Integrated Medicare Easyclaim

You are ready to start developing your Integrated Medicare Easyclaim feature now that you have successfully setup your POS to initiate and process requests through/with iClient in the test environment. Before you begin, please have a look at the certification criteria which provides a checklist of the minimum requirements for the certification of integrated Medicare Easyclaim with Tyro.

Certification Criteria for iClient Health

Bulk Bill

In the PMS, the staff select the doctor and patient and build up a list of services provided to the patient. Once complete the PMS should determine if the claim can be sent via Easyclaim services not accepted through Medicare if it can, invoke iClient passing in the bulk bill XML payload. The terminal will then attempt to have the claim validated by Medicare and if validated, iClient will ask the practice to accept the amount of the claim and if accepted, the terminal will ask the patient to 'Assign their right to benefit?'. Once the patient presses 'YES' the terminal will return the bulk bill XML response to the PMS. Please note that bulk bill claims are not assessed in real time and as such bulk bill claims will need to be reconciled via Medicare's Bulk Bill Integrated Reconciliation.

Fully Paid

In the PMS, the staff select the doctor and patient and build up a list of services provided to the patient. Once complete allow the patient to pay for the services provided in full. Once paid ask the patient if they would like to claim the rebate from Medicare in the practice. Ensure that the patient has an EFTPOS card (Cheque or Savings). Invoke iClient passing in the fully paid XML payload. The terminal will then attempt to have the claim approved by Medicare and if approved, the terminal will display the benefit amount on the screen and asks the patient to swipe their EFTPOS card followed by selecting CHQ or SAV followed by their PIN. Once approved, the terminal will return the fully paid XML response to the PMS and the rebate is in the patients account in around 11 seconds.

Part Paid

In the PMS, the staff select the doctor and patient and build up a list of services provided to the patient. Once complete allow the patient to pay for part or all of the gap. Once paid invoke iClient passing in the part paid XML payload. The terminal will then attempt to have the claim approved by Medicare and if approved, the terminal will return the part paid XML response to the PMS indicating that the claim is approved PDVC.

Bulk Bill Integrated Reconciliation

Please see the pages on BIR Workflow.

Testing Integrated Medicare Easyclaim

The are two systems that we provide that Practice Management Systems (PMS) providers can use to test their Integrated Medicare Easyclaim development against:

1. Tyro Integration Server Simulator.
2. Tyro Test system.

Both of these systems are discussed in more detail in the getting started section.

Both of these systems are connected to a test Medicare Easyclaim system maintained by Medicare. To send test payloads through to the test Medicare Easyclaim system, Medicare have provided us with the following test patient card and provider details:

1. These providers can be used as servicing, payee, or referring providers.

2. The following providers may be used for Referral / Request purposes only.

Please refer to the Please refer to the iClient API for sample EasyClaim code. After downloading the zip folder, unzip it and click on the iclient-api folder, and then index. At the top left corner underneath the APIs, click on Classes, and then click on TYRO.IClientWithUI, scroll down until you see the index and method tabs, then click on index.

The Medicare Easyclaim payload specifications are available in the EasyClaim Logic Pack Users Guide V2

A note on Fully Paid claims

When a Fully Paid Medicare Easyclaim response is marked as APPROVED, this only means that we successfully submitted the claim to Medicare and received a response. It does not necessarily mean that the claim was approved or that the patient's bank account has been credited. To determine the outcome of the claim the medicareAcceptanceType attribute in the response should be determine as it will show the outcome of the claim. The possible values of medicareAcceptanceType are:

1. PAID: The claim has been approved by Medicare and Tyro can go ahead with the refund.
2. NAC: The claim has not been accepted and no benefit is payable.
3. PEND: For “pended” patient claims where the claimant has not paid or only partially paid the accounts, Medicare Australia will issue a statement and a cheque made in favour of the Medical Practitioner where a benefit is payable, and forward to the claimant’s address recorded by Medicare Australia.
4. PDVC: Medicare Australia will issue a statement and the Pay Doctor via Claimant (PDVC) cheque, which is mailed to the claimant’s address recorded by Medicare Australia. This would be the case when a partly paid or a unpaid patient claim is submitted.

Demo

Below is a JS Fiddle demo for Fully Paid, Part Paid, and Bulk Bill Claim.

Demo - JS Fiddle