Claim flows and states
Once successfully submitted, a claim will be categorised into one of the following status:
| Status | Description |
|---|---|
| Medicare has responded with Under Review. The Tyro Health transaction will be in this state until Medicare has reviewed it and responded later with Accepted, Partially Accepted, or Rejected. | |
| One or more claim items accepted and approved by Medicare. Settlement not yet issued to provider. | |
| An Approved claim where payment has been issued by Tyro Heath to the provider. | |
| Medicare has responded with Rejected. Tyro Health will not payout the claim | |
| Tyro health have initiated a cancellation request on the claim and Medicare have responded with a successful cancellation |
If multiple service items are claimed the invoice will still transition to completed if at least one claim item is approved.
Some claims will be processed instantly by Medicare using their straight-through adjudication method. Those claims will return an approved or declined status within 30 seconds and the SDK will return that status via a callback.
However, partners will need to accommodate claims which undergo manual review and status updates hours to days post submission. For each claim, a partner can nominate one or more webhooks which fire depending on the claim status. Each successfully submitted claim will also return, via SDK callback, a Tyro Health unique transaction Id which can be used to periodically poll for current status.