> ## Documentation Index > Fetch the complete documentation index at: https://docs.halth.com/llms.txt > Use this file to discover all available pages before exploring further. # Create a Medicare claim > Create a Medicare claim for a patient ## OpenAPI ````yaml https://api.halth.com/v1/au/api-yaml post /v1/au/medicare/claims openapi: 3.0.0 info: title: GovAU Connect Service description: HaltH connector for Australian Government services version: 1.0.0 contact: {} servers: - url: https://api.halth.com description: Production - url: https://api.stg.halth.com description: Staging security: - apiKey: [] tags: [] paths: /v1/au/medicare/claims: post: tags: - Medicare Claim summary: Create a Medicare claim description: Create a Medicare claim for a patient operationId: MedicareClaimController_create parameters: [] requestBody: required: true content: application/json: schema: $ref: '#/components/schemas/MedicareClaimCreateParams' responses: '200': description: '' content: application/json: schema: allOf: - $ref: '#/components/schemas/ApiResponse' - properties: items: type: array items: $ref: '#/components/schemas/MedicareClaim' page: type: number example: 1 limit: type: number example: 10 totalItems: type: number example: 100 totalPages: type: number example: 10 '201': description: '' content: application/json: schema: $ref: '#/components/schemas/MedicareClaim' components: schemas: MedicareClaimCreateParams: type: object properties: locationId: type: string example: prlo_39SaCy77MShwXBMzwFVSMHOtXdq description: Location ID type: enum: - patient - bulk_bill type: string example: patient description: Type of claim claimant: description: Optional override for the claimant if different from the patient. allOf: - $ref: '#/components/schemas/MedicareClaimCreateClaimantParams' reference: type: string minLength: 1 maxLength: 9 example: INV000001 description: Reference number to identify the claim in the system paymentStatus: enum: - full_paid - part_paid - not_paid type: string example: full_paid description: Payment status paymentAmount: type: number minimum: 50 maximum: 9999999 example: 25000 description: Total amount that has already been paid submit: type: boolean example: true description: >- Whether to submit the claim to Medicare Online immediately or store for later submission transactionId: type: string maxLength: 255 example: btrn_39Q57MwxjLyx7PBXZObTpY4JQr6 description: Transaction ID serviceProvider: $ref: '#/components/schemas/MedicareClaimProviderParams' payeeProvider: $ref: '#/components/schemas/MedicareClaimProviderParams' patient: $ref: '#/components/schemas/MedicareClaimCreateMemberParams' referral: $ref: '#/components/schemas/MedicareClaimReferralParams' overrides: $ref: '#/components/schemas/MedicareClaimOverrides' items: minItems: 1 maxItems: 16 type: array items: $ref: '#/components/schemas/MedicareClaimItemParams' metadata: type: object required: - locationId - type - paymentStatus - submit - serviceProvider - patient - items ApiResponse: type: object properties: {} MedicareClaim: type: object properties: id: type: string status: enum: - created - submitted - confirmed - rejected - requires_review - in_review - cancelled - failed type: string locationId: type: string reference: type: string patientMedicareCardId: type: string claimantMedicareCardId: type: string createdAt: format: date-time type: string type: enum: - patient - bulk_bill type: string totalChargeAmount: type: number totalRebateAmount: type: number totalGapAmount: type: number itemsCount: type: number mcolTransactionId: type: string mcolClaimId: type: string mcolErrorCode: type: string mcolErrorMessage: type: string items: type: array items: $ref: '#/components/schemas/MedicareClaimItem' paymentStatus: enum: - full_paid - part_paid - not_paid type: string transactionId: type: string referral: $ref: '#/components/schemas/MedicareClaimReferral' referralOverrideCode: enum: - E - H - L - 'N' type: string required: - id - status - locationId - createdAt - type - totalChargeAmount - totalRebateAmount - totalGapAmount - itemsCount - mcolTransactionId - items - paymentStatus MedicareClaimCreateClaimantParams: type: object properties: medicareCardId: type: string example: mccd_39SaCy77MShwXBMzwFVSMHOtXdq description: Medicare card ID residentialAddress: $ref: '#/components/schemas/AddressDetails' phoneNumber: type: string bankAccount: $ref: '#/components/schemas/BankAccountCreateParams' required: - medicareCardId MedicareClaimProviderParams: type: object properties: providerNumber: type: string example: 2447391F description: Provider number required: - providerNumber MedicareClaimCreateMemberParams: type: object properties: medicareCardId: type: string example: mccd_39SaCy77MShwXBMzwFVSMHOtXdq description: Medicare card ID required: - medicareCardId MedicareClaimReferralParams: type: object properties: providerNumber: type: string example: 2447391F description: Provider number issuedAt: type: string example: '2026-07-01T10:07:55.435Z' description: Issued at typeCode: enum: - S - D - P type: string example: S