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POST
/
medicare
/
claims
Create a Medicare claim
curl --request POST \
  --url https://api.example.com/medicare/claims \
  --header 'Content-Type: application/json' \
  --data '
{
  "type": "patient",
  "paymentStatus": "full_paid",
  "submit": true,
  "serviceProvider": {
    "providerNumber": "2447391F"
  },
  "patient": {
    "medicareCardId": "mdcd_35aXQHn0UgavunIPFfFKWdMmfdG",
    "referenceNumber": "1"
  },
  "items": [
    {
      "itemCode": "903",
      "chargeAmount": 25000,
      "serviceDate": "2023-11-07T05:31:56Z",
      "quantity": 1,
      "duration": 30,
      "notes": "<string>",
      "patientCount": 1,
      "overrides": {
        "overrideMultipleProcedureRule": true,
        "overrideDuplicateServiceRule": true,
        "overrideAftercareRule": true,
        "overrideRestrictionCode": "SP"
      },
      "site": {
        "locationSpecificPracticeNumber": "12345",
        "isHospital": true,
        "facilityId": "731247FT",
        "specimenCollectionPointId": "1234"
      }
    }
  ],
  "claimant": {
    "medicareCardId": "mdcd_35aXQHn0UgavunIPFfFKWdMmfdG",
    "referenceNumber": "1",
    "residentialAddress": {
      "line1": "<string>",
      "line2": "<string>",
      "suburb": "<string>",
      "city": "<string>",
      "state": "<string>",
      "postcode": "<string>",
      "country": "<string>",
      "countryCode": "<string>"
    },
    "phoneNumber": "<string>",
    "bankAccount": {
      "routingNumber": "123456",
      "accountNumber": "123456789",
      "accountName": "Test Account",
      "countryCode": "AU"
    }
  },
  "reference": "INV000001",
  "paymentAmount": 25000,
  "payeeProvider": {
    "providerNumber": "2447391F"
  },
  "referral": {
    "name": "John Doe",
    "providerNumber": "2447391F",
    "issuedAt": "2025-12-05T04:18:40.802Z"
  },
  "metadata": {}
}
'
{
  "items": [
    {
      "id": "<string>",
      "status": "created",
      "createdAt": "2023-11-07T05:31:56Z",
      "type": "patient",
      "transactionId": "<string>",
      "totalChargeAmount": 123,
      "totalRebateAmount": 123,
      "totalGapAmount": 123,
      "itemsCount": 123,
      "items": [
        {
          "id": "<string>",
          "itemCode": "<string>",
          "chargeAmount": 123,
          "rebateAmount": 123,
          "gapAmount": 123,
          "mcolAssessmentCode": "<string>",
          "mcolErrorCode": "<string>",
          "mcolErrorMessage": "<string>",
          "patientCount": 123,
          "quantity": 123
        }
      ],
      "paymentStatus": "full_paid",
      "reference": "<string>",
      "mcolClaimId": "<string>",
      "mcolErrorCode": "<string>",
      "mcolErrorMessage": "<string>"
    }
  ],
  "page": 1,
  "limit": 10,
  "totalItems": 100,
  "totalPages": 10
}

Body

application/json
​
type
enum<string>
required

Type of claim

Available options:
patient,
bulk_bill
Example:

"patient"

​
paymentStatus
enum<string>
required

Payment status

Available options:
full_paid,
part_paid,
not_paid
Example:

"full_paid"

​
submit
boolean
required

Whether to submit the claim to Medicare Online immediately or store for later submission

Example:

true

​
serviceProvider
object
required
​
patient
object
required
​
items
object[]
required
Required array length: 1 - 16 elements
​
claimant
object

Optional override for the claimant if different from the patient.

​
reference
string

Reference number to identify the claim in the system

Required string length: 1 - 9
Example:

"INV000001"

​
paymentAmount
number

Total amount that has already been paid

Required range: 50 <= x <= 9999999
Example:

25000

​
payeeProvider
object
​
referral
object
​
metadata
object

Response

​
items
object[]
​
page
number
Example:

1

​
limit
number
Example:

10

​
totalItems
number
Example:

100

​
totalPages
number
Example:

10