For all Medicare transactions, it's important the patient and/or claimant details match exactly to that listed on a Medicare card rather than what may be recorded in your system. Tyro Health Online will prompt the user to verify and update details where account details vary from those registered with Medicare.
Creating a transaction
Use function:
To process a Medicare insurance claim, the following fields apply. Any required field not passed to the SDK will be prompted at the TyroHealth submission page.
Required column values:
| Value | Description |
|---|---|
| M | Mandatory |
| O | Optional |
| C | Conditional |
| Field | Type/Format | Required | Description | Example |
|---|---|---|---|---|
funder | String | M | Set to Medicare for Medicare claims | Medicare |
providerNumber | String | M | Medicare Provider Number. Should be 8 characters alpha-numeric | 2429591L |
invoiceReference | String | M | Provider nominated unique transaction reference number, such as an invoice number from the practice management or accounting system. Up to 16 characters | 20200901ABCD |
benefitPayee {} object - Only applicable for bulk bill claims | ||||
benefitPayee.providerFullName | String | O | Full name of the payee provider. Only applicable for bulk bill claims. The servicing provider and payee provider cannot be the same. | Dr Jane Smith |
benefitPayee.providerNumber | String | O | Medicare Provider Number of the payee provider. Should be 8 characters alpha-numeric | 2409661B |
patient {} object | ||||
patient.firstName | String Up to 40 characters | M | Patient first name as registered with Medicare. Middle name is not supported. If the patient has only one name, then set name in lastName field and set firstName to "Onlyname". | Emily |
patient.lastName | String Up to 40 characters | M | Patient last name as registered with Medicare. | Harris |
patient.mobile | String | O | The mobile phone number of the patient. Can be either international notation: +61411111111 or national notation: 0411111111 | +61411111111 |
patient.dob | String YYYY-MM-DD | M | Patient/employee's Date of Birth in 'YYYY-MM-DD' format. • must be a valid date• must not be a date in the future• must not be after each serviceDate For Medicare patient claims, if the patient is <15 years old as at each serviceDate, an adult =>18 years old claimant is required. | 1988-03-29 |
patient.accountNumber | String | M | Unique Medicare issued account number for patient. Maps to: medicareNumber | 2123456789 |
patient.reference | String | O | Unique patient reference with Medicare. Maps to: medicareReferenceNumber (Medicare) | 1 |
patient.email | String | O | Any valid email address. Used for receipts and statements. | mw@tyro.io |
patient.usePatientPaymentMethod | Boolean | O | If set to true the patients payment method will be used | true |
OR | ||||
patient.refId | String | O | An optional but recommended patient unique reference as set by you, such as a UUID. This value is used to uniquely identify a patient in Tyro Health Online. Omitting refId will cause duplicate patient records to be created and could make patient searches more difficult for providers who also use the Tyro Health Online portal to check on status of a claim and remittance. If supplied and valid, this value will pre-populate patient details from the patient record in the business as set in any prior claim. Any patient details sent for an existing patient record will update those values. | 5AD5E2AF-69D2-43D3-9321-428495205E5E |
claimableItems [] array - Array of fund claimable items | ||||
claimableItems[].itemCode | String Up to 8 characters | M | Medicare supported pay code which include MBS items. Item code must be valid for Medicare, the provider registered profession and service date. | 104 |
claimableItems[].serviceDate | String YYYY-MM-DD | M | Date of the service in 'YYYY-MM-DD' format. | 2022-01-12 |
claimableItems[].item.price | String Currency notation | M | Item per unit pricing in $XX.XX format. Net (excluding GST) price each unit in $XX.XX format. Charge amount for the service. For bulk bill, this is normally the same as MBS benefit amount. Note that in bulk bill claims, Medicare will pay the MBS benefit amount which can be greater than the amount charged. The minimum charge amount is $1 | $15.95 |
funderData {} object | ||||
funderData.medicare {} object | ||||
funderData.medicare.claimType | String Up to 8 characters | O | bulkbill claim or patient claim | bulkbill |
funderData.medicare.lspNumber | String | O | Location Specific Practice Number. lsp Number may be required for diagnostic imaging items. When set, this value will be set on all claimed items. | 01 |
funderData.medicare.isInHospital | Boolean | O | Set to true for admitted patient services. Defaults to false. Value applied for all claimed item. | True |
funderData.medicare.facilityId | String | O | When isInHospital set to true, the Commonwealth Hospital Facility ID must be supplied which shares same format as a Medicare issued providerNumber. | 9988770W |
funderData.medicare.referral.providerNumber | String | O | Referring provider number - usually a Medicare issued number. | 2054781W |
funderData.medicare.referral.providerName | String | O | Name of the referring provider. | Dr Jane Smith |
funderData.medicare.referrerType | String | O | Type of the referring provider. 'gp' or 'specialist'. | GP |
funderData.medicare.referral.issueDateString | String YYYY-MM-DD | O | Issue date of the referral in YYYY-MM-DD format. | 2019-01-25 |
funderData.medicare.referral.period | String | O | Period of the referral. Can be: 'standard', 'non-standard', 'indefinite' | standard |
funderData.medicare.referral.periodDescription | Number | O | Number of months if referral.period is set to 'non-standard' | 2 |
funderData.medicare.nonReferral.reason | String | O | Only for exception claims normally requiring a referral. One of:• E: Emergency• H: Hospital in-patient referral (isInHospital should be Y for all services)• L: Lost• N: Not required, non-standard referral• 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) and a facilityId should be set | E |
funderData.medicare.nonReferral.description | String Up to 40 alpha characters | O | Description of non-referral reason. Where:• H: name of hospital• L: supporting text Must be present if nonReferral details supplied 'non-standard' | Lost referral letter |
funderData.medicare.claimant.firstName | String | O | Claimant first name as displayed on Medicare card. Middle name is not supported. If a patient has only one name, set the first name field to 'Onlyname' and set name in lastName. | Dominic |
funderData.medicare.claimant.lastName | String | O | Claimant last name as displayed on Medicare card. | Harris |
funderData.medicare.claimant.mobile | String | O | Mobile Phone number of the claimant | +61411111111 |
funderData.medicare.claimant.dob | String YYYY-MM-DD | O | Claimant Date of Birth in 'YYYY-MM-DD' format. | 1967-11-22 |
funderData.medicare.claimant.accountNumber | String | O | Claimant Medicare card number. | 2123456789 |
funderData.medicare.claimant.reference | String | O | Claimant Individual Reference Number from Medicare card eg 1, 2 etc. This number appears on the left of the cardholder's name on the medicare card and distinguishes the individuals named on the card. | 1 |
Or | ||||
funderData.medicare.claimantPatientId | String | O | Alternative claimant patient identifier | 5AD5E2AF-69D2-43D3-9321-428495205E5E |
Claimable items Additional item attributes such as admitted patient indicator, service text, Number Of Patients Seen and Duplicate Service Overrides can be set in the Tyro Health Online UI. A maximum of 16 items are permitted for patient claims and 80 items per bulk bill claim.