description: |- Referral type code. S = Specialist referral D = Diagnostic referral/request P = Pathology request periodCode: enum: - S - 'N' - I type: string example: S default: S description: |- Referral period code. S = Standard (12 months for a GP, 3 months for a Specialist) required: - providerNumber - issuedAt MedicareClaimOverrides: type: object properties: referralOverrideCode: enum: - E - H - L - 'N' type: string description: >- Indicates why a service that normally requires a referral was provided without one. E = Emergency H = Hospital L = Lost referral N = Not required MedicareClaimItemParams: type: object properties: itemCode: type: string maxLength: 255 example: '903' description: MBS item code quantity: type: number minimum: 0 maximum: 99 example: 1 description: Quantity of the item (fields irradiated or 15-minute time blocks) chargeAmount: type: number minimum: 100 maximum: 9999999 example: 25000 description: Price in cents of each item serviceDate: type: string example: '2026-01-01' description: Date of the service serviceTime: type: string pattern: /^\d{2}:\d{2}:\d{2}\.\d+(Z|[+-]\d{2}:\d{2})$/ example: 10:00:00.0+10:00 description: Time of the service in hh:mm:ss.sTZD format duration: type: number minimum: 1 maximum: 999 example: 30 description: Duration of the service in minutes notes: type: string maxLength: 1000 description: Notes about the service. May be required when using certain options. patientCount: type: number minimum: 1 maximum: 99 example: 1 description: Number of patients seen overrides: $ref: '#/components/schemas/MedicareClaimItemOverrides' site: $ref: '#/components/schemas/MedicareClaimItemSiteParams' required: - itemCode - chargeAmount - serviceDate MedicareClaimItem: type: object properties: id: type: string itemCode: type: string chargeAmount: type: number rebateAmount: type: number gapAmount: type: number mcolAssessmentCode: type: string mcolErrorCode: type: string mcolErrorMessage: type: string patientCount: type: number quantity: type: number required: - id - itemCode - chargeAmount - rebateAmount - gapAmount MedicareClaimReferral: type: object properties: providerNumber: type: string issuedAt: type: string periodCode: type: string typeCode: type: string required: - providerNumber - issuedAt AddressDetails: type: object properties: line1: type: string line2: type: string nullable: true suburb: type: string nullable: true city: type: string nullable: true state: type: string nullable: true postcode: type: string nullable: true country: type: string nullable: true countryCode: type: string nullable: true required: - line1 BankAccountCreateParams: type: object properties: routingNumber: type: string example: '123456' description: The routing number of the bank account accountNumber: type: string example: '123456789' description: The account number of the bank account accountName: type: string example: Test Account description: The name of the bank account countryCode: type: string enum: - AU example: AU description: The country of the bank account required: - routingNumber - accountNumber - accountName - countryCode MedicareClaimItemOverrides: type: object properties: overrideMultipleProcedureRule: type: boolean description: >- Override the multiple procedure rule. Notes with explanation required when true. Example use would be if multiple related item numbers were billed but the provider believes the usual multiple-procedure reduction should not apply due to clinical justification. overrideDuplicateServiceRule: type: boolean description: >- Override the duplicate service rule. Notes with explanation required when true. Example use would be if patient receives the same service on the same day from the same provider. overrideAftercareRule: type: boolean description: >- If a provider believes the service is not normal aftercare this can be set to true to request full assessment. overrideRestrictionCode: enum: - SP - NR - NC type: string description: Declare that a restrictive rule should be overridden. referralSelfDeemedCode: enum: - SD - SS type: string description: >- Indicates that the servicing provider is "self-deeming" the referral/request requirement under specific Medicare rules, instead of supplying an actual referral SD = Self Deemed SS = Substituted MedicareClaimItemSiteParams: type: object properties: locationSpecificPracticeNumber: type: string minLength: 1 maxLength: 6 example: '12345' description: >- Location specific practice number (LSP Number). Identifies the exact site of diagnostic imaging and radiation oncology services. isHospital: type: boolean example: true description: Whether the service is provided in a hospital. facilityId: type: string minLength: 8 maxLength: 8 example: 731247FT description: >- The Commonwealth Hospital Facility Provider Number. A unique identifier of a Registered Hospital or Day Care Facility. specimenCollectionPointId: type: string minLength: 3 maxLength: 5 example: '1234' description: >- Specimen collection point ID (SCP ID). Used to identify the site where the pathology specimen was collected. ````