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(verifications: OCV = Concession, OVV = DVA, OPV = Medicare/Fund)
IMC
DVA
VAA
Medicare
BulkBill
OCV
OVV
OPV
Medicare IMC

claimant.address.line1

String

First line of the temporary address to be used for the claim. Cannot be a PO Box Claimant address details must only be transmitted at the request of the claimant. These address details are temporary and must be used for that claim only. Software must not default to supplying claimant address details with every claim.

Validation Rules:

  • All Must have no more than 40 characters

Medicare IMC

claimant.address.line2

String

Second line of the temporary address to be used for the claim.

Validation Rules:

Medicare IMC

claimant.address.locality

String

The locality of the temporary address to be used for the claim.

Validation Rules:

Medicare IMC

claimant.address.postcode

ZeroPaddedNumeric

The post code for the temporary address to be used for the claim.

Validation Rules:

Medicare IMC

claimant.bank.accountName

String

Used for EFT payments. The claimants bank or financial institution account name.

Validation Rules:

Medicare IMC

claimant.bank.accountNumber

AlphaNumeric

Used for EFT payments. The claimants bank or financial institution account number.

Validation Rules:

  • All Must have no more than 9 characters
  • All Must only be set when flags.accountPaid is Y

Medicare IMC

claimant.bank.bsb

Numeric

Used for EFT Payments. The BSB code for the bank and branch where the account is held.

Validation Rules:

Medicare IMC

claimant.dateOfBirth

Date

The claimants Date of Birth, where a claimant is specified.

Validation Rules:

claimant.gender

String

Validation Rules:

Medicare IMC

claimant.medicare.number

Numeric

The claimants Medicare Card number when the patient and claimant are not one and the same.

Validation Rules:

Medicare IMC

claimant.medicare.ref

Numeric

The claimants individual Reference Number (found to the left of the claimants name on their Medicare card), when the patient and claimant are not one and the same.

Validation Rules:

Medicare IMC

claimant.name.family

NameString

The claimants family name when the patient and the claimant are not one and the same. Required if claimant is not the patient.

Validation Rules:

Medicare IMC

claimant.name.first

NameString

The claimants first name when the patient and claimant are not one and the same. Required if claimant is not the patient

Validation Rules:

IMC

contact.name

String

Name of contact at claim submission site to be contacted should clarification about claim details be required.

Validation Rules:

  • All Must have no more than 40 characters

IMC

contact.phone

Numeric

Phone number of contact at claim submission site to be used should clarification about claim details be required.

Validation Rules:

  • All Must have no more than 19 characters

OPV OCV

earliestDateOfService

Date

The date to be used for the validation check.

Validation Rules:

Medicare IMC

flags.accountPaid

Bool

Indicates whether or not an account has been paid in full.

Validation Rules:

  • All Must have no more than 1 character
  • IMC Required
  • All Must equal 'N' when flags.imcClaimType is MB,MO,AG,SC
  • Medicare Required

VAA IMC

flags.admission.admissionDate

Date

The date the patient was admitted to hospital, nursing service

Validation Rules:

VAA IMC

flags.admission.dischargeDate

Date

The date the patient was discharged from hospital.

Validation Rules:

DVA VAA

flags.certifiedInd

Enum

Indicates the provider has certified the services within the claim have been provided. Must be Y to submit the claim.

Validation Rules:

  • All Must and be one of 'Y,N'

IMC

flags.compensationClaim

Bool

Indicates whether or not the voucher contains services that are subject to a compensation claim. Note: if not set assumed not to be subject to compensation.

Validation Rules:

IMC

flags.financialInterestDisclosureInd

Bool

Indicates that the Provider providing hospital treatment or associated professional attention under a gap cover scheme has disclosed to the insured person any financial interest that the first-mentioned Provider or associated professional person has in any products or services recommended or given to the insured person.

Validation Rules:

DVA VAA Medicare BulkBill

flags.hospitalInd

Bool

Indicates if service rendered in hospital or not. Note: if not set assumed the service was not rendered in hospital.

