Submitting claims
Provider and location details
Provider and practice location details can be set with a single providerNumber attribute. Importantly, this provider number must be defined and active in Tyro Health and for the given business API Key. Provider numbers which are not registered in Tyro Health or for the given business API key will error. Only one provider can claim per invoice.
Provider number formats can vary by type of professional category and issuing organisation. In general, the provider number will be defined as follows:
| Professional category | Type of Professional category | Issued to | Issuing body | Format | Examples |
|---|---|---|---|---|---|
| Aboriginal and Torres Strait Islander Health Practice, Acupuncture, Audiology, Chinese Medicine, Chiropractic, Counselling, Dental, Diagnostic Imaging, Dietetics, Exercise Physiology, General Health Equipment, General Practice, Genetic Counselling, Hospital,Home Care service and Aids Mental Health, Myotherapy, Naturopathy Nursing and Midwifery, Occupational Therapy, Optometry, Orthoptics, Orthotics/ Prosthetics, Pharmacy, Osteopathy, Pathology, Perfusion (Medical), Physiotherapy, Podiatry, Psychology Radiology, Remedial Massage, Social Work, Specialist Physician, Specialist Treatment centres, Speech Pathology, | Individual Provider | Individual, unique for each location |
WorkCover Queensland or Medicare or AHPRA |
For medical or allied healthcare providers, this is usually a Medicare issued provider number 8 characters alpha-numeric such as 1234565X. If Medicare provider number is not applicable, WorkCover Queensland account numbers (Pxxxxxxxxxx) for non-medical providers and AHPRA numbers are also supported if that same number was registered with Tyro Health Online . |
1234565X |
For the SDK, if a provider number is not sent in the claim payload, the the user will be prompted to manually select:
- The practice location
- Individual provider
-
Provider profession type and/or specialist category
If only one of each category has been defined, that will be automatically selected.
Registration of provider numbers
Providers must first register with Tyro Health and WorkCover Queensland prior to submitting a WorkCover Queensland claim. We do not currently offer an API for partners to self-register providers.
This registration process is self-service.If providers deliver services from multiple locations or businesses, each unique provider number must be registered. Details on provider registration and WorkCover Queensland activation is provided at:https://help.medipass.com.au/en/articles/4824343-enable-workcover-queensland-digital-claims
Patients
For WorkCover Queensland, a claim requires one valid patient. Multiple patients are not supported - each must be submitted as a separate claim.
A claim requires:
- firstName :which can be up to 40 characters, and only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe ( ' ) and hyphen (- ) characters. Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. At least one alpha or numeric character required. If the patient has only one name, set that in the lastName field and set firstName to " onlyname " .
- lastName: which can be up to 40 characters, and only contain alpha (A-Z and a-z), numeric (0- 9), space ( ), apostrophe ( ' ) and hyphen (- ) characters. Spaces must not appear before or after apostrophes, hyphens, other spaces or the supplied value. At least one alpha or numeric character required.
- dob : Date of birth in YYYY-MM-DD format, must be a valid date,must not be date in the future, must not be after each serviceDate, must not be > 130 years in the past
- accountNumber : Set to the WorkCover Queensland issued Claim Number. Usually, these are formatted like SNNAANNNNNN or DNNAANNNNNN where N = numeric and A = alpha character.
- accidentDate: Date of accident/injury in 'YYYY-MM-DD' format.
- refId (optional): An optional but highly recommended patient unique reference as set by you, such as a UUID/GUID. This value is used to uniquely identify a patient in the Tyro Health platform. Omitting refId will cause duplicate patient records to be created in Tyro Health and could make patient searches more difficult for providers who also use the Tyro Health 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 set for an existing patient record will update those values and override what was previously stored.
Items
Over 10,000 unique item codes - also referred to as service items, item numbers, material numbers or pay codes - are supported by Tyro Health for WorkCover Queensland claims.
Item codes are updated dynamically by WorkCover Queensland and new codes will be automatically integrated into the Tyro Health platform. Current WorkCover Queensland rates for for medical and allied health treatment can be obtained via : (https://www.worksafe.qld.gov.au/service-providers/fees)
A valid claim will contain the following item attributes:
- serviceDateString : date of service in YYYY-MM-DD format. Past service dates are supported.
- itemCode : up to 10 characters. The item code must be applicable for a given service date and provider registered professional category.
- price : net (excluding GST) price each unit in $XX.XX format.
Units of measure vary depending on item code. The current supported WorkCover Queensland units of measure include:
| Unit of measure | Applicable professional category | Quantity |
|---|---|---|
| Items (default) | All | Defaults to 1 for items. Quantity should not be set. |