Medicare Verification

Verify Medicare details #

Concession card verification is quite limited, the entitlementId can be provided but is not mandatory, if you provide the medicare card number a confirmation or rejection of concession status will be returned.

POST - Verify Medicare details #

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "medicare": {
      "number": "2952631861",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Bernhardt",
      "family": "Griffith"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "medicare": {
      "number": "2952631861",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Bernhardt",
      "family": "Griffith"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "name": {
      "family": "Griffith",
      "first": "Bernhardt"
    },
    "medicare": {
      "number": "2952631861",
      "ref": "1"
    }
  },
  "status": {
    "concession": {
      "code": "3004",
      "message": "Concession verification is not currently available, please try again later."
    },
    "medicare": {
      "message": "Patient is eligible to claim for Medicare with details provided.",
      "code": 0
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length385
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Unknown #

If the patient is unknown to Medicare the response code will be 9650 and the associated message will be “The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1979-09-13",
    "medicare": {
      "number": "2398125261",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "John",
      "family": "Doe"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1979-09-13",
    "medicare": {
      "number": "2398125261",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "John",
      "family": "Doe"
    }
  }
}'

Example Response:

Body:

{
    "patient": {
        "dateOfBirth": "1979-09-13",
        "name": {
            "family": "Doe",
            "first": "John"
        },
        "gender": "M",
        "medicare": {
            "number": "2398125261",
            "ref": "1"
        }
    },
    "status": {
        "medicare": {
            "message": "The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.",
            "code": 9650
        }
    }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length367
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Old Card #

If the patient has provided an old Medicare number the response code will be 8015, and the associated message will be “Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number before claiming.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1970-05-12",
    "medicare": {
      "number": "2298264833",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Gregory",
      "family": "WATTS"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1970-05-12",
    "medicare": {
      "number": "2298264833",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Gregory",
      "family": "WATTS"
    }
  }
}
'

Example Response:

Body:

{
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "Gregory"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264836",
            "ref": "1"
        }
    },
    "status": {
        "medicare": {
            "message": "Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number before claiming.",
            "code": 8015
        }
    }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length359
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Wrong first name #

If the patient has provided an incorrect first name, the response code will be 8017 and the associated message will be “Patient Verification has been accepted however patient details were not an exact match. Please check patient Given Name before claiming.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1974-02-28",
    "medicare": {
      "number": "2952631861",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Bernie",
      "family": "Griffith"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1974-02-28",
    "medicare": {
      "number": "2952631861",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Bernie",
      "family": "Griffith"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "name": {
      "family": "Griffith",
      "first": "BERNHARDT"
    },
    "gender": "M",
    "medicare": {
      "number": "2952631861",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been accepted however patient details were not an exact match. Please check patient Given Name before claiming.",
      "code": 8017
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length353
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - RHCA #

The Reciprocal Health Care Agreement (RHCA) applies to Australians visiting certain countries overseas, and to travelers from those countries visit Australia. If a patient is covered under the RHCA, the response code will be 9626 and the associated message will be “The patient is or was covered under the Reciprocal Health Care Agreement.”

{{base_url}}/{{version}}/verify

Headers

Content-TypeValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1975-09-15",
    "medicare": {
      "number": "2297582343",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "English",
      "family": "Xpatriot"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1975-09-15",
    "medicare": {
      "number": "2297582343",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "English",
      "family": "Xpatriot"
    }
  }
}
'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1975-09-15",
    "name": {
      "family": "Xpatriot",
      "first": "English"
    },
    "gender": "M",
    "medicare": {
      "number": "2297582343",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "The patient is or was covered under the Reciprocal Health Care Agreement.",
      "code": 9626
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length288
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - RHCA Expired #

If a patient’s coverage under the RHCA has expired, the response code will be 9649 and the associated message will be “Patient’s eligibility cannot be determined.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-16",
    "medicare": {
      "number": "2297402204",
      "ref": 1
    },
    "gender": "F",
    "name": {
      "first": "French",
      "family": "Forigner"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-16",
    "medicare": {
      "number": "2297402204",
      "ref": 1
    },
    "gender": "F",
    "name": {
      "first": "French",
      "family": "Forigner"
    }
  }
}
'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1980-05-16",
    "name": {
      "family": "Forigner",
      "first": "French"
    },
    "gender": "F",
    "medicare": {
      "number": "2297402204",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient's eligibility cannot be determined.",
      "code": 9649
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length257
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Deceased #

In the event that you attempt to submit a claim for a patient who is deceased, the response code will be 9649 and the associated message will be “Patient’s eligibility cannot be determined.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-09-15",
    "medicare": {
      "number": "2296510126",
      "ref": 4
    },
    "gender": "M",
    "name": {
      "first": "Sad",
      "family": "JONES"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-09-15",
    "medicare": {
      "number": "2296510126",
      "ref": 4
    },
    "gender": "M",
    "name": {
      "first": "Sad",
      "family": "JONES"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1964-09-15",
    "name": {
      "family": "JONES",
      "first": "Sad"
    },
    "gender": "M",
    "medicare": {
      "number": "2296510126",
      "ref": "4"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient's eligibility cannot be determined.",
      "code": 9649
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length251
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Lost Card #

If you submit a claim for a patient who has lost their medicare card, the response code will be 9650 and the associated message will be “The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.”

{{base_url}}/{{version}}/verify

Headers

Content-TypeValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-23",
    "medicare": {
      "number": "5500393925",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Simon",
      "family": "Boyes"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-23",
    "medicare": {
      "number": "5500393925",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Simon",
      "family": "Boyes"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1980-05-23",
    "name": {
      "family": "Boyes",
      "first": "Simon"
    },
    "gender": "M",
    "medicare": {
      "number": "5500393925",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.",
      "code": 9650
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3T
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length370
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS

POST - Verify Medicare details - Replacement Card #

If you submit a claim for a patient who is in need of a new medicare card, the response code will be 9633 and the associated message will be “A new Medicare card has been issued. Please confirm your records with the patient and if required update for any future claims.”

{{base_url}}/{{version}}/verify

Headers

HeaderValue
Acceptapplication/json
Content-Typeapplication/json
AuthorizationBearer {{oauth_token}}

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "2950862041",
      "ref": 2
    },
    "gender": "M",
    "name": {
      "first": "Happy",
      "family": "JONES"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "2950862041",
      "ref": 2
    },
    "gender": "M",
    "name": {
      "first": "Happy",
      "family": "JONES"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1964-05-04",
    "name": {
      "family": "JONES",
      "first": "HAPPY"
    },
    "gender": "M",
    "medicare": {
      "number": "2950862132",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "A new Medicare card has been issued. Please confirm your records with the patient and if required update for any future claims.",
      "code": 9633
    }
  }
}

Headers:

HeaderValue
Servernginx/1.19.3
DateTue, 08 Jun 2021 04:49:28 GMT
Content-Typeapplication/json
Content-Length337
Connectionkeep-alive
Access-Control-Allow-Origin*
Access-Control-Allow-MethodsGET, POST, OPTIONS