Validation Rules:

IMC

flags.ifc

Enum

Indicates 'IFC' was provided prior to the Episode of care. Note: if not set assumed not issued.

Options:

  • V: Verbal
  • W: In writing, where appropriate
  • N: Not Issued
  • X: Not obtained

Validation Rules:

IMC

flags.imcClaimType

Enum

Determines the processing class under which a claim is submitted.

Options:

  • MO: Billing Agent Medicare Only
  • PR: Private hospital claim
  • PU: Public hospital claim
  • AG: Agreements
  • SC: Scheme
  • MB: Billing Agent
  • PC: Patient Claims

Validation Rules:

  • All Must be one of 'MO,PR,PU,AG,SC,MB,PC' unless OECTypeCde is OEC
  • All Required and be one of 'AG,SC,MB,PC' when OECTypeCde is OEC
  • IMC Required

IMC

flags.isAccident

Bool

Indicates whether or not the associated information relates to the patient experiencing an accident.

Options:

  • Y: Service is the result of accident
  • N: Service not result of accident or unknown

Validation Rules:

DVA VAA BulkBill IMC

flags.serviceType

Enum

Indicates the type of service that makes up the claim. All ItemNum/s within the claim must be consistent with the Service Type selected.

Options:

  • P: Pathology services
  • S: Specialist
  • O: General
  • F: Community Nursing
  • G: Dental
  • L: Optical
  • I: Speech Pathology
  • J: Allied
  • K: Psych

Validation Rules:

  • All Must be one of 'P,S,O,F,G,L,I,J,K'
  • DVA BulkBill IMC Required and must be one of 'P,S,O'
  • VAA Required and be one of 'F,G,L,I,J,K'

DVA VAA Medicare BulkBill IMC

item.SCPId

AlphaNumeric

The Licensed Collection Centre Identifier, now known as Specimen Collection Point (SCPId), is used to identify the site where the pathology specimen was collected.

Validation Rules:

  • All Must have between 3 and 5 characters, and not be all zeros
  • DVA VAA BulkBill IMC Must only be set when flags.serviceType is P
  • DVA Required when flags.serviceType is P

DVA Medicare BulkBill IMC

item.afterCareOverride

Bool

Indicates if service is part of normal aftercare for the patient.

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.chargeAmount

Currency

The amount charged for the service in dollars and cents (e.g. 50.50). For Bulk Bill and DVA claims, this is the benefit assigned. Note: Notional charge amounts are not acceptable for DVA medical/pathology claims.

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.date

Date

The date the service was rendered to the patient or the patient was assessed.

Validation Rules:

  • All Required and must be after patient.dateOfBirth and be before today
  • InPatientMedical BulkBill Must be after y2 and be before today

VAA

item.dental.jaw

Enum

Identifies if the dental service relates to the upper or lower jaw. Note: The DVA Dental items that may require either a value of 'UPR' or 'LWR' to be present for claims processing purposes are as follows: D744,D743,S744 and S743

Options:

  • UPR: Upper Jaw
  • LWR: Lower Jaw

Validation Rules:

VAA

item.dental.numberOfTeeth

ZeroPaddedNumeric

Validation Rules:

  • All Must have no more than 2 characters
  • All Must only be set when flags.serviceType is G

VAA

item.dental.tooth

Numeric

Identifies the tooth number that relates to the dental service provided. Note: The DVA Dental items that may require a Tooth number to be present for claims processing purposes are as follows: D311, D314, D322, D323, D324, D597, S311, S314, S322, S323, S324, S597

Validation Rules:

  • All Must have no more than 2 characters
  • All Must only be set when flags.serviceType is G

DVA VAA

item.distance

Numeric

Indicates travelling distance involved in a Home, Nursing Home or Hospital visit.

Validation Rules:

  • All Must have between 2 and 4 characters
  • All Must not be set when location.type is R

DVA VAA Medicare BulkBill IMC

item.duplicateServiceOverride

Bool

Indicates if practitioner attended patient on more than one occasion on same day.

