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

Information and resources to assist developers integrating our online claiming applications with their software products.

Online claiming channels and functionality

Information to assist software vendors to choose an electronic claiming channel. Channels include:

  • Medicare Online
  • ECLIPSE
  • PBS Online
  • Aged Care Online

We are committed to working collaboratively with the health care sector and software vendors to offer a range of integrated electronic claiming solutions for lodging various types of electronic claims.

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)
ECLIPSE
  • 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 for more information. Read more about Medicare Easyclaim information for software vendors.

Software development process and checklist

The generic process for developing integrated software for:

  • Medicare Online
  • ECLIPSE
  • PBS Online, and
  • Aged Care Online electronic claiming channels

Step 1 - Developer agreement

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

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

Sign and return the completed agreement.

Step 2 - Developer kit

Once the agreement is approved a developer's kit is sent to you. 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 Helpdesk helps software vendors diagnose and resolve technical issues during the development and production stages including technical issues encountered in the vendor environment.

There is no set development timeframe. Contact the OTS Help Desk for support with diagnosing and resolving any technical issues.

Step 4 - Preliminary testing

We recommend you complete in house testing of your software product. In house testing ensures your software product functions correctly and any issues are resolved before integration testing.

Step 5 - Integration testing

Integration testing must be successfully completed.

Book in for integration testing with OTS Product Integration Team:

  • a testing officer is assigned to help vendors with integration
  • testing can occur on-site or online

This verifies your software product correctly integrates with our online claiming channels.

Step 6 - Notice of Integration (NOI)

This is issued once we approve your software. You can't send production transmissions to us until integration testing has been successfully completed and a NOI issued.

When an NOI is issued you can use your approved software product to transmit claims.

Changes or updates to approved software require a new NOI.

Other topics of interest for developers

Information for developers using different claiming channels.

More information

Online:

New software vendors can contact Online Technical Services to provide advice on:

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

Read more information about our website disclaimer.

Page last updated: 4 October 2016

This information was printed Tuesday 6 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-software-vendors-information-and-resources-developing It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.