Medicare, DVA, and ECLIPSE Testing

Introduction

This page provides comprehensive testing guidelines and data for Medicare, DVA, and ECLIPSE integrations. It covers test credentials, provider information, patient data, and validation scenarios to ensure your integration works as planned. It can be used to trigger different flows in your integration and ensure they are handled accordingly.

• 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

Environment Setup Requirements

• API Key requirement: Valid Tyro Health Online STG environment API key
• Credentials: Testing credentials issued by Tyro Health Online
• Account validation: Only authorized test accounts can access the staging environment

For credential requests, please contact: healthpartnerships@tyro.com

Provider test data

Payee providers

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

Allied professions include:

• Aboriginal And Torres Strait Islander Health Practitioner
• Acupuncturist
• Audiologist
• Chiropractor
• Clinical Psychologist
• Dentist
• Diabetes Educator
• Dietitian
• Exercise Physiologist
• Mental Health Worker
• Occupational Therapist
• Ophthalmologist
• Optometrist
• Orthoptists
• Orthotists/prosthetists
• Osteopath
• Physiotherapist
• Podiatrist
• Psychologist
• Social Worker
• Speech Pathologist

Medicare test patients

Claims submitted to Services Australia 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 patients

Only valid patient test details can be used. 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

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

Concession Entitlement Verification

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

Special Eclipse test member accounts

Other IDs or special numbers

Notes

For bank accounts use BSBs: 062-902 or 801-003

For Private Health Insurance under ECLIPSE use brand: TST and use any member number and an IRN of 01 or 02

To trigger a private health fund negative scenario - failed patient verification via ECLIPSE,do the following lastName under Alias last name= statuscode9663- fund = TST

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

Extended Test Data list

Other Test providers

Note: provider numbers can be used as servicing, payee (benefit) or referring provider numbers unless otherwise noted

Other test patients

Other DVA Patients