Submitting ECLIPSE batch files with Tyro Health Online
Tyro Health Online supports bulk transmission of invoices to healthcare funders. Batched invoices are processed individually according to funder rules.
A single batch file can support multiple funders, invoices and claimed items. For all invoices, it’s important to note:
- Files must be in a CSV format. Double quoted fields (i.e. using quotes as text qualifiers) are optional, but recommended when dealing with text columns (like descriptions)
- Template and example CSV files for each funder are posted on Tyro Health Online.
- The first row must be a header record and must conform to template values provided.
- Each row’s column must be ordered according to the header record.
- Up to 10,000 rows can be included in a single file.
- Fields listed as mandatory for each funder must be complete and valid for successful upload.
- After uploading to Tyro Health Online, invoices that pass business rule validation will be in a Draft ready to submit status. Select those invoices and click submit to process.
- Invoices that fail validation will be in a Draft incomplete status and require attention prior to submission.
Importantly, if you create, open or save the file using Microsoft Excel or other spreadsheet programs, please note that date and time fields may be automatically updated to a format that is not accepted - be sure to save the file in the formats defined below.
Invoice guidelines:
- An invoice will result in a single unique Tyro Health Online transaction identifier, invoice date and status;
- An invoice will have a single unique invoiceReference as nominated by you;
- An invoice will have a single patient and health fund account;
- An invoice will have a single principle provider;
- An invoice will have one or more medical events and claimed services;
- Each item will have at least a unique reference , serviceDate , itemCode and price ;
- Additional item attributes can be set ; and
- Non-mandatory columns may be deleted from the uploaded file if not used.
To support invoices with multiple claimed items:
- Invoices with the same invoiceReference will be grouped into a single invoice for submission to a funder.
- Rows for a unique invoice should be grouped together sequentially and each item should use a unique services.reference for that invoice.
- For invoice level (but not item level) attributes that repeat, only the first instance of those values will be used.
For those that create batch files using Microsoft Excel, Apple Numbers or Google Sheets:
- All fields should use a format of “Plan Text” or “Text” .
- Special care should be taken while entering serviceDate , time of service and other date/time numbered fields as these tools may apply an automatic format different from expected.
-
Files must be saved/exported as:
- Microsoft Excel - Windows: CSV Comma delimited ( * .csv)
- Microsoft Excel - Mac: Comma-separated Values (.csv)
- Apple Numbers: CSV, Text Encoding: Unicode (UTF-8)
- Google Sheets: Comma-separated values (.csv, current sheet)
Field condition table
| Value | Description |
|---|---|
| M | Mandatory |
| O | Optional |
| C | Conditional |
| Blank | Not applicable, do not set in request |
ECLIPSE invoices
Both inpatient medical claims (IMC) and overseas claims (OVS) are supported in a single batch submission, of any supported claim processing class.
IMC Claims
| Field | AG | SC | MB | MO | PC | Format | Example value | Notes | Key constraints |
|---|---|---|---|---|---|---|---|---|---|
funder |
M | M | M | M | M | Valid values only | eclipse | use eclipse for all eclipse transactions | |
sequenceNumber |
O | O | O | O | O | Valid values only | 1 | ||
invoiceReference |
M | M | M | M | M | Up to 16 characters | 20200901ABCD | Your unique invoice/transaction reference. Typically generated from a practice management or accounting system. This value will be traced through to settlement reporting and is separate from any funder defined transaction identifier or claim reference. Where multiple service items exist for an invoice, all rows for a unique invoiceReference will be grouped into a single invoice and the first occurrence of repeating invoice level (but not service level) details will be used. Note: these rows should be grouped sequentially. |
• Must be unique for an invoice/claim in a single batch file. • Should be globally unique across the business for search and reporting purposes. |
| Patient details | |||||||||
patient.identity.dobString |
M | M | M | M | M | YYYY-MM-DD | 2010-09-01 | Date of birth in YYYY-MM-DD format. | For Medicare patient claims, if patient is <15 years old as at each serviceDate, an adult =>18 years old claimant is required. • must be a valid date • must not be a date in the future • must not be after each serviceDate |
patient.identity.firstName |
M | M | M | M | M | 1 to 40 characters | Mila | Patient first / given name as registered with funder. If a patient has only one name, use "Onlyname" as placeholder in the firstName field. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.identity.lastName |
M | M | M | M | M | 1 to 40 characters | Willis | Patient last / family name as registered with the funder. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.identity.refId |
O | O | O | O | O | Up to 128 characters | 3DE2D2BC-17CC-4978-A79D-2151DC417B2F | A unique patient identifier - such as a UUID - generated by your system. Used for searching and reporting on transactions by patients in Tyro Health Online and for support purposes. Setting a unique refId per patient is highly recommended. If provided, future transactions can be processed using refId rather than providing patient and health fund account details. Any differing patient details for a given refId will update the patient record on Tyro Health Online. |
• A unique invoice can include only one patient. |
patient.identity.secondInitial |
O | O | O | O | O | One character | P | The first initial of the patient's second given name. Alpha (A-Z, a-z) | |
patient.medicareHealthFundAccount.cardRank |
M | M | M | M | M | Either 1 or 2 numbers | 1 | Individual patient reference number (IRN), one digit of 1-9, as noted on the physical card. | |
patient.medicareHealthFundAccount.membershipNumber |
M | M | M | M | M | 10 digits | 2953878061 | Medicare card number, 10 digits | The value must adhere to the Medicare Card check digit routine. |
patient.medicareHealthFundAccount.sex |
O | O | O | O | O | Valid values only | F | Patient sex, as one of: • M: Male • F: Female • O: Other • Null: Not stated/inadequately described (default value) |
|
patient.phiHealthFundAccount.cardRank |
M | M | M | M | Either 1 or 2 numbers | 1 | Private insurance patient reference (UPI) or card rank, two digits as noted on physical card. Numeric, 0-99 with or without leading zeros. | ||
patient.phiHealthFundAccount.firstName |
O | O | O | O | 1 to 40 characters | Mia | The patient's first given name as known by the Health Fund if different to Medicare. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
|
patient.phiHealthFundAccount.lastName |
O | O | O | O | 1 to 40 characters | Wilis | The patient's family name as known by the Health Fund if different to Medicare. | A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
|
patient.phiHealthFundAccount.membershipNumber |
M | M | M | M | 1-19 alphanumeric characters | 88812345 | Patient's Health Fund Membership or Card number. | ||
| Claimant details - only applicable for IMC-PC claims | |||||||||
claimant.identity.dobString |
M | YYYY-MM-DD | 1999-01-25 | Claimant date of birth in YYYY-MM-DD format. | • must be => 18 years old as at date of each service • must be a valid date • must not be a date in the future • must not be after each serviceDate |
||||
claimant.identity.firstName |
M | 1 to 40 characters | Charles | Claimant first / given name as registered with Medicare. If only one name, set field to "Only Name". | • A unique invoice can include only one claimant. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
||||
claimant.identity.lastName |
M | 1 to 40 characters | Willis | Claimant last / family name as registered with Medicare. | • A unique invoice can include only one claimant. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
||||
claimant.identity.refId |
O | Up to 128 characters | 3DE2D2BC-17CC-4978-A79D-2151DC417B2F | A unique patient identifier generated by your system. If provided, future transactions can be processed using refId rather than providing patient and health fund account details. Any differing patient details for a given refId will update the patient record on Tyro Health Online. | • A unique invoice can include only one claimant | ||||
claimant.identity.secondInitial |
M | One character | N | The first initial of the patient's second given name. Alpha (A-Z, a-z) | |||||
claimant.bankAccount.accountName |
O | Up to 30 characters | Charles Willis | Name of account holder. | • The value supplied must be alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (’), hyphen (-) and other special characters (.,/) only. • Spaces must not appear before or after the supplied value. |
||||
claimant.bankAccount.accountNumber |
O | Up to 9 numbers | 987654321 | Account number. | • The value supplied must be alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (’), hyphen (-) and other special characters (.,/) only. • Spaces must not appear before or after the supplied value. |
||||
claimant.bankAccount.bankName |
O | Up to 30 characters | NAB | bank name not processed by Medicare, but we use for validation to show in claim | |||||
claimant.bankAccount.bsb |
O | 6 numbers | 023456 | Six digit BSB number. | • Must be a valid BSB. | ||||
claimant.medicareHealthFundAccount.membershipNumber |
M | 10 numbers | 1234567890 | Medicare card number - 10 digits | |||||
claimant.medicareHealthFundAccount.cardRank |
M | 1 number | 1 | Medicare individual reference number, one digit of 1-9, as noted on the physical card. | |||||
claimant.medicareHealthFundAccount.sex |
O | ||||||||
claimant.postalAddress.address |
O | Up to 40 characters | 4 Duke Street | A valid street address. | • The value supplied must be alpha (A-Z and a-z), numeric (0-9), space ( ), apostrophe ('), hyphen (-) and other special characters (/ , . : ; ) only. • Spaces must not appear before or after other spaces or the supplied value. • The value must contain at least one alpha or numeric character. |
||||
claimant.postalAddress.addressLine2 |
O | Up to 40 characters | Unit 827 | Address line 2, typically unit or apartment or unit number. | • The value supplied must be alpha (A-Z and a-z), numeric (0-9), space ( ), apostrophe ('), hyphen (-) and other special characters (/ , . : ; ) only. • Spaces must not appear before or after other spaces or the supplied value. |
||||
claimant.postalAddress.addressPrefix |
O | ||||||||
claimant.postalAddress.city |
O | Up to 40 alphanumeric characters | Windsor | Also known as locality. | • must be a valid city/locality as defined by Medicare • The value supplied must be alpha (A-Z and a-z), numeric (0-9), space ( ), apostrophe ('), hyphen (-) and other special characters (/ , . : ; ) only. • Spaces must not appear before or after other spaces or the supplied value. • The value must contain at least one alpha or numeric character. |
||||
claimant.postalAddress.country |
O | ||||||||
claimant.postalAddress.countryCode |
O | ||||||||
claimant.postalAddress.postcode |
O | 4 numbers | 3181 | Postcode | • Must be valid. | ||||
claimant.postalAddress.state |
O | ||||||||
claimant.contactDetails.phoneNumber |
Mobile number | 0411111111 | Claimant contact number | ||||||
accident.accidentInd |
M | M | boolean | N | Indicates whether or not the associated information relates to the patient experiencing an accident. | ||||
accountPaidInd |
M | M | M | M | M | boolean | N | Indicates whether or not an account has been paid in full. | Must not be set to Y when Claim Type Code is set to AG, SC, MB or MO. |
accountReferenceId |
