Claims #

A claim is for one patient and one servicing provider, but may contain several service items on the same and/or different days. The request object consists of:

• General Details

• The Type of claim being submitted (DVA, Medicare, Bulk Bill, In Patient Medical)
• Location of service (In Hospital, Consulting Rooms, At Home etc)
• the service_type where ‘S’ is for specialist claims and ‘O’ is for other (non-specialist claims)

• Patient Details

• Name
• Date Of Birth
• Medicare, DVA or Fund details

• Practitioner/Medical Professional Details

• Uniquely identifying ‘Provider Number’

• Referral/Request details (where required on specialist claims)

• Referring / Requesting Practitioner’s Provider Number
• Referral Date and period
• Alternatively a referral override code can be given; (L)OST, (E)MERGENCY, (H)OSPITAL, (N)OT REQUIRED

• List of Items

• Date of service
• Item Number
• Amount charged
• Any extra details on the items depending on the claim type

Responses:

There are three synchronous response scenarios you can receive when creating a claim:

• OK: Claim has been successfully received and will be queued for submission.
• INVALID: Failed processing checks, no record has been created
• DUPLICATE: Claim Already exists