Medicare & Fund eligibility (OEC) #
Both Medicare and Fund eligibility can be checked with the one request (type = OEC)
POST - Mandatory elements (OEC)
#
This example will check the patient’s level of cover with the fund, and the expected rebate on an MBS item.
{{base_url}}/{{version}}/eligibility?location={{location_id}}
Headers
| Header | Value |
|---|---|
| Content-Type | application/json |
| Authorization | Bearer {{oauth_token}} |
Body
{
"type": "OEC",
"admission": {
"admissionDate" : "{{today}}",
"dischargeDate" : "{{today}}",
"sameDay": "Y",
"preExistingAilmentInd" : "N",
"presentingIllnessItemNumber" : "30026"
},
"flags": {
"accountPaid": "N",
"compensationClaim": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": "N",
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd" : "Y"
},
"items": [
{
"chargeAmount": "144.40",
"date": "{{today}}",
"itemNumber": "30026",
"serviceCodeType": "C"
}
],
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}
Params
| Param | value |
|---|---|
| location | {{location_id}} |
Example Request:
curl --location 'https://sandbox.claiming.com.au/v2/eligibility?location=25' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
"type": "OEC",
"admission": {
"admissionDate" : "{{today}}",
"dischargeDate" : "{{today}}",
"sameDay": "Y",
"preExistingAilmentInd" : "N",
"presentingIllnessItemNumber" : "30026"
},
"flags": {
"accountPaid": "N",
"compensationClaim": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": "N",
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd" : "Y"
},
"items": [
{
"chargeAmount": "144.40",
"date": "{{today}}",
"itemNumber": "30026",
"serviceCodeType": "C"
}
],
"location": {
"name": "St Elsewhere'\''s Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}'
Example Response:
Body:
{
"type": "OEC",
"admission": {
"admissionDate": "2021-06-09",
"dischargeDate": "2021-06-09",
"sameDay": true,
"preExistingAilmentInd": false,
"presentingIllnessItemNumber": "30026"
},
"flags": {
"accountPaid": "N",
"compensationClaim": false,
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": false,
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd": "Y"
},
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
},
"items": [
{
"chargeAmount": 144.4,
"date": "2021-06-09",
"itemNumber": "30026",
"serviceCodeType": "C",
"MedicareVoucherId": "01",
"MedicareServiceId": "0001",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0"
},
{
"assessor": "Fund",
"code": "A"
}
],
"benefit": [
{
"assessor": "Medicare",
"scheduleFee": 53.85,
"benefit": 40.4
},
{
"assessor": "Fund",
"benefit": 93.6
}
]
}
],
"eligibilityId": 37,
"transactionId": "SAP00000mcRWAFxE8ApKxc2F",
"timeReceived": "2021-06-09 13:31:49",
"medicareResponse": "0",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0",
"note": "Patient is eligible to claim for Medicare with details provided."
},
{
"assessor": "Fund",
"code": "0",
"note": "Patient is eligible to claim with Health Fund specified in the request."
},
{
"assessor": "Fund",
"code": "1001",
"note": "Patient to contact Health Fund"
}
],
"estimations": {
"medicare": {
"fundLocationId": "AAA99556",
"lodgementDate": "2021-06-09"
},
"fund": {
"benefitLimitations": "This is to test a return of 100 character entry in the table description or benefit limitations....",
"financialStatus": "Y",
"assessmentCode": "A",
"referenceId": "STS012102",
"table": {
"name": "Basic Hospital",
"scale": "SINGLE",
"description": "Hospital cover only"
},
"peaPotentialInd": "N"
}
},
"status": "COMPLETE"
}
Headers:
| Header | Value |
|---|---|
| Server | nginx/1.19.3 |
| Date | Tue, 08 Jun 2021 04:49:28 GMT |
| Content-Type | application/json |
| Content-Length | 2032 |
| Connection | keep-alive |
| Access-Control-Allow-Origin | * |
| Access-Control-Allow-Methods | GET, POST, OPTIONS |
POST - Optional elements (OEC)
#
This example includes both an MBS item and and Miscellaneous item
{{base_url}}/{{version}}/eligibility?location={{location_id}}
Headers
| Header | Value |
|---|---|
| Content-Type | application/json |
| Authorization | Bearer {{oauth_token}} |
Body
{
"type": "OEC",
"admission": {
"admissionDate": "{{today-2}}",
"dischargeDate": "{{today}}",
"lengthOfStay": "1",
"accidentDate": "{{today-2}}",
"sameDay": "N",
"preExistingAilmentInd": "N",
