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 vendors 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 vendors.

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 - Licenced agreement

An agreement establishes the terms and conditions between you and us.

Contact Online Technical Support (OTS) Liaison to get a licence agreement. OTS Liaison is the first point of contact for software vendors.

Sign and return the completed agreement.

Step 2 - Developer kit

Once approved, we’ll send you a developer's kit. Contents vary depending on the claiming channel and may include:

  • client adaptor
  • support information
  • test Medicare Public Key Infrastructure (PKI) certificates
  • test data.

Step 3 - Development

OTS support desk helps software vendors 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 4 - Preliminary testing

We recommend you test your software product in-house. This will help to resolve issues before integration testing and make sure your software product functions correctly.

Step 5 - Integration testing

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

Book in for integration testing with OTS Product Integration Team:

  • we’ll assign a testing officer to help with integration.
  • we can test on site or online.

Step 6 - Notice of Integration (NOI)

We’ll issue an NOI when we approve your software.

After we issue your NOI, you can use your approved software product to transmit claims.

Changes or updates to approved software need a new NOI.

Step 7 - Your clients need to register with eBusiness

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

Your customers will then need to register for the relevant claiming channel by completing the relevant form below:

Your customer 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.

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Page last updated: 22 September 2020