Simulation (development environment only) #

A claim begins its digital journey in a waiting room with a status of [NEW].

The API queues claims and sends then to Medicare Online Services one by one at a throttled pace.

For some claims, that is the end of the journey - There is currently no way to track the progress of a ‘Store And Forward’ claim, which is the type we use for Medicare submissions. Those claims will get a status of [COMPLETE]

IMC Claims have a detailed status structure as they progress through Medicare to the Health Fund and back.

For the other types (currently DVA, Bulk Bill), the journey has just begun. Once submitted, they have a status of [WITH MEDICARE].

To progress the claim in development, you can simulate a ‘Processing Report’.

The default call sets the claim to be fully successful. To simulate more complex results, you can set querystring parameters.

The processing report outlines the benefit various organisations will pay for the claim. If all of those are $0, the claim will be marked as [COMPLETE], and no more information is expected

If an organisation will be paying a benefit, the status will be [PROCESSED] until it has been paid, which will again have a status of [COMPLETE].

GET - Check the status of a single claim #

Most commonly you would fetch the status of a single claim with its ID. The assessmentNotes and benefit arrays will contain information on each item in the original claim.

{{base_url}}/{{version}}/claims/{{claim_id}}?location={{location_id}}

Headers

Params

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/claims/123?location=25' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer '

Example Response:

Body:

{
  "type": "BulkBill",
  "flags": {
    "serviceType": "O"
  },
  "patient": {
    "dateOfBirth": "1974-02-28",
    "medicare": {
      "number": "0",
      "ref": 0
    },
    "gender": "M",
    "name": {
      "first": "",
      "family": ""
    }
  },
  "provider": {
    "servicing": "2433411Y"
  },
  "items": [
    {
      "chargeAmount": 75.05,
      "date": "2021-05-30",
      "itemNumber": "00104",
      "MedicareVoucherId": "01",
      "MedicareServiceId": "0001",
      "assessmentNotes": [
        {
          "assessor": "Medicare",
          "code": "103",
          "note": "Letter of explanation is being sent separately"
        }
      ],
      "benefit": [
        {
          "assessor": "Medicare",
          "benefitPaid": 15.5
        }
      ]
    }
  ],
  "claimId": 179220,
  "transactionId": "SAP00000HGlUIOosbhuJCiEd",
  "medicareClaimId": "A0016@",
  "timeReceived": 1622447790,
  "medicareError": 0,
  "assessmentNotes": [],
  "paymentId": 14832,
  "status": "COMPLETE"
}

Headers:

GET - Simulate processing of a claim #

the b{{itemPosition}} parameter will arrange for a given item to be paid with a specified benefit amount.

{{base_url}}/{{version}}/claim/{{claim_id}}/simulate/processing?location={{location_id}}&b1=15.50

Headers

Params

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/123/simulate/processing?b1=15.50&r2=125' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer '

Example Response:

Body:

"OK"

GET - Simulate rejection of a claim #

the r{{itemPosition}} parameter will arrange for the rejection of an item at a given position within the claim. You can mix b and r parameters for a claim so log as they do not specify the same position.

{{base_url}}/{{version}}/claim/{{claim_id}}/simulate/processing?location={{location_id}}&r1=106

Headers

Params

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/123/simulate/processing?b1=15.50&r2=125' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer '

Example Response:

Body:

"OK"

GET - Simulate payment of a claim #

{{base_url}}/{{version}}/payments/simulate?claims={{claim_id}}&location={{location_id}}

Headers

Params

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/payments/simulate?claims=123&location=25' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer '

Example Response:

Body:

"OK"