"presentingIllnessItemNumber": "30026",
"emergencyAdmission": "Y"
},
"flags": {
"accountPaid": "N",
"compensationClaim": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": "Y",
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd": "Y"
},
"items": [
{
"afterCareOverride": "Y",
"chargeAmount": "144.40",
"date": "{{today-2}}",
"duplicateServiceOverride":"Y",
"itemNumber": "30026",
"serviceCodeType": "C"
},
{
"chargeAmount": "200",
"date": "{{today-2}}",
"serviceCode": "M123",
"serviceCodeType": "M",
"serviceQuantity": "1",
"serviceRate": 200
}
],
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678",
"payeeId": "454545",
"ref": "1"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee",
"second": "P"
},
"alias": {
"family": "Soda",
"first": "Monkey"
}
},
"contact": {
"name": "Sbeve Steve",
"email": "site@email.info",
"phone": "0123 456 789"
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}
Params
| Param | value |
|---|---|
| location | {{location_id}} |
Example Request:
curl --location 'https://sandbox.claiming.com.au/v2/eligibility?location=25' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data-raw '{
"type": "OEC",
"admission": {
"admissionDate": "{{today-2}}",
"dischargeDate": "{{today}}",
"lengthOfStay": "1",
"accidentDate": "{{today-2}}",
"sameDay": "N",
"preExistingAilmentInd": "N",
"presentingIllnessItemNumber": "30026",
"emergencyAdmission": "Y"
},
"flags": {
"accountPaid": "N",
"compensationClaim": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": "Y",
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd": "Y"
},
"items": [
{
"afterCareOverride": "Y",
"chargeAmount": "144.40",
"date": "{{today-2}}",
"duplicateServiceOverride":"Y",
"itemNumber": "30026",
"serviceCodeType": "C"
},
{
"chargeAmount": "200",
"date": "{{today-2}}",
"serviceCode": "M123",
"serviceCodeType": "M",
"serviceQuantity": "1",
"serviceRate": 200
}
],
"location": {
"name": "St Elsewhere'\''s Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678",
"payeeId": "454545",
"ref": "1"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee",
"second": "P"
},
"alias": {
"family": "Soda",
"first": "Monkey"
}
},
"contact": {
"name": "Sbeve Steve",
"email": "site@email.info",
"phone": "0123 456 789"
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}'
Example Response:
Body:
{
"type": "OEC",
"admission": {
"admissionDate": "2021-06-07",
"dischargeDate": "2021-06-09",
"lengthOfStay": "1",
"accidentDate": "2021-06-07",
"sameDay": false,
"preExistingAilmentInd": false,
"presentingIllnessItemNumber": "30026",
"emergencyAdmission": true
},
"flags": {
"accountPaid": "N",
"compensationClaim": false,
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"imcClaimType": "AG",
"isAccident": true,
"oecTypeCode": "OEC",
"serviceType": "O",
"certifiedInd": "Y"
},
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"fund": {
"eclipseId": "TST",
"number": "12345678",
"payeeId": "454545",
"ref": "1"
},
"gender": "F",
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee",
"second": "P"
},
"alias": {
"family": "Soda",
"first": "Monkey"
}
},
"contact": {
"name": "Sbeve Steve",
"email": "site@email.info",
"phone": "0123 456 789"
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
},
"items": [
{
"afterCareOverride": true,
"chargeAmount": 144.4,
"date": "2021-06-07",
"duplicateServiceOverride": true,
"itemNumber": "30026",
"serviceCodeType": "C",
"MedicareVoucherId": "01",
"MedicareServiceId": "0001",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0"
},
{
"assessor": "Fund",
"code": "A"
}
],
"benefit": [
{
"assessor": "Medicare",
"scheduleFee": 53.85,
"benefit": 40.4
},
{
"assessor": "Fund",
"benefit": 93.6
}
]
},
{
"chargeAmount": 200,
"date": "2021-06-07",
"serviceCode": "M123",
"serviceCodeType": "M",
"serviceQuantity": "1",
"serviceRate": 200,
"MedicareVoucherId": "01",
"MedicareServiceId": "0002",
"assessmentNotes": [
{
"assessor": "Fund",
"code": "2001",
"note": "The Fund does not pay for this sort of stuff"
}
],
"benefit": [
{
"assessor": "Fund",
"benefit": 20
}
]
}
],
"eligibilityId": 38,
"transactionId": "SAP00000RE691OJsa8hpy9lQ",
"timeReceived": "2021-06-09 13:32:09",
"medicareResponse": "0",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0",
"note": "Patient is eligible to claim for Medicare with details provided."
},
{
"assessor": "Fund",
"code": "0",
"note": "Patient is eligible to claim with Health Fund specified in the request."
},
{
"assessor": "Fund",
"code": "1001",
"note": "Patient to contact Health Fund"
}
],
"estimations": {
"medicare": {
"fundLocationId": "AAA99556",
"lodgementDate": "2021-06-09"
},
"fund": {
"benefitLimitations": "This is to test a return of 100 character entry in the table description or benefit limitations....",
"financialStatus": "Y",
"assessmentCode": "A",
"referenceId": "STS012102",
"table": {
"name": "Basic Hospital",
"scale": "SINGLE",
"description": "Hospital cover only"
},
"peaPotentialInd": "N"
}
},
"status": "COMPLETE"
}
Headers:
| Header | Value |
|---|---|
| Server | nginx/1.19.3 |
| Date | Tue, 08 Jun 2021 04:49:28 GMT |
| Content-Type | application/json |
| Content-Length | 2720 |
| Connection | keep-alive |
| Access-Control-Allow-Origin | * |
| Access-Control-Allow-Methods | GET, POST, OPTIONS |
POST - Patient not eligible for item (OEC)
#
Confirming support of all mandatory data elements
{{base_url}}/{{version}}/eligibility?location={{location_id}}
Headers
| Header | Value |
|---|---|
| Content-Type | application/json |
| Authorization | Bearer {{oauth_token}} |
Body
{
"_NOITestCase": "14.2.3.1",
"type": "OEC",
"flags": {
"accountPaid": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"oecTypeCode": "OEC",
"serviceType": "O",
"compensationClaim": "Y",
"isAccident": "N",
"imcClaimType": "PC"
},
"admission": {
"admissionDate": "{{today-4}}",
"lengthOfStay": "2",
"preExistingAilmentInd": "N",
"presentingIllnessItemNumber": "320",
"sameDay": "N"
},
"items": [
{
"chargeAmount": "600.00",
"date": "{{today}}",
"itemNumber": "42968",
"serviceCodeType": "C"
},
{
"chargeAmount": "300.00",
"date": "{{today}}",
"itemNumber": "42701",
"serviceCodeType": "C"
},
{
"chargeAmount": "250",
"date": "{{today}}",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": "250",
"serviceCode": "AO001"
},
{
"chargeAmount": "220",
"date": "{{today}}",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": "210",
"serviceCode": "AL003"
}
],
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"gender": "F",
"fund": {
"eclipseId": "TST",
"number": "4545454"
},
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}
Params
| Param | value |
|---|---|
| location | {{location_id}} |
Example Request:
curl --location 'https://sandbox.claiming.com.au/v2/eligibility?location=25' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
"_NOITestCase": "14.2.3.1",
"type": "OEC",
"flags": {
"accountPaid": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"oecTypeCode": "OEC",
"serviceType": "O",
"compensationClaim": "Y",
"isAccident": "N",
"imcClaimType": "PC"
},
"admission": {
"admissionDate": "{{today-4}}",
"lengthOfStay": "2",
"preExistingAilmentInd": "N",
"presentingIllnessItemNumber": "320",
"sameDay": "N"
},
"items": [
{
"chargeAmount": "600.00",
"date": "{{today}}",
"itemNumber": "42968",
"serviceCodeType": "C"
},
{
"chargeAmount": "300.00",
"date": "{{today}}",
"itemNumber": "42701",
"serviceCodeType": "C"
},
{
"chargeAmount": "250",
"date": "{{today}}",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": "250",
"serviceCode": "AO001"
},
{
"chargeAmount": "220",
"date": "{{today}}",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": "210",
"serviceCode": "AL003"
}
],
"location": {
"name": "St Elsewhere'\''s Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"gender": "F",
"fund": {
"eclipseId": "TST",
"number": "4545454"
},
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
}
}'
Example Response:
Body:
{
"_NOITestCase": "14.2.3.1",
"type": "OEC",
"flags": {
"accountPaid": "N",
"financialInterestDisclosureInd": "Y",
"ifc": "W",
"oecTypeCode": "OEC",
"serviceType": "O",
"compensationClaim": true,
"isAccident": false,
"imcClaimType": "PC"
},
"admission": {
"admissionDate": "2021-06-05",
"lengthOfStay": "2",
"preExistingAilmentInd": false,
"presentingIllnessItemNumber": "320",
"sameDay": false
},
"location": {
"name": "St Elsewhere's Hospital",
"provider": "9988770W",
"type": "H"
},
"patient": {
"dateOfBirth": "1951-04-24",
"gender": "F",
"fund": {
"eclipseId": "TST",
"number": "4545454"
},
"medicare": {
"number": "5950969521",
"ref": "1"
},
"name": {
"family": "POST",
"first": "Jamee"
}
},
"provider": {
"principal": "2433411Y",
"servicing": "2433411Y"
},
"items": [
{
"chargeAmount": 600,
"date": "2021-06-09",
"itemNumber": "42968",
"serviceCodeType": "C",
"MedicareVoucherId": "01",
"MedicareServiceId": "0001",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "206",
"note": "Item number does not attract a benefit at date of service"
},
{
"assessor": "Fund",
"code": "2001",
"note": "The Fund does not pay for this sort of stuff"
}
],
"benefit": [
{
"assessor": "Medicare",
"benefit": 0
},
{
"assessor": "Fund",
"benefit": 0
}
]
},
{
"chargeAmount": 300,
"date": "2021-06-09",
"itemNumber": "42701",
"serviceCodeType": "C",
"MedicareVoucherId": "01",
"MedicareServiceId": "0002",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0"
},
{
"assessor": "Fund",
"code": "A"
}
],
"benefit": [
{
"assessor": "Medicare",
"scheduleFee": 342.05,
"benefit": 256.55
},
{
"assessor": "Fund",
"benefit": 39.1
}
]
},
{
"chargeAmount": 250,
"date": "2021-06-09",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": 250,
"serviceCode": "AO001",
"MedicareVoucherId": "01",
"MedicareServiceId": "0003",
"assessmentNotes": [
{
"assessor": "Fund",
"code": "2001",
"note": "The Fund does not pay for this sort of stuff"
}
],
"benefit": [
{
"assessor": "Fund",
"benefit": 20
}
]
},
{
"chargeAmount": 220,
"date": "2021-06-09",
"serviceCodeType": "P",
"serviceQuantity": "1",
"serviceRate": 210,
"serviceCode": "AL003",
"MedicareVoucherId": "01",
"MedicareServiceId": "0004",
"assessmentNotes": [
{
"assessor": "Fund",
"code": "2001",
"note": "The Fund does not pay for this sort of stuff"
}
],
"benefit": [
{
"assessor": "Fund",
"benefit": 20
}
]
}
],
"eligibilityId": 39,
"transactionId": "SAP00000RwDja3i2aAlli3s0",
"timeReceived": "2021-06-09 13:32:32",
"medicareResponse": "0",
"assessmentNotes": [
{
"assessor": "Medicare",
"code": "0",
"note": "Patient is eligible to claim for Medicare with details provided."
},
{
"assessor": "Fund",
"code": "0",
"note": "Patient is eligible to claim with Health Fund specified in the request."
},
{
"assessor": "Fund",
"code": "1001",
"note": "Patient to contact Health Fund"
}
],
"estimations": {
"medicare": {
"fundLocationId": "AAA99556",
"lodgementDate": "2021-06-09"
},
"fund": {
"benefitLimitations": "This is to test a return of 100 character entry in the table description or benefit limitations....",
"financialStatus": "Y",
"assessmentCode": "A",
"referenceId": "STS012102",
"table": {
"name": "Basic Hospital",
"scale": "SINGLE",
"description": "Hospital cover only"
},
"peaPotentialInd": "N"
}
},
"status": "COMPLETE"
}
Headers:
| Header | Value |
|---|---|
| Server | nginx/1.19.3 |
| Date | Tue, 08 Jun 2021 04:49:28 GMT |
| Content-Type | application/json |
| Content-Length | 3225 |
| Connection | keep-alive |
| Access-Control-Allow-Origin | * |
| Access-Control-Allow-Methods | GET, POST, OPTIONS |