Check Eligibility | RebateRight

curl -X POST https://api.rebateright.com.au/CalculateRebate \
     -H "x-minor-id: {{MinorId}}" \
     -H "x-api-key: <apiKey>" \
     -H "Content-Type: application/json"

{
  "Reason": "[Medicare] The patient information matches Medicare's records.",
  "Rebates": [
    {
      "Reason": "[RebateRight] Rebate for this Medicare item is available to patients younger than 25 years, this patient is 39 years and 3 months and 6 days old. [RebateRight] Medicare does not support eligibility checks for this item. This item has frequency of service limits, so eligibility cannot be fully determined.",
      "Benefit": "0",
      "IsEligible": false,
      "ItemNumber": "139",
      "ItemScheduleFee": "156.95"
    },
    {
      "Reason": "[RebateRight] All RebateRight eligibility checks have passed (referrer specialty, patient age, in-patient status, etc.). Medicare covers 100% of the Schedule Fee for this item. [RebateRight] Medicare does not support eligibility checks for this item. This item has no frequency of service limits, so RebateRight considers the patient likely eligible based on the available information.",
      "Benefit": "20.05",
      "IsEligible": true,
      "ItemNumber": "3",
      "ItemScheduleFee": "20.05"
    },
    {
      "Reason": "[RebateRight] All RebateRight eligibility checks have passed (referrer specialty, patient age, in-patient status, etc.). Medicare covers 100% of the Schedule Fee for this item. [RebateRight] Medicare does not support eligibility checks for this item. This item has no frequency of service limits, so RebateRight considers the patient likely eligible based on the available information.",
      "Benefit": "202.65",
      "IsEligible": true,
      "ItemNumber": "123",
      "ItemScheduleFee": "202.65"
    },
    {
      "Reason": "[RebateRight] All RebateRight eligibility checks have passed (referrer specialty, patient age, in-patient status, etc.). Medicare covers 100% of the Schedule Fee for this item when provided to out-of-hospital patients. [Medicare] 0: All Medicare eligibility checks have passed (claim history, multiple service rules, service provider, etc.).",
      "Benefit": "0",
      "IsEligible": true,
      "ItemNumber": "124",
      "ItemScheduleFee": "233.35"
    }
  ],
  "PatientVerification": {
    "Reason": "[Medicare] The patient information matches Medicare's records.",
    "Verified": true
  }
}

This endpoint receives patient details and Medicare items. It verifies patient information with Medicare and calculates rebate amounts.

🎨 How It Works

Uses Medicare Patient Verification, Medicare Eligibility Check, and RebateRight Rules Engine services behind the scenes.
The response includes enriched data, combining RebateRight insights and MBS item details.
Returns the rebate amount Medicare will pay for a specific item for a given patient. The reason for the benfit amount is also included in the response.
If no rebate is payable, the response includes the reason why (e.g., limitations, ineligibility).

In summary, this endpoint performs multiple checks and provides a detailed breakdown of Medicare rebate eligibility and the reasons behind the rebate amount.

This endpoint receives patient details and Medicare items. It verifies patient information with Medicare and calculates rebate amounts. #### 🎨 **How It Works** - Uses **Medicare Patient Verification**, **Medicare Eligibility Check**, and **RebateRight Rules Engine** services behind the scenes. - The response includes enriched data, combining RebateRight insights and MBS item details. - Returns the rebate amount Medicare will pay for a specific item for a given patient. The **reason** for the benfit amount is also included in the response. - If no rebate is payable, the response includes the **reason** why (e.g., limitations, ineligibility). In summary, this endpoint performs multiple checks and provides a detailed breakdown of Medicare rebate eligibility and the reasons behind the rebate amount.

Authentication

x-api-keystring

API Key authentication via header

Request

This endpoint expects an object.

PatientSexstringRequired

MedicareItemslist of objectsRequired

PatientGivenNamestringRequired

PatientFamilyNamestringRequired

PatientDateOfBirthdateRequired

InHospitalTreatmentbooleanRequired

PatientMedicareNumberstringRequired

PrincipalProviderNumberstringRequired

ServicingProviderNumberstringRequired

PatientMedicareRefNumberