Medicare Verification Errors #

The examples below will assist you capturing the full range of return codes.

`POST` - 8015 - Old or Wrong Medicare Card #

A verify request with the wrong or old Medicare card number now returns status.medicare.code of 8015 with the message “Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number before claiming.”

You should display the updated data from patient.medicare.number in the UI and store in the patient record.

NOTE that you can expect a confirmation from the fund even if the Medicare Card is incorrect

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "Gregory"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "Gregory"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1970-05-12",
    "name": {
      "family": "WATTS",
      "first": "Gregory"
    },
    "gender": "M",
    "medicare": {
      "number": "2298264836",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number before claiming.",
      "code": 8015
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3T
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	359
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8016 - Wrong IRN #

A verify request with the wrong IRN now returns status.medicare.code of 8016 with the message “Patient Verification has been accepted however patient details were not an exact match. Please check patient Individual Reference Number (IRN) before claiming.”

You should display the updated data from patient.medicare.ref in the UI and store in the patient record.

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-28",
        "name": {
            "family": "Griffith",
            "first": "Bernhardt"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861",
            "ref": "7"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-28",
        "name": {
            "family": "Griffith",
            "first": "Bernhardt"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861",
            "ref": "7"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "name": {
      "family": "Griffith",
      "first": "Bernhardt"
    },
    "gender": "M",
    "medicare": {
      "number": "2952631861",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been accepted however patient details were not an exact match. Please check patient Individual Reference Number (IRN) before claiming.",
      "code": 8016
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	376
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8017 - Wrong Given Name #

A verify request with the wrong Medicare card number now returns status.medicare.code of 8017 with the message “Patient Verification has been accepted however patient details were not an exact match. Please check patient Given Name before claiming.”

You should display the updated data from patient.name.first in the UI and store in the patient record.

{{base_url}}/{{version}}/verify

Headers

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

Body

{ 
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-28",
        "name": {
            "family": "Griffith",
            "first": "Bernie"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "STS",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{ 
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-28",
        "name": {
            "family": "Griffith",
            "first": "Bernie"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "STS",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1974-02-28",
    "name": {
      "family": "Griffith",
      "first": "BERNHARDT"
    },
    "gender": "M",
    "medicare": {
      "number": "2952631861",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been accepted however patient details were not an exact match. Please check patient Given Name before claiming.",
      "code": 8017
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	353
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8018 - Wrong DoB #

A verify request with the wrong Date of Birth now returns `status.medicare.code’ of 8018 with the message “Patient Verification has been accepted however patient details were not an exact match. Please check patient Date of Birth before claiming.”

You should display the error in the UI. The response does not typically contain a corrected DoB, check with the patient.

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-23",
        "name": {
            "family": "Griffith",
            "first": "Bernhardt"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861", 
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1974-02-23",
        "name": {
            "family": "Griffith",
            "first": "Bernhardt"
        },
        "gender": "M",
        "medicare": {
            "number": "2952631861", 
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1974-02-23",
    "name": {
      "family": "Griffith",
      "first": "Bernhardt"
    },
    "gender": "M",
    "medicare": {
      "number": "2952631861",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been accepted however patient details were not an exact match. Please check patient Date of Birth before claiming.",
      "code": 8018
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	356
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8019 - Wrong Card and Given Name #

A verify request with the wrong Medicare Card Number and Date of Birth now returns `status.medicare.code’ of 8019 with the message “Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Given Name before claiming.”

You should display the error in the UI. The response will return the corrected patient.medicare.number and patient.name.first.

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "GREG"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "GREG"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1970-05-12",
    "name": {
      "family": "WATTS",
      "first": "GREGORY"
    },
    "gender": "M",
    "medicare": {
      "number": "2298264836",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Given Name before claiming.",
      "code": 8019
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	374
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8020 - Wrong Card and IRN #

A verify request with the wrong Card Number and IRN returns `status.medicare.code’ of 8020 with the message “Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Individual Reference Number (IRN) before claiming.”

You should display the error in the UI. The response will return the corrected patient.medicare.number and patient.name.first.

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "GREGORY"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "2"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-12",
        "name": {
            "family": "WATTS",
            "first": "GREGORY"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "2"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1970-05-12",
    "name": {
      "family": "WATTS",
      "first": "GREGORY"
    },
    "gender": "M",
    "medicare": {
      "number": "2298264836",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Individual Reference Number (IRN) before claiming.",
      "code": 8020
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	397
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 8021 - Wrong Card and DoB #

A verify request with the wrong Medicare Card Number and Date of Birth now returns status.medicare.code of 8021 with the message “Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Date of Birth before claiming.”

You should display the error in the UI. The response will return the corrected card data patient.medicare.number but does not typically contain a corrected DoB, check with the patient.

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-10",
        "name": {
            "family": "WATTS",
            "first": "Gregory"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1970-05-10",
        "name": {
            "family": "WATTS",
            "first": "Gregory"
        },
        "gender": "M",
        "medicare": {
            "number": "2298264833",
            "ref": "1"
        },
        "fund": {
            "eclipseId": "TST",
            "number": "12345678A",
            "ref": "01"
        }
    }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1970-05-10",
    "name": {
      "family": "WATTS",
      "first": "Gregory"
    },
    "gender": "M",
    "medicare": {
      "number": "2298264836",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient Verification has been completed however patient details were not an exact match. Please check patient Medicare Card Number and Date of Birth before claiming.",
      "code": 8021
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	377
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 9649 - Undetermined Eligibility #

If a patient’s coverage under the RHCA has expired, the response code will be 9649 and the associated message will be “Patient’s eligibility cannot be determined.”

{{base_url}}/{{version}}/verify

Headers

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

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-16",
    "medicare": {
      "number": "2297402204",
      "ref": 1
    },
    "gender": "F",
    "name": {
      "first": "French",
      "family": "Forigner"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-09-15",
    "medicare": {
      "number": "2296510126",
      "ref": 4
    },
    "gender": "M",
    "name": {
      "first": "Sad",
      "family": "JONES"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1964-09-15",
    "name": {
      "family": "JONES",
      "first": "Sad"
    },
    "gender": "M",
    "medicare": {
      "number": "2296510126",
      "ref": "4"
    }
  },
  "status": {
    "medicare": {
      "message": "Patient's eligibility cannot be determined.",
      "code": 9649
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	251
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` 9650 - No Match #

If the patient is unknown to Medicare or the card has been reported as lost, the response code will be 9650 and the associated message will be “The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.”

{{base_url}}/{{version}}/verify

Headers

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

Body

{
    "type": "Verify:Medicare",
    "patient": {
        "dateOfBirth": "1979-09-13",
        "medicare": {
            "number": "2398125261",
            "ref": 1
        },
        "gender": "M",
        "name": {
            "first": "John",
            "family": "Doe"
        }
    }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1980-05-23",
    "medicare": {
      "number": "5500393923",
      "ref": 1
    },
    "gender": "M",
    "name": {
      "first": "Simon",
      "family": "Boyes"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1980-05-23",
    "name": {
      "family": "Boyes",
      "first": "Simon"
    },
    "gender": "M",
    "medicare": {
      "number": "5500393923",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available.",
      "code": 9650
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	370
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 9633 - Replacement Card #

If you submit a claim for a patient who has had a new medicare card issued, the response code will be 9633 and the associated message will be “A new Medicare card has been issued. Please confirm your records with the patient and if required update for any future claims.”

{{base_url}}/{{version}}/verify

Headers

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

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "2950862041",
      "ref": 2
    },
    "gender": "M",
    "name": {
      "first": "Happy",
      "family": "JONES"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "2950862041",
      "ref": 2
    },
    "gender": "M",
    "name": {
      "first": "Happy",
      "family": "JONES"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1964-05-04",
    "name": {
      "family": "JONES",
      "first": "HAPPY"
    },
    "gender": "M",
    "medicare": {
      "number": "2950862132",
      "ref": "1"
    }
  },
  "status": {
    "medicare": {
      "message": "A new Medicare card has been issued. Please confirm your records with the patient and if required update for any future claims.",
      "code": 9633
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	337
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

`POST` - 9675 - Expired Medicare card #

Where the Medicare card has expired, the response code will be 9675 and the associated message will be “Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.”

{{base_url}}/{{version}}/verify

Headers

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

Body

{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "3950084431",
      "ref": 3
    },
    "gender": "F",
    "name": {
      "first": "Marie",
      "family": "SIMEON"
    }
  }
}

Example Request:

curl --location 'https://sandbox.claiming.com.au/v2/verify' \
--header 'Accept: application/json' \
--header 'Content-Type: application/json' \
--header 'Authorization: Bearer ' \
--data '{
  "type": "Verify:Medicare",
  "patient": {
    "dateOfBirth": "1964-05-04",
    "medicare": {
      "number": "3950084431",
      "ref": 3
    },
    "gender": "F",
    "name": {
      "first": "Marie",
      "family": "SIMEON"
    }
  }
}'

Example Response:

Body:

{
  "patient": {
    "dateOfBirth": "1964-05-04",
    "name": {
      "family": "SIMEON",
      "first": "Marie"
    },
    "gender": "F",
    "medicare": {
      "number": "3950084431",
      "ref": "3"
    }
  },
  "status": {
    "medicare": {
      "message": "Current Medicare card has expired. Patient must contact Medicare as claims using this Medicare card may be rejected.",
      "code": 9675
    }
  }
}

Headers:

Header	Value
Server	nginx/1.19.3
Date	Tue, 08 Jun 2021 04:49:28 GMT
Content-Type	application/json
Content-Length	327
Connection	keep-alive
Access-Control-Allow-Origin	*
Access-Control-Allow-Methods	GET, POST, OPTIONS

Medicare Verification Errors #

POST - 8015 - Old or Wrong Medicare Card #

POST - 8016 - Wrong IRN #

POST - 8017 - Wrong Given Name #

POST - 8018 - Wrong DoB #

POST - 8019 - Wrong Card and Given Name #

POST - 8020 - Wrong Card and IRN #

POST - 8021 - Wrong Card and DoB #

POST - 9649 - Undetermined Eligibility #

POST 9650 - No Match #

POST - 9633 - Replacement Card #

POST - 9675 - Expired Medicare card #

`POST` - 8015 - Old or Wrong Medicare Card #

`POST` - 8016 - Wrong IRN #

`POST` - 8017 - Wrong Given Name #

`POST` - 8018 - Wrong DoB #

`POST` - 8019 - Wrong Card and Given Name #

`POST` - 8020 - Wrong Card and IRN #

`POST` - 8021 - Wrong Card and DoB #

`POST` - 9649 - Undetermined Eligibility #

`POST` 9650 - No Match #

`POST` - 9633 - Replacement Card #

`POST` - 9675 - Expired Medicare card #