The claiming.com.au API allows software vendors to easily integrate Medicare, Bulk Bill, DVA and ECLIPSE claim submissions in a standardised and modern way.
There are several types of request which can be sent through our API:
You can verify patient details against Medicare, DVA and Health Fund databases.
With the 'verify' API call you send the name, date of birth and membership number of the patient for checking with Medicare, DVA or Fund databases. The response to a verification request is synchronous, typically within a few seconds.
If Medicare or the Fund is offline then no verification is possible. The response object will contain an alert, and you should try again later.
With the 'claim' API call you can submit a claim for consultations and procedures to Medicare, DVA and/or the Fund
An API claim request is for 1 patient and 1 provider at 1 location, but can include several items and dates of service. These requests are pre-validated (checked for common errors that would result in a rejection if submitted) then queued at the API server and passed to Medicare Online at the first opportunity.
There is an initial synchronous response confirming that the claim has been received and has passed pre-validation. Further information on the status of the claim is available with asynchronous API calls (see below).
Processing by Medicare and the Funds can take anywhere between a few hours and a few days.
The API has a facility to check on the progress of individual claims or to request all processing status reports that have changed since a given date/time
You should check daily on the status of each active claim and display the current status to your end users. The response object will contain all of the original data, plus additional data on the progress of the claim.
Where a claim has been rejected the response will include claim and item level rejection information where this has been provided by Medicare or the Fund.
Where a claim has been fully or partially paid, the response will include the ID of the relevant payment report.
Payment reports for successful claims are available for most claim types with the 'payment' API call.
Once claims are accepted, they are typically aggregated with other claims from the same practitioner for payment in a batch. For example all BulkBill claims that have been procesessed and paid on a given day will appear as a single deposit in the practitioner's nominated bank account. The API appends a payment ID to each successful claim object, which is then retrieved with the 'payment' API call.
Claims can result in payment to the practitioner, the patient, or a billing agent, depending on the type of claim and if the patient paid the invoice in full prior to submission.
Medicare claims where the patient has paid in full can be submitted to Medicare via the API on behalf of the patient, but no further processing or payment reports will be available.