Medicare
Medicare verification allows you to confirm a patient’s eligibility and validate their Medicare details before processing claims. This helps ensure accurate billing and reduces the risk of claim rejections.Response
A verification response will always return one of the following status codes:matched
The client’s Medicare details have been successfully verified and match the provided information. This indicates that the patient is eligible and their details are correct.
partial_match
The client exists in the Medicare system, but some of the provided details don’t match exactly.
The response will generally include an adviceCode advising which details are incorrect.
no_match
No matching client was found in the Medicare system with the provided details. This could indicate the client doesn’t exist, has never been registered, or all provided details are incorrect.
failed
A system error occurred during the verification process. This is typically a temporary issue and the request can be retried.
Test Data
Use the following test Medicare card numbers to simulate different verification scenarios:| Card Number | Scenario | Status code | Advice Code |
|---|---|---|---|
1000000000 | Exact match | matched | |
1000000005 | System error | failed | |
1000000001 | Medicare number is wrong | partial_match | check_medicare_number |
1000000002 | Reference number is wrong | partial_match | check_reference_number |
1000000003 | Date of birth is wrong | partial_match | check_date_of_birth |
1000000004 | Patient details are wrong | partial_match | check_patient_details |
1000000006 | A new card has been issued | partial_match | new_card_issued |
1000000007 | We cannot verify this card, do not try again (possible patient deceased, expired RHCA card) | partial_match | cannot_confirm |
1000000008 | Matched RHCA card | matched | |
| Any other number | No match | no_match | check_patient_details |