M | M | M | M | M | 1-20 alphanumeric characters | 19-1125B | Account Reference (ACRF). A reference used by the claim submitter to identify a claim. | • The value supplied must be alpha (A-Z and a-z), numeric (0-9) only. • Spaces must not appear before or after other spaces or the supplied value. • Must be 1 to 20 characters when Claim Type Code is set to AG, SC, MB or MO. • Must be 1 to 9 characters when Claim Type Code is set to PC. |
benefitAssignmentAuthorisedInd |
M | M | boolean | Y | Indicates that the patient has authorised the assignment of their right of benefit to a billing agent. | • Must not be set when Claim Type Code is set to AG, SC or PC. • Must be set to Y when Claim Type Code is set to MB or MO to submit the claim. |
|||
| Principal provider & location details | |||||||||
billingAgent.providerNumber |
O | O | M | M | 8 alphanumeric characters | 3539440H | The provider number of the billing agent. This is used to direct payments. | ||
claimTypeCode |
M | M | M | M | M | Valid values only | AG | Claim processing class as one of: • AG = Agreement • SC = Scheme • MB = Billing Agent • MO = Medicare Only • PC = Patient Claim |
|
compensationClaimInd |
O | O | O | O | O | boolean | N | Indicates whether or not the claim contains services that are subject to a compensation claim: Y = Claim may be a part of compensation. N = claim is not part of compensation. |
|
facilityId |
M | M | M | M | M | 8 alphanumeric characters | 9988770W | The Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility. The value supplied must be in the format of Provider stem (6 digit number), 1 Practice Location character, 1 Check Digit (similar to medicare provider numbers). Must be filled with leading zeros if the provider number is greater than 2 characters but less than 8 characters. | |
fundPayeeId |
O | O | O | 1-12 alphanumeric characters. | abc12345 | The Private Health Insurer Agreement identifier for the practitioner (used to map Fund payment arrangement details). | Fund Payee Id must only be set when Claim Type Code is set to AG (Agreement), SC (Scheme) or MB (Billing Agent). | ||
| Medical event - one or more required | |||||||||
medicalEvents.id |
M | M | M | M | M | 1 or 2 numeric | 1 | sequential number for each medical event starting with 1. All services within a medical event must use the same ID. Each medical event must have a unique ID. | |
medicalEvents.admissionDateString |
C | C | C | C | C | YYYY-MM-DD | 2020-07-23 | The date the patient was admitted to hospital. | • Must not be a date in the future. • Must not be before the Patient Date of Birth. |
medicalEvents.dischargeDateString |
C | C | C | C | C | YYYY-MM-DD | 2020-07-23 | The date the patient was discharged from hospital. | • If set, Admission Date must also be set. • Must not be a date in the future. |
medicalEvents.financialInterestDisclosureInd |
O | M | O | O | O | boolean | Y | Indicates that the health professional providing hospital treatment or associated professional attention under a gap cover scheme has disclosed to the insured person any financial interest they have in any products or services recommended or given to the insured person. Y = Financial Interest Disclosed. |
Must be set to Y if Claim Type Code is set to SC. |
medicalEvents.ifcIssueCode |
M | M | O | O | O | Valid values only | W | Informed financial consent as one of: V = Verbal W = In writing, where appropriate N = Not issued X = Not obtained |
• Must be set to V, W or X if Claim Type Code is set to AG. • Must be set to W or X if Claim Type Code is set to SC. |
medicalEvents.referral.issueDateString |
C | C | C | C | C | YYYY-MM-DD | 2020-07-23 | Date of referral/request issuance in YYYY-MM-DD. Only used where referral is required. | • must be a valid date • must be greater than or equal to the Patient dob • must be present if Referral details supplied • must not be a date in the future • must not be after each serviceDate • must be present for referred services |
medicalEvents.referral.period |
C | C | C | C | C | 1 or 2 numeric | 10 | For non-standard referral periods only, the number of months for referral validity. Numeric two digits from 01-97. Note: not applicable for Pathology or Diagnostic Imaging referrals and should not be set for those claims. |
• must be present if Referral details supplied, unless for Pathology or Diagnostic Imaging claims. • If N or I, details are required in serviceText. • Do not set for Pathology or Diagnostic Imaging claims. |
medicalEvents.referral.periodCode |
C | C | C | C | C | Valid values only | S | Period type code as defined by Medicare and only used where referral is used. Valid values: • S: Standard – 12 months for GP or 3 months for Specialist referrals (Default value) • N: Non-standard, if set must supply duration in serviceText field • I: Indefinite Note: referral period is not applicable for Pathology or Diagnostic Imaging referrals and should not be set for those claims. |
• must be present if Referral details supplied, unless for Pathology or Diagnostic Imaging claims. • If N or I, details are required in serviceText. • Do not set for Pathology or Diagnostic Imaging claims. |
medicalEvents.referral.providerNumber |
C | C | C | C | C | Up to 8 alphanumeric characters | 4452232B | Referring provider number. Note this must be a valid provider number, but the provider number does not need to be registered with Tyro Health Online. | • must be present if Referral details supplied • must be a valid provider number |
medicalEvents.referral.referralTypeCode |
C | C | C | C | C | Valid values only | S | Set as one of: • D: Diagnostic Imaging, including Radiology • P: Pathology • S: Specialist, including allied health |
• must be present if Referral details supplied |
medicalEvents.referralOverrideCode |
C | C | C | C | C | Valid values only | H | Only for exception claims normally requiring a referral. One of: • H: Hospital in-patient referral • E: Emergency • L: Lost • N: Not required, non-standard referral • O: Omitted, referral object not set (may be required for self deemed services) |
• Only used where referral normally required and replaces referral details. • If Referral Override Code is set to H (Hospital) then Hospital Indicator must be set to Y (In Hospital) for OVS claims |
medicalEvents.services.reference |
O | O | O | O | O | Up to 128 alphanumeric characters | 01 | Line item reference as nominated by you. Assists with reconciliation where multiple of the same item code and service date are claimed. | • This reference should be unique within a given invoice. |
medicalEvents.services.accessionDateString |
O | O | O | O | O | Date | 2021-02-21 | Date for pathology test. Only for pathology services. The format is YYYY-MM-DD. | • Must not be equal to or less than service date • Must not be prior to patient date of birth • Must not be future dated • Value must be Australian time zone |
medicalEvents.services.accessionTimeString |
O | O | O | O | O | Time | 17:30 | Time for a pathology test. Only for pathology services. The format is HH:MM | • Must not be equal to or less than service date • Must not be prior to patient date of birth • Must not be future dated • Value must be Australian time zone |
medicalEvents.services.aftercareOverrideInd |
O | O | O | O | O | boolean | true | Indicates whether the service was performed as part of normal aftercare for the patient. Valid values: true = Not Normal Aftercare. Default is not set. | • Only applicable for General or Specialist Services. |
medicalEvents.services.collectionDateString |
O | O | O | O | O | Date | 2021-02-26 | The pathology sample was taken from the patient. The format is YYYY-MM-DD. | • Must not be after accession date time • If set, Accession date time must be set • Must not be prior to patient date of birth • Must not be prior to referral issue date • Value must be Australian time zone |
medicalEvents.services.collectionTimeString |
O | O | O | O | O | Time | 17:30 | The time pathology sample was taken from the patient. The format is HH:MM. | • Must not be after accession date time • If set, Accession date time must be set • Must not be prior to patient date of birth • Must not be prior to referral issue date • Value must be Australian time zone |
medicalEvents.services.duplicateServiceOverrideInd |
O | O | O | O | O | boolean | Y | Indicates whether multiple services performed on the same day, by the same Service provider and should be treated as separate services. Valid values: Y = duplicate service override. Default is not set. | • If the Duplicate Service Override Indicator is set to true (Not Duplicate) then serviceTime or additional information in serviceText is required to support the reason for the override. • Only applicable for General or Specialist Services. |
medicalEvents.services.fieldQuantity |
O | O | O | O | O | 3 numbers | 060 | Time duration in minutes. In 15 minute intervals only. | • Only applicable for General or Specialist Services. |
medicalEvents.services.itemCode |
M | M | M | M | M | Up to 5 numbers | 23 | Any valid Medicare supported MBS code for a given date of service. | • Only valid MBS items for a given serviceDate can be processed. |
medicalEvents.services.lspNumber |
O | O | O | O | O | 1 or 2 numbers, 1-99 | 4 | The number of fields irradiated or the quantity of (15 minute) time blocks or derived fee intrathecal or epidural infusion services (e.g. items 18219 and 18227). | • Only applicable for General or Specialist Services. • Field Quantity and Number of Patients Seen or Time Duration must not be set against the same service. |
medicalEvents.services.multipleProcedureOverrideInd |
O | O | O | O | O | boolean | Y | Indicates whether the multiple services rule must or must not be applied to the service being claimed. Valid values: true, Not Multiple. Default is not set. | • Only applicable for General or Specialist Services. • If Multiple Procedure Override Indicator is set to true (Not Multiple) then must list serviceText providing the reason |
medicalEvents.services.numberOfPatientsSeen |
O | O | O | O | O | 1 or 2 numbers, 1-99 | 2 | The number of patients seen. Must be set for group attendance items (e.g. counseling) or visits (home, hospital or institution) to ensure the correct payment is made. | • Only applicable for General or Specialist Services. • Number of Patients Seen and Time Duration must not be set against the same service |
medicalEvents.services.price |
M | M | M | M | M | Currency notation, up to 5 numeric and 2 decimal digits | 50.67 | Charge amount for the service. | |
medicalEvents.services.restrictiveOverrideCode |
O | Valid values only | SP | This code is used to allow payment for services where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history. Valid values: • SP: Separate Sites • NR: Not Related to consult • NC: Not for Comparison |
|||||
medicalEvents.services.rule3ExemptInd |
O | O | O | O | O | boolean | Y | Indicates if the pathology service is exempt from Rule 3 in the MBS. When set to true, the item is yes, exempt. Default is not set. | • Must only be set when provider is Pathology • If Rule 3 Exempt Indicator is set, serviceTime must be set. |
medicalEvents.services.s4b3ExemptInd |
O | O | O | O | O | boolean | Y | Indicates if the pathology service is exempt from assessing in accordance with the S4b3 requirements in the MBS. When set to true, the item is yes, exempt. Default is not set. | • The value supplied must be set to true to indicate Pathology Service is exempt from S4b3 assessing requirements • Must only be set when provider is Pathology • If set, Hospital Indicator must be set to true • Must not be set if Rule 3 Exempt Indicator is set |
medicalEvents.services.scpId |
O | O | O | O | O | 3-5 alphanumeric values | 014 | The Specimen Collection Point ID is used to identify the site where the pathology specimen was collected. The value supplied must be alpha (A-Z) or numeric (0- 9) and three to five characters long. Value must not be set to or equal zero. Leading zeros for values less than 5 characters, are acceptable e.g. 001, 0001 or 00001. | • Specimen Collection Point Id (SCPId) must only be set when provider is Pathology |
medicalEvents.services.selfDeemedCode |
O | O | O | O | O | Valid values only | SD | A Self Deemed service is an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested. Valid values: • SD: Self Deemed • SS: Substituted Service |
• Self Deemed Code must not be set when Referral Override Code is set |
medicalEvents.services.serviceDateString |
M | M | M | M | M | YYYY-MM-DD | 2020-08-25 | Date of service in YYYY-MM-DD format. | • must be a valid date • must be within 2 years as at date of submission • must not be future dated • must not be before patient date of birth |
medicalEvents.services.serviceText |
O | O | O | O | O | Up to 50 alphanumeric characters | Free text for additional information on claim assessment. Usually used for claims with exceptions - will be reviewed by Medicare staff. | • The value supplied must be alpha (A-Z and a- z), numeric (0-9), space ( ), and special characters @ # $ % + = : ; , . -. • Spaces must not appear before or after other spaces or the supplied value. |
|
medicalEvents.services.serviceTimeString |
O | O | O | O | O | HH:MM | 14:25 | Time of service in 24 hour format: HH:MM as in Australian time zone. Used if multiple of the same items claimed on the same day, by the same provider, for the same patient. | • The time supplied must reflect the time zone in Australia, the transaction was created in. |
medicalEvents.services.timeDuration |
O | O | O | O | O | 3 numbers | 060 | Time duration in minutes. 0-999 | • Only applicable for General or Specialist Services. |
medicalEvents.serviceProvider.providerNumber |
M | M | M | M | M | 8 alphanumeric characters | 2429581T | The provider number of the medical practitioner rendering the service(s) (as allocated by Medicare). | • Provider number must be registered with Tyro Health Online and enabled for Medicare. |
principalProvider.providerNumber |
M | M | M | M | M | Up to 8 alphanumeric characters | 3452232B | Benefits will be paid to the Principle Provider's bank account unless a billing agent is used. Note: this provider number must also be registered and active with Tyro Health Online. Can be different from the servicing provider. | • A unique invoice can include only one Principle Provider. • Provider number must be registered with Tyro Health Online and enabled for Medicare. |
senderContact.emailAddress |
O | O | O | O | O | Email address | sd@Tyro Health Online.io | Email address of the sender. | |
senderContact.name |
O | O | O | O | O | 1 to 40 characters | Sandra Day | Name of contact at claim submission site to be contacted should clarification about claim details be required. | • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
senderContact.phoneNumber |
O | O | O | O | O | Mobile number | 0411111111 | Phone number of contact at claim submission site to be used should clarification about claim details be required. Only numeric characters 0-9, spaces and certain special characters ( ) - + are acceptable. |
|
serviceTypeCode |
M | M | M | M | M | Valid values only | S | Indicates the type of service that makes up the claim. All Item numbers within the claim must be consistent with the Service Type selected. One of: • O = General • P = Pathology services • S = Specialist (inc Diagnostic Imaging) |
|
submissionAuthorityInd |
M | boolean | Y | Indicates the patient/claimant has authorised the practice location to submit the claim on their behalf. | Must be set when Claim Type Code is set to PC. |
OVS CLAIMS
| Field | AG | SC | MB | PC | Format | Example value | Notes | Key constraints |
|---|---|---|---|---|---|---|---|---|
funder |
M | M | M | M | Valid values only | eclipse | use eclipse for all eclipse transactions |
|
sequenceNumber |
O | O | O | O | Valid values only | 1 | ||
invoiceReference |
M | M | M | M | Up to 16 characters | 20200901ABCD | Your unique invoice/transaction reference. Typically generated from a practice management or accounting system. This value will be traced through to settlement reporting and is separate from any funder defined transaction identifier or claim reference. Where multiple service items exist for an invoice, all rows for a unique invoiceReference will be grouped into a single invoice and the first occurrence of repeating invoice level (but not service level) details will be used. Note: these rows should be grouped sequentially. |
• Must be unique for an invoice/claim in a single batch file. • Should be globally unique across the business for search and reporting purposes. |
| Patient details | ||||||||
patient.identity.dobString |
M | M | M | M | YYYY-MM-DD | 2010-09-01 | Date of birth in YYYY-MM-DD format. | For Medicare patient claims, if patient is <15 years old as at each serviceDate, an adult =>18 years old claimant is required. • must be a valid date • must not be a date in the future • must not be after each serviceDate |
patient.identity.firstName |
M | M | M | M | 1 to 40 characters | Mila | Patient first / given name as registered with funder. If patient has only one name, use "Onlyname" as placeholder in firstName field. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.identity.lastName |
M | M | M | M | 1 to 40 characters | Willis | Patient last / family name as registered with funder. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.identity.refId |
O | O | O | O | Up to 128 characters | 3DE2D2BC-17CC-4978-A79D-2151DC417B2F | A unique patient identifier - such as a UUID - generated by your system. Used for searching and reporting on transactions by patient in Tyro Health Online and for support purposes. Setting a unique refId per patient is highly recommended. If provided, future transactions can be processed using refId rather than providing patient and health fund account details. Any differing patient details for a given refId will update the patient record on Tyro Health Online. |
• A unique invoice can include only one patient. |
patient.identity.secondInitial |
O | O | O | O | One character | P | The first initial of the patient's second given name. Alpha (A-Z, a-z) | |
patient.medicareHealthFundAccount.cardRank |
Either 1 or 2 numbers | 1 | Individual patient reference number (IRN), one digit of 1-9, as noted on physical card. | |||||
patient.medicareHealthFundAccount.membershipNumber |
10 digits | 2953878061 | Medicare card number, 10 digits | The value must adhere to Medicare Card check digit routine. | ||||
patient.medicareHealthFundAccount.sex |
Valid values only | F | Patient sex, as one of: • M: Male • F: Female • O: Other • Null: Not stated/inadequately described (default value) |
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patient.phiHealthFundAccount.cardRank |
M | M | M | M | Either 1 or 2 numbers | 1 | Private insurance patient reference (UPI) or card rank, two digits as noted on physical card. Numeric, 0-99 with or without leading zeros. | |
patient.phiHealthFundAccount.firstName |
O | O | O | O | 1 to 40 characters | Mia | The patient's first given name as known by the Health Fund if different to Medicare. | • A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.phiHealthFundAccount.lastName |
O | O | O | O | 1 to 40 characters | Wilis | The patient's family name as known by the Health Fund if different to Medicare. | A unique invoice can include only one patient. • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
patient.phiHealthFundAccount.membershipNumber |
M | M | M | M | 1-19 alphanumeric characters | 88812345 | Patient's Health Fund Membership or Card number. | |
accident.accidentInd |
M | M | M | M | boolean | N | Indicates whether or not the associated information relates to the patient experiencing an accident. | |
accountPaidInd |
M | M | M | M | boolean | N | Indicates whether or not an account has been paid in full. | Must not be set to Y when Claim Type Code is set to AG, SC, MB or MO. |
accountReferenceId |
M | M | M | M | 1-20 alphanumeric characters | 19-1125B | Account Reference (ACRF). A reference used by the claim submitter to identify a claim. | • The value supplied must be alpha (A-Z and a-z), numeric (0-9) only. • Spaces must not appear before or after other spaces or the supplied value. • Must be 1 to 20 characters when Claim Type Code is set to AG, SC, MB or MO. • Must be 1 to 9 characters when Claim Type Code is set to PC. |
benefitAssignmentAuthorisedInd |
boolean | Y | Indicates that the patient has authorised the assignment of their right of benefit to a billing agent. | • Must not be set when Claim Type Code is set to AG, SC or PC. • Must be set to Y when Claim Type Code is set to MB or MO to submit the claim. |
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| Principal provider & location details | ||||||||
billingAgent.providerNumber |
O | O | M | 8 alphanumeric characters | 3539440H | The provider number of the billing agent. This is used to direct payments. | ||
claimTypeCode |
M | M | M | M | Valid values only | AG | Claim processing class as one of: • AG = Agreement • SC = Scheme • MB = Billing Agent • MO = Medicare Only • PC = Patient Claim |
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compensationClaimInd |
M | M | M | M | boolean | N | Indicates whether or not the claim contains services that are subject to a compensation claim: Y = Claim may be a part of compensation. N = claim is not part of compensation. |
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facilityId |
M | M | M | M | 8 alphanumeric characters | 9988770W | The Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility. The value supplied must be in the format of Provider stem (6 digit number), 1 Practice Location character, 1 Check Digit (similar to medicare provider numbers). Must be filled with leading zeros if the provider number is greater than 2 characters but less than 8 characters. | |
fundPayeeId |
O | O | O | 1-12 alphanumeric characters. | abc12345 | The Private Health Insurer Agreement identifier for the practitioner (used to map Fund payment arrangement details). | Fund Payee Id must only be set when Claim Type Code is set to AG (Agreement), SC (Scheme) or MB (Billing Agent). | |
| Medical event - one or more required | ||||||||
medicalEvents.id |
M | M | M | M | 1 or 2 numeric | 1 | sequential number for each medical event starting with 1. All services within a medical event must use the same ID. Each medical event must have a unique ID. | |
medicalEvents.admissionDateString |
C | C | C | C | YYYY-MM-DD | 2020-07-23 | The date the patient was admitted to hospital. | • Must not be a date in the future. • Must not be before Patient Date of Birth. |
medicalEvents.dischargeDateString |
C | C | C | C | YYYY-MM-DD | 2020-07-23 | The date the patient was discharged from hospital. | • If set, Admission Date must also be set. • Must not be a date in the future. |
medicalEvents.financialInterestDisclosureInd |
O | M | O | O | boolean | Y | Indicates that the health professional providing hospital treatment or associated professional attention under a gap cover scheme has disclosed to the insured person any financial interest they have in any products or services recommended or given to the insured person. Y = Financial Interest Disclosed. |
Must be set to Y if Claim Type Code is set to SC. |
medicalEvents.ifcIssueCode |
M | M | O | O | Valid values only | W | Informed financial consent as one of: V = Verbal W = In writing, where appropriate N = Not issued X = Not obtained |
• Must be set to V, W or X if Claim Type Code is set to AG. • Must be set to W or X if Claim Type Code is set to SC. |
medicalEvents.referral.issueDateString |
C | C | C | C | YYYY-MM-DD | 2020-07-23 | Date of referral/request issuance in YYYY-MM-DD. Only used where referral is required. | • must be a valid date • must be greater than or equal to the Patient dob • must be present if Referral details supplied • must not be a date in the future • must not be after each serviceDate • must be present for referred services |
medicalEvents.referral.period |
C | C | C | C | 1 or 2 numeric | 10 | For non-standard referral periods only, the number of months for referral validity. Numeric two digits from 01-97. Note: not applicable for Pathology or Diagnostic Imaging referrals and should not be set for those claims. |
• must be present if Referral details supplied, unless for Pathology or Diagnostic Imaging claims. • If N or I, details are required in serviceText. • Do not set for Pathology or Diagnostic Imaging claims. |
medicalEvents.referral.periodCode |
C | C | C | C | Valid values only | S | Period type code as defined by Medicare and only used where referral used. Valid values: • S: Standard – 12 months for GP or 3 months for Specialist referrals (Default value) • N: Non-standard, if set must supply duration in serviceText field • I: Indefinite Note: referral period is not applicable for Pathology or Diagnostic Imaging referrals and should not be set for those claims. |
• must be present if Referral details supplied, unless for Pathology or Diagnostic Imaging claims. • If N or I, details are required in serviceText. • Do not set for Pathology or Diagnostic Imaging claims. |
medicalEvents.referral.providerNumber |
C | C | C | C | Up to 8 alphanumeric characters | 4452232B | Referring provider number. Note this must be a valid provider number, but the provider number does not need to be registered with Tyro Health Online. | • must be present if Referral details supplied • must be a valid provider number |
medicalEvents.referral.referralTypeCode |
C | C | C | C | Valid values only | S | Set as one of: • D: Diagnostic Imaging, including Radiology • P: Pathology • S: Specialist, including allied health |
• must be present if Referral details supplied |
medicalEvents.referralOverrideCode |
C | C | C | C | Valid values only | H | Only for exception claims normally requiring a referral. One of: • H: Hospital in-patient referral • E: Emergency • L: Lost • N: Not required, non-standard referral • O: Omitted, referral object not set (may be required for self deemed services) |
• Only used where referral normally required and replaces referral details. • If Referral Override Code is set to H (Hospital) then Hospital Indicator must be set to Y (In Hospital) for OVS claims |
medicalEvents.services.reference |
O | O | O | O | Up to 128 alphanumeric characters | 01 | Line item reference as nominated by you. Assists with reconciliation where multiple of the same item code and service date claimed. | • This reference should be unique within a given invoice. |
medicalEvents.services.accessionDateString |
Date | 2021-02-21 | Date for pathology test. Only for pathology services. The format is YYYY-MM-DD. | • Must not be equal to or less than service date • Must not be prior to patient date of birth • Must not be future dated • Value must be Australian time zone |
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medicalEvents.services.accessionTimeString |
Time | 17:30 | Time for pathology test. Only for pathology services. The format is HH:MM | • Must not be equal to or less than service date • Must not be prior to patient date of birth • Must not be future dated • Value must be Australian time zone |
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medicalEvents.services.aftercareOverrideInd |
boolean | true | Indicates whether the service was performed as part of normal aftercare for the patient. Valid values: true = Not Normal Aftercare. Default is not set. | • Only applicable for General or Specialist Services. | ||||
medicalEvents.services.collectionDateString |
Date | 2021-02-26 | Date the pathology sample was taken from patient. The format is YYYY-MM-DD. | • Must not be after accession date time • If set, Accession date time must be set • Must not be prior to patient date of birth • Must not be prior to referral issue date • Value must be Australian time zone |
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medicalEvents.services.collectionTimeString |
Time | 17:30 | Time the pathology sample was taken from patient. The format is HH:MM. | • Must not be after accession date time • If set, Accession date time must be set • Must not be prior to patient date of birth • Must not be prior to referral issue date • Value must be Australian time zone |
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medicalEvents.services.duplicateServiceOverrideInd |
O | O | O | O | boolean | Y | Indicates whether multiple services performed on the same day, by the same Service provider and should be treated as separate services. Valid values: Y = duplicate service override. Default is not set. | • If Duplicate Service Override Indicator is set to true (Not Duplicate) then serviceTime or additional information in serviceText is required to support the reason for the override. • Only applicable for General or Specialist Services. |
medicalEvents.services.fieldQuantity |
3 numbers | 060 | Time duration in minutes. In 15 minute intervals only. | • Only applicable for General or Specialist Services. | ||||
medicalEvents.services.itemCode |
M | M | M | M | Up to 5 numbers | 23 | Any valid Medicare supported MBS code for a given date of service. | • Only valid MBS items for a given serviceDate can be processed. |
medicalEvents.services.lspNumber |
1 or 2 numbers, 1-99 | 4 | The number of fields irradiated or the quantity of (15 minute) time blocks or derived fee intrathecal or epidural infusion services (e.g. items 18219 and 18227). | • Only applicable for General or Specialist Services. • Field Quantity and Number of Patients Seen or Time Duration must not be set against the same service. |
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medicalEvents.services.multipleProcedureOverrideInd |
O | O | O | O | boolean | Y | Indicates whether the multiple services rule must or must not be applied to the service being claimed. Valid values: true, Not Multiple. Default is not set. | • Only applicable for General or Specialist Services. • If Multiple Procedure Override Indicator is set to true (Not Multiple) then must list serviceText providing the reason |
medicalEvents.services.numberOfPatientsSeen |
O | O | O | O | 1 or 2 numbers, 1-99 | 2 | The number of patient’s seen. Must be set for group attendance items (e.g. counseling) or visits (home, hospital or institution) to ensure the correct payment is made. | • Only applicable for General or Specialist Services. • Number of Patients Seen and Time Duration must not be set against the same service |
medicalEvents.services.price |
M | M | M | M | Currency notation, up to 5 numeric and 2 decimal digits | 50.67 | Charge amount for the service. | |
medicalEvents.services.restrictiveOverrideCode |
Valid values only | SP | This code is used to allow payment for services where the account provides indication that the service is not restrictive with another service either within the same claim or on the patient history. Valid values: • SP: Separate Sites • NR: Not Related to consult • NC: Not for Comparison |
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medicalEvents.services.rule3ExemptInd |
boolean | Y | Indicates if the pathology service is exempt from Rule 3 in the MBS. When set to true, the item is yes, exempt. Default is not set. | • Must only be set when provider is Pathology • If Rule 3 Exempt Indicator is set, serviceTime must be set. |
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medicalEvents.services.s4b3ExemptInd |
boolean | Y | Indicates if the pathology service is exempt from assessing in accordance with the S4b3 requirements in the MBS. When set to true, the item is yes, exempt. Default is not set. | • The value supplied must be set to true to indicate Pathology Service is exempt from S4b3 assessing requirements • Must only be set when provider is Pathology • If set, Hospital Indicator must be set to true • Must not be set if Rule 3 Exempt Indicator is set |
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medicalEvents.services.scpId |
3-5 alphanumeric values | 014 | The Specimen Collection Point ID is used to identify the site where the pathology specimen was collected. The value supplied must be alpha (A-Z) or numeric (0- 9) and three to five characters long. Value must not be set to or equal zero. Leading zeros for values less than 5 characters, are acceptable e.g. 001, 0001 or 00001. | • Specimen Collection Point Id (SCPId) must only be set when provider is Pathology | ||||
medicalEvents.services.selfDeemedCode |
O | O | O | O | Valid values only | SD | A Self Deemed service is an additional service to a valid request. A substituted service is a service provided that has replaced the original service requested. Valid values: • SD: Self Deemed • SS: Substituted Service |
• Self Deemed Code must not be set when Referral Override Code is set |
medicalEvents.services.serviceDateString |
M | M | M | M | YYYY-MM-DD | 2020-08-25 | Date of service in YYYY-MM-DD format. | • must be a valid date • must be within 2 years as at date of submission • must not be future dated • must not be before patient date of birth |
medicalEvents.services.serviceText |
O | O | O | O | Up to 50 alphanumeric characters | Free text for additional information on claim assessment. Usually used for claims with exceptions - will be reviewed by Medicare staff. | • The value supplied must be alpha (A-Z and a- z), numeric (0-9), space ( ), and special characters @ # $ % + = : ; , . -. • Spaces must not appear before or after other spaces or the supplied value. |
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medicalEvents.services.serviceTimeString |
O | O | O | O | HH:MM | 14:25 | Time of service in in 24 hour format: HH:MM as in Australian time zone. Used if multiple of same items claimed on same day, by same provider, for same patient. | • The time supplied must reflect the time zone in Australia, the transaction was created in. |
medicalEvents.services.timeDuration |
O | O | O | O | 3 numbers | 060 | Time duration in minutes. 0-999 | • Only applicable for General or Specialist Services. |
medicalEvents.serviceProvider.providerNumber |
M | M | M | M | 8 alphanumeric characters | 2429581T | The provider number of the medical practitioner rendering the service(s) (as allocated by Medicare). | • Provider number must be registered with Tyro Health Online and enabled for Medicare. |
principalProvider.providerNumber |
M | M | M | M | Up to 8 alphanumeric characters | 3452232B | Benefits will be paid to the Principle Provider's bank account unless billing agent used. Note: this provider number must also be registered and active with Tyro Health Online. Can be different from the servicing provider. | • A unique invoice can include only one Principle Provider. • Provider number must be registered with Tyro Health Online and enabled for Medicare. |
senderContact.emailAddress |
O | O | O | O | Email address | sd@Tyro Health Online.io | Email address of the sender. | |
senderContact.name |
O | O | O | O | 1 to 40 characters | Sandra Day | Name of contact at claim submission site to be contacted should clarification about claim details be required. | • Can only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe (') and hyphen (- ) characters • Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. • At least one alpha or numeric character required. |
senderContact.phoneNumber |
O | O | O | O | Mobile number | 0411111111 | Phone number of contact at claim submission site to be used should clarification about claim details be required. Only numeric characters 0-9, spaces and certain special characters ( ) - + are acceptable. |
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serviceTypeCode |
M | M | M | M | Valid values only | S | Indicates the type of service that makes up the claim. All Item numbers within the claim must be consistent with the Service Type selected. One of: • O = General • P = Pathology services • S = Specialist (inc Diagnostic Imaging) |
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submissionAuthorityInd |
M | boolean | Y | Indicates the patient/claimant has authorised the practice location to submit the claim on their behalf. | Must be set when Claim Type Code is set to PC. |