](https://app.rebateright.com.au/docs/statement-of-claim-benefit-payment.pdf)
Issued when the claim is referred to a Services Australia operator for further assessment (pendable).
[Download template PDF](https://app.rebateright.com.au/docs/lodgement-advice.pdf)
The location must produce a printed copy for the claimant's record, and may keep its own copy in electronic or hard copy form.
### Override Indicator Requirements
If any of these override indicators are used in a claim, the printed statement must display additional information:
| Field | Printed form requirement |
| ------------------------------ | ----------------------------------------------------------------------------------------------------------------------------- |
| `duplicateServiceOverrideInd` | Indicator value plus text explaining the reason |
| `multipleProcedureOverrideInd` | Indicator value plus text explaining the reason. If set to `Y` (Not Multiple), `serviceText` providing the reason is required |
| `restrictiveOverrideCode` | Indicator value |
Any relevant supporting material or text must also appear on the printed statement.
***
## Pathology Request Form
For pathology patient claims, the combined request form must include all of the following.
### Requesting Practitioner
* Surname and initials
* Address
* Provider number
* Date of request
### Patient Details
* Name (surname, first name)
* Address
* Date of birth
* Sex
* Medicare card number and Individual Reference Number
* Hospital status
### Required Sections
* **Tests Requested** — a titled area is required. Terms such as *order*, *require*, or *referred* must not be used.
* **Self Determine (SD)** — a tick box is required (used when the APP determines that pathologist-determinable tests are necessary).
### Privacy Notice
The following wording must appear on the patient's copy of the form:
**Privacy 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.
The notice may sit in the clinical notes area or on the back of the patient copy if more practical.
### Combined Online Patient Claiming Authority
The form must include patient authorisation for the APP/APA to submit an electronic claim on the patient's behalf. Example wording:
> *I 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.*
Patient Signature: \_\_\_\_\_ Date: \_\_\_\_\_ / \_\_\_\_\_ / \_\_\_\_\_
If the patient cannot sign:
> *Verbal consent was provided by patient to submit unpaid account to Services Australia. No signature available.*
A **Practitioner's Use Only** text box is also required for cases where the patient is unable to sign and an appropriate person endorses on their behalf.
***
## Implementation Note
Services Australia requires that error messages are displayed to the end user exactly as supplied in the response — not truncated, transformed, or changed in any way.