Validation Rules:

VAA Medicare BulkBill IMC

item.duration

Numeric

The duration of the service in minutes.

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.equipmentId

ZeroPaddedNumeric

The identification number of equipment used for the service provided (allocated by the Dept. of Health and Ageing).

Validation Rules:

  • All Must have no more than 5 characters

DVA VAA Medicare BulkBill IMC

item.fieldQuantity

Numeric

The number of fields irradiated or the quantity of time blocks for derived fee intratheecal or epidural infusion services (e.g. items 18219 and 18227)

Validation Rules:

  • All Must have no more than 2 characters

DVA VAA Medicare BulkBill IMC

item.itemNumber

AlphaNumeric

A number that identifies the services provided to enable assessment of the claim for benefit (See the Dept. of Health and Ageing website for details) or as stated by DVA.

Validation Rules:

  • All Must have no more than 5 characters
  • All Required

DVA VAA Medicare BulkBill IMC

item.lspNumber

ZeroPaddedNumeric

Location Specific Practice Number Only to be used in association with: services listed in the Diagnostic Imaging Services Table (DIST) Group T2 - Radiation Oncology services in the General Medical Services Table (GMST) Where these services occur this field is to be considered mandatory. For details on the services that require an LSPN specified see LSPN Requirements

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.multipleProcedureOverride

Bool

Indicates whether service part of a multiple procedure or not. Note: when set, the associated claim is automatically sent to pend.

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.numberOfPatients

Numeric

The number of patients seen. Must be set for group attendance items (eg. counselling) or visits (home, hospital or institution) to ensure the correct payment is made.

Validation Rules:

  • All Must have no more than 2 characters

VAA

item.opticalScript

Enum

Identifies the restriction override for optical claims.

Validation Rules:

  • All Must be one of 'LS,BR,RC'

Medicare

item.patientContributionAmount

Currency

The amount paid by a patient to a provider for a service. It can be any amount paid by the patient where the service charge has not been fully paid.

Validation Rules:

  • All Must have no more than 7 characters
  • All Must not be set when flags.accountPaid is Y

Medicare BulkBill IMC

item.restrictiveOverride

Enum

RestrictiveOverrideCde indicator is used to allow payment for service where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history.

Options:

  • SP: Separate Sites
  • NR: Not Related ( Care Plans )
  • NC: Not for Comparison

Validation Rules:

VAA

item.secondDeviceInd

Bool

This field identifies the provision of a second medical grade footwear service.

Validation Rules:

DVA VAA Medicare BulkBill IMC

item.selfDeemedCode

Enum

A Self Deemed service is a service provided by a consultant physician or specialist as an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested.

Options:

  • SD: Self Deemed
  • SS: Substituted Service
  • N: Not Self Deemed

Validation Rules:

  • All Must be one of 'SD,SS,N'

DVA VAA Medicare BulkBill IMC

item.serviceText

String

Free text used to provide additional information to assist with the benefit assessment of the service. Note: Where used, the contents of ServiceText must also appear on the printed statement. Note: see Text Field Abbreviations for a list of suggested abbreviations for use with this field.

Validation Rules:

  • DVA VAA Must have no more than 100 characters
  • Medicare BulkBill IMC Must have no more than 50 characters

DVA VAA Medicare BulkBill IMC

item.time

Time

The time the service(s) was rendered.

Validation Rules:

DVA VAA Medicare BulkBill

location.name

String

The name of the treatment location (Hospital, Nursing home etc)

Validation Rules:

IMC

location.provider

ProviderNumber

The Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility. If [TransferCde] is set to A, this is the transferring facility If [TransferCde] is set to S, this is the receiving facility

Validation Rules:

  • All Must have no more than 8 characters
  • IMC Required

DVA VAA BulkBill

location.type

Enum

A code specifying where the treatment/service was provided.

Options:

  • V: Home Visit
  • H: Hospital
  • R: Rooms
  • N: Residential Care facility
  • C: Community Health Centres

Validation Rules:

  • All Must be one of 'V,H,R,N,C'
  • All Must not be set when flags.serviceType is P
  • All Must

DVA VAA OVV OPV

patient.address.locality

String

The locality for the address to be used for patient.

Validation Rules:

  • All Must have no more than 40 characters
  • All Must

DVA VAA OVV OPV

patient.address.postcode

ZeroPaddedNumeric

The postcode for the patient address.

Validation Rules:

DVA VAA IMC OVV OPV

patient.alias.family

NameString

Patient s Family Name as known to the Provider for DVA if different to that known by Medicare (or DVA).

Validation Rules:

  • All Must have no more than 40 characters

DVA VAA IMC OVV OPV

patient.alias.first

NameString

Patient s First Name as known to the Provider

Validation Rules:

OCV

patient.concession.entitlementId

String

Indicates the number of one of the following cards: Health Care Card Pensioner Concession Card Repatriation Health Card (Specific or All Conditions) Commonwealth Seniors Health Card Repatriation Pharmaceutical Benefits Card Safety Net Entitlement card Safety Net Concession card

Validation Rules:

  • All Must have no more than 11 character

DVA VAA Medicare BulkBill IMC OVV OPV OCV

patient.dateOfBirth

Date

The patient s date of birth.

Validation Rules:

  • All Must be before today
  • DVA VAA Required

VAA

patient.dva.adl.cognitiveBehavioralInd

Bool

Indicates if the veteran requires Cognitive Behavioral assistance for (ADL) Activities of daily living.

Validation Rules:

VAA

patient.dva.adl.eatingInd

Bool

Indicates if the veteran requires assistance for Eating (ADL) Activities of daily living.

Validation Rules:

VAA

patient.dva.adl.personalHygieneInd

Bool

Indicates if the veteran requires assistance for Personal Hygiene (ADL) Activities of daily living.

Validation Rules:

VAA

patient.dva.adl.toiletingContinenceInd

Bool

Indicates if the veteran requires assistance for Toileting (ADL) Activities of daily living.

Validation Rules:

VAA

patient.dva.adl.tool

Enum

Indicator used for recording the level of (ADL) Activities of daily living functional assessment measure.

Options:

  • 1: RUGS III
  • 2: KATZ
  • 3: ONI/INI/ACNA
  • 4: FIM/FAM
  • 5: CNMDSA
  • 6: Other
  • 7: Reserved for future use
  • 8: Reserved for future use
  • 9: Reserved for future use

Validation Rules:

VAA

patient.dva.adl.transferMobilityInd

Bool

Indicates if the veteran requires assistance for Transfer Mobility (ADL) Activities of daily living.

Validation Rules:

DVA VAA

patient.dva.disability

String

Free text used to provide details regarding the condition being treated in conjunction with AcceptedDisabilityInd

Validation Rules:

  • All Must have between 1 and 100 characters

DVA VAA

patient.dva.disabilityInd

Bool

Indicates whether the service rendered are for a White Card holder and the service is in accordance with the White Card Condition

Options:

  • Y: Condition Treated relates to a condition for a White Card holder
  • N: Condition does not relates to a condition for a White Card holder

Validation Rules:

DVA VAA OVV OPV

patient.dva.number

String

Veterans File Number as it appears on the Veteran Card. See DVA File Number Validation for validation details.

Validation Rules:

  • All Must have no more than 9 characters

IMC OPV

patient.fund.eclipseId

Alpha

A unique identifier for each Health Fund Brand Name.

Validation Rules:

IMC OPV

patient.fund.number

AlphaNumeric

Patient's Health Fund Membership or Card number. Where FundBrandId is DVA, this should be populated by the DVA Veteran File Number

Validation Rules:

IMC

patient.fund.payeeId

AlphaNumeric

The Health Fund Agreement identifier for the practitioner (used to map Fund payment arrangement details).

Validation Rules:

  • All Must have no more than 12 characters
  • All Must not be set when flags.imcClaimType is PC

IMC OPV

patient.fund.ref

Numeric

Fund 'Universal Patient Identifier' (UPI). The UPI appears on the Patient's fund membership card to uniquely identify individuals. (Fund equivalent of Medicare PatientReferenceNum).

Validation Rules:

  • All Must have no more than 2 characters

DVA VAA IMC OVV OPV

patient.gender

Enum

Patient's gender

Options:

  • 1: Male
  • 2: Female
  • 3: Indeterminate
  • 9: Unknown or inadequately described
  • M: Male
  • F: Female

Validation Rules:

Medicare BulkBill IMC OPV OCV

patient.medicare.number

MedicareCard

The patients Medicare Card Number.

Validation Rules:

  • All Must have no more than 10 characters
  • BulkBill IMC Required

Medicare BulkBill IMC OPV OCV

patient.medicare.ref

Numeric

The patients Medicare Reference Number. This number appears to the left of the patients name on their Medicare card.

Validation Rules:

DVA VAA Medicare BulkBill IMC OVV OPV OCV

patient.name.family

NameString

The patient's family name.

Validation Rules:

DVA VAA Medicare BulkBill IMC OVV OPV OCV

patient.name.first

NameString

The patient's first given name. Where a patient has only one name, that name should appear in the [PatientFamilyName] field and the word Onlyname be entered in the PatientFirstName field.

Validation Rules:

VAA IMC OVV OPV

patient.name.second

Alpha

The first initial of the patient's second given name.

Validation Rules:

  • All Must have no more than 1 character

IMC

provider.billing

ProviderNumber

The provider number of the billing agent. This is used to direct payments.

Validation Rules:

DVA VAA Medicare BulkBill IMC

provider.payee

ProviderNumber

The provider number of the principal provider where the payment is to be directed to other than the servicing provider.

Validation Rules:

IMC

provider.principal

ProviderNumber

The Principal Provider Number is used to direct payment.

Validation Rules:

  • All Must have no more than 8 characters

DVA VAA Medicare BulkBill IMC OVV OPV OCV

provider.servicing

ProviderNumber

The provider number of the medical practitioner rendering the service(s) as allocated by Medicare

Validation Rules:

  • All Must have no more than 8 characters
  • BulkBill IMC Required

DVA VAA Medicare BulkBill IMC

referral.date

Date

The date the referral was issued.

Validation Rules:

DVA VAA Medicare BulkBill IMC

referral.overrideCode

Enum

Indicates why referral services were provided without referral from another practitioner.

Validation Rules:

  • All Must be one of 'L,E,H,N,R'

DVA VAA Medicare BulkBill IMC

referral.period

AlphaNumeric

The length of the referral in months.

Validation Rules:

DVA VAA Medicare BulkBill IMC

referral.periodType

Enum

Indicates period of referral.

Options:

  • S: = Standard (12 months from a GP and 3 months from a Specialist)
  • N: = Non standard
  • I: = Indefinite

Validation Rules:

DVA VAA Medicare BulkBill IMC

referral.provider

ProviderNumber

The referring provider number (allocated by Medicare).

Validation Rules:

DVA VAA Medicare BulkBill IMC

referral.providerType

Enum

Set by the PMS to indicate if the referrer is GP or Specialist

Validation Rules:

  • All Must be one of 'G,S'

DVA VAA Medicare BulkBill IMC

request.date

Date

Date the request was issued.

Validation Rules:

VAA

request.overrideCode

Enum

Indicates why requested services were provided without a request from another practitioner.

Validation Rules:

  • All Must be one of 'L,E,H,N,G,R,V'
  • All Required with request.date

DVA VAA Medicare BulkBill IMC

request.provider

ProviderNumber

The provider number for the requesting provider (allocated by the Medicare).

Validation Rules:

DVA VAA Medicare BulkBill IMC

request.providerType

Enum

Set by the PMS to indicate if the requesting provider is GP or Specialist

Validation Rules:

  • All Must be one of 'G,S'

Medicare BulkBill IMC

request.requestType

Enum

Indication of the type of a request

Options:

  • P: Pathology
  • D: Diagnostic Imaging

Validation Rules: