Overseas Eligibilty (ECO) #

It’s also possible to check the eligibility for patients without a Medicare Card who have cover with a health fund, eg overseas students and people on working visas.

`POST` - Mandatory elements (ECO) #

{{base_url}}/{{version}}/eligibility?location={{location_id}}

Headers

Header	Value
Content-Type	application/json
Authorization	Bearer {{oauth_token}}

Body

{
    "type": "OEC",
    "flags": {
        "accountPaid": "N",
        "compensationClaim": "N",
        "financialInterestDisclosureInd": "Y",
        "ifc": "W",
        "imcClaimType": "SC",
        "oecTypeCode": "ECO",
        "serviceType": "O",
        "hospitalInd": "N"
    },
    "admission": {
        "lengthOfStay": 2,
        "preExistingAilmentInd": "N",
        "presentingIllnessItemNumber": "320",
        "sameDay": "N",
        "accidentInd": "N"
    },
    "items": [
        {
            "chargeAmount": "244.40",
            "date": "{{today-3}}",
            "itemNumber": "30026",
            "serviceCodeType": "C"
        }
    ],
    "location": {
        "name": "St Elsewhere's Hospital",
        "provider": "9988770W",
        "type": "H"
    },
    "patient": {
        "dateOfBirth": "1951-04-24",
        "gender": "F",
        "name": {
            "family": "POST",
            "first": "Jamee"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "4545454"
        }
    },
    "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",
    "flags": {
        "accountPaid": "N",
        "compensationClaim": "N",
        "financialInterestDisclosureInd": "Y",
        "ifc": "W",
        "imcClaimType": "SC",
        "oecTypeCode": "ECO",
        "serviceType": "O",
        "hospitalInd": "N"
    },
    "admission": {
        "lengthOfStay": 2,
        "preExistingAilmentInd": "N",
        "presentingIllnessItemNumber": "320",
        "sameDay": "N",
        "accidentInd": "N"
    },
    "items": [
        {
            "chargeAmount": "244.40",
            "date": "{{today-3}}",
            "itemNumber": "30026",
            "serviceCodeType": "C"
        }
    ],
    "location": {
        "name": "St Elsewhere'\''s Hospital",
        "provider": "9988770W",
        "type": "H"
    },
    "patient": {
        "dateOfBirth": "1951-04-24",
        "gender": "F",
        "name": {
            "family": "POST",
            "first": "Jamee"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "4545454"
        }
    },
    "provider": {
        "principal": "2433411Y",
        "servicing": "2433411Y"
    }
}'

Example Response:

Body:

{
  "type": "OEC",
  "flags": {
    "accountPaid": "N",
    "compensationClaim": false,
    "financialInterestDisclosureInd": "Y",
    "ifc": "W",
    "imcClaimType": "SC",
    "oecTypeCode": "ECO",
    "serviceType": "O",
    "hospitalInd": false
  },
  "admission": {
    "lengthOfStay": "2",
    "preExistingAilmentInd": false,
    "presentingIllnessItemNumber": "320",
    "sameDay": false,
    "accidentInd": false
  },
  "location": {
    "name": "St Elsewhere's Hospital",
    "provider": "9988770W",
    "type": "H"
  },
  "patient": {
    "dateOfBirth": "1951-04-24",
    "gender": "F",
    "name": {
      "family": "POST",
      "first": "Jamee"
    },
    "fund": {
      "eclipseId": "TST",
      "number": "4545454"
    }
  },
  "provider": {
    "principal": "2433411Y",
    "servicing": "2433411Y"
  },
  "items": [
    {
      "chargeAmount": 244.4,
      "date": "2021-05-30",
      "itemNumber": "30026",
      "serviceCodeType": "C",
      "MedicareVoucherId": "01",
      "MedicareServiceId": "0001",
      "assessmentNotes": [
        {
          "assessor": "Fund",
          "code": "2001",
          "note": "Benefit not payable"
        }
      ],
      "benefit": [
        {
          "assessor": "Fund",
          "benefit": 20
        }
      ]
    }
  ],
  "eligibilityId": 34,
  "transactionId": "SAP00000edn7G1bDclPPMu2E",
  "timeReceived": "2021-06-02 08:56:24",
  "medicareResponse": "0",
  "assessmentNotes": [
    {
      "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": {
    "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	1706
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

Overseas Eligibilty (ECO) #

POST - Mandatory elements (ECO) #

`POST` - Mandatory elements (ECO) #