Medicare testing

This page includes test data and other information to make sure your integration works as planned. It can be used to trigger different flows in your integration and ensure they are handled accordingly.

Test data:

Claims submitted to Medicare are validated by medicare number and patient details.

Valid patient test details include:

Medicare card Individual reference Last name First name Date of birth
6950507392 1 HENDRIX FELICA 14/04/1975
2950975362 1 HEATH KYM 22/02/1983
6950507482 1 CONNOR CLAUDIA 25/11/1998
3950387652 1 BAXTER CORAZON 28/12/1983
2951201842 1 ARTHUR MADELAINE 15/01/1987
2951201842 2 ARTHUR CHANTELLE 02/01/1986
2951201842 3 ARTHUR FRANCIS 13/02/2012
2951201842 4 ARTHUR DIMITY 10/02/2011

Alternative/exception patient test details include:

Medicare card Individual reference Last name First name Date of birth Enrollment type
2297460336 1 Devo Onlyname 1/1/1980 Only Name
2298039874 1 Jones Marrianna-Louise 19/05/1967 Long First Name
2298325524 1 Thompson-Blackwood Annette 15/08/2009 Long Name
2297582343 1 Xpatriot English 15/09/1975 Long First Name
2297402204 2 Foreigner French 16/05/1980 Expired RHCA
5500393923 4 Boyes Simon 23/05/1980 Lost card
2950862041 2 Jones Happy 4/5/1964 Transferred to a different card, Old card quoted.
2296510126 4 Jones Sad 15/09/1964 Deceased (20112008)
2398125261 1 Doe John 13/09/1979 Unknown on Medicare Australia systems
2298264833 1 Watts Gregory 12/5/1970 Unknown on Medicare Australia systems
2295919745 1 Davis Eva 2/5/1979 Safety Net Patient - concession entitled

Concession details:

Medicare card Individual reference Last name First name Date of birth Enrollment Id Enrollment type
2293653284 1 Leonard Bobby 10/02/1958 100015482A Concession Entitled

Provider details

To get going quickly, we have created test business, practice and providers. Each test business has:

  • two practice locations
  • three providers: one allied healthcare professional, one GP and one Medical Specialist
  • Providers enabled for claims across all Medicare functions, all CTP / icare functions
  • A merchant account enabled for all card payments Contact the Tyro Health Online support team at healthpartnerships@tyro.com for access credentials and API keys. Alternatively, you can use the details listed below:
Provider type Provider number Last name First name
Physiotherapist 2429581T Han Clifton
General Practitioner 2429581T Han Clifton
Medical Specialist 2429591L Browning Charlene

Payee providers

Any valid servicing provider can be used as a payee provider.

Referee providers

Provider type Provider number Provider name
General Practitioner 2054781W Dr Breanda Reed
Medical Specialist 2121331W Dr Vivian Mortier

Medicare Bulk Bill simulated responses

Medicare Bulk Bill submissions are usually processed overnight. To quickly simulate responses (and test configured webhooks), transactions can be stubbed. Stubs can be applied at multiple levels:

  • Submission
  • Processing
  • Processing claim item
  • Payment
Sub Text Level Expected Response Notes
STUB_OK Submissions (required) Submission succeeds
STUB_DOWN Submissions (required) Submission fails with 3004 (medicare down) Claim will be successful after the next batch run. Approx every 2 hour
STUB_FAIL Submissions (required) Submission returns a fail 3999 Claim will not be resubmitted
STUB_FAIL_XXXX Submissions (required) Submission returns a fail XXXX Replace XXXX
STUB_PROCESSING_ITEM_FAIL Processing claim item Processing report returns with Explanation code 160
STUB_PROCESSING_ITEM_FAIL_XXX Processing claim item Processing report returns with Explanation code XXX Links to return codes: Medicare,
STUB_PAYMENT_FAIL Payment Payment report returns with fail 8002
STUB_PAYMENT_FAIL_XXXX Payment Payment report returns with fail XXXX

Stub text(s) are applied on claim item's Service Text field and should be set on the first claim item of the claim, with the exception of STUB_PROCESSING_ITEM_FAIL, which can differ for each claim item. Stub outcome can also be applied on different levels ie. Submission, Processing claim item, Payment. To initiate a stub, Submission level is mandatory.

Examples:

  • STUB_OK;STUB_PROCESSING_ITEM_FAIL_123: Submission submits successfully, but processing report returns an explanation code of 123 and results in no benefits paid for the item.
  • STUB_DOWN;STUB_PAYMENT_FAIL_1234 : Submission failed because medicare was down. After a couple of hours, re-submission succeeds with a successful approval of claim. Payment fails with an error code of 1234.