Medicare and DVA testing

• To get started with testing, we will need to issue you with some credentials that will allow you to interact with the Tyro Health Online. To get in touch with us, please send us an email at healthpartnerships@tyro.com and we’ll help you get started.
• Only valid test accounts with Tyro Health Online arranged staging business and providers can be used to test the resource.
• A Tyro Health Online STG environment API key is required

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.

Provider test data

The following providers are authorised for claim authorisation. These providers can be used as GP, Specialist, Diagnostic Imaging, MRI, Radiology Oncology servicing, payee or referring providers (not Pathology).

• If transmitting claims for Diagnostic Imaging use LSPN Number: 14
• If transmitting claims for Pathology use SCP Number: 00001
• If transmitting claims for Radiation Oncology use Equipment Number: 00901

The following provider is a ‘Generalist Provider’ (to only be used where asked for in the test plan).

Referee providers

The following providers can only be used for Referral and Request purposes.

Payee providers

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

Medicare patient test data

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

Valid test patients can be found in the table below

The following Single Medicare cards have been set up for testing. The Individual Reference Number (IRN) is found next to the name of the person on the Medicare Card.

The following Families have been set up for use during testing.

DVA test patient

Valid patient test details include:

The following Veterans cards have been set up for use during testing. These veterans can also be used for Medicare Claims if the Medicare Card Number is used. DVA Card Types: PT

Alternative/exception patient test details include

The following alternate enrolment types have been set up for use during testing:

Concession Entitlement Verification

Inpatient Medical Claiming, In-Hospital Claiming, Online Eligibility Checking and Overseas Claiming

The following details have been set up for Inpatient Medical Claiming, In-Hospital Claiming, Online Eligibility Checking and Overseas Claiming for testing

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

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.

Our STG environment is connected to Medicare/DVA by default. Their adjudication engine will approve some claims and others might stay in a forever "under review" status. This is a condition of the Medicare/DVA non-production environment.

We can manually request processing but for most instances, it's best to stub the response by inserting the text "STUB_OK" into service text for each item claimed. For example: serviceText: STUB_OK,

You can also simulate other Medicare/DVA decline/response codes by substituting STUB_OK with STUB_<ERROR_CODE>, using any valid return code published here: https://www.servicesaustralia.gov.au/medicare-digital-claiming-return-codes?context=22796