Education guide - Software developers information and resources for developing online claiming

Help for software developers - integrating our online claiming applications.

Online claiming channels and functions

We work with the healthcare sector and software developers to offer integrated digital claiming solutions.

Claiming channel Supports Other functionality
Medicare Online
  • Bulk bill (BB) claims.
  • Patient claims (PC).
  • Department of Veterans’ Affairs (DVA) claims.
  • Complex pathology claims.
  • In-hospital Medicare Benefit Schedule (MBS) services.
  • Transferring Australian Immunisation Register (AIR) data.
  • Online Patient Verification (OPV).
  • Online Concession Entitlement Verification (OCV).
  • Same Day Delete (SDD).
  • In-patient Medical Claims (IMC) - submit claims to both Medicare and private health insurers.
  • In-Hospital Claims (IHC).
  • Complex pathology claims.
  • In-Hospital Claims DVA (IHC DVA).
  • Overseas claims (OVS).
  • OPV:
    • Medicare and private health insurer patient check.
  • Online Veteran Verification (OVV):
    • verifies veteran patient details with DVA.
  • Online Eligibility Check (OEC):
    • hospital and medical checks with both Medicare and private health insurers (OEC)
    • hospital only checks (ECF)
    • Medicare only checks (ECM).
PBS Online Claiming
  • Pharmacy claims for dispensed PBS and RPBS medicines.
  • Ostomy claims processing.
Aged Care Online Claiming
  • Residential care:
    • business to business (B2B)
    • file upload.
  • Aged Care Assessment Teams (ACATs):
    • B2B.
  • Not applicable.

To develop an integrated Medicare Easyclaim solution together with a financial institution, contact the relevant institution. Read more about Medicare Easyclaim information for software developers.

Software development process and checklist

The generic process for developing integrated software for:

  • Medicare Online
  • PBS Online
  • Aged Care Online electronic claiming channels.

Step 1: Register for an individual PRODA account

To get started, you’ll need to register for an individual PRODA account.

Read more about PRODA.

Step 2: Register for the Health Systems Developer Portal

After you register for an individual PRODA account, you can register your organisation in the Health Systems Developer Portal (the portal).

On the portal homepage, select Register your organisation. You’ll need to:

  • provide your details and your organisation’s details
  • enter your PRODA number
  • provide details about your head office
  • provide details about your production support office and software development office
  • provide your email notification preferences
  • enter your product platform type.

After we review your registration, we’ll send you an email with your portal login details.

Step 3: Login to the portal

Login to the portal using your portal login details.

Before you can access development resources, you’ll need to read and accept the Interface Agreement. This agreement is a legal contract between your organisation and us.

We’ll send you an email after we process your agreement. This will confirm you can now access the technical resources.

Step 4: Invite your staff to the portal

You’ll need to decide what level of access you want to give your staff. There are 3 levels of access:

  • administrator
  • developer
  • view only.

Your staff will get an email asking them to create a username and password. It can take up to 2 working days before they can access the portal and licensed information.

Step 5: Begin developing products

You’re now ready to start developing for Web Services.

The OTS support desk helps software developers diagnose and resolve technical issues during development and production. This includes technical issues in the vendor environment.

There’s no set development timeframe. Contact the OTS Support Desk for assistance.

Step 6: Preliminary testing

We recommend you test your software product in-house. This helps resolve issues before integration testing and ensures your software product functions correctly.

Step 7: Integration testing

Integration testing verifies your software product works with our online claiming channels. Your software must pass all tests.

We’ll issue a Notice of Integration (NOI) when we approve your software.

Once you get your NOI, you can use your approved software product to transmit claims.

Book in for integration testing through the portal.

Step 8: Your customers need to register with eBusiness

You must supply each of your customers with a Minor ID.

They’ll then need to register for the relevant claiming channel by completing one of the forms below:

Customers can contact our eBusiness Service Centre for help.

Other topics of interest for developers

Read more about:

More information

Contact Online Technical Support team for advice on:

  • new business
  • online claiming
  • PBS Online Claiming
  • Aged Care Online Claiming
  • Medicare Easyclaim
  • PKI
  • HI Service
  • My Health Record
  • NASH.

Read more about:

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Page last updated: 6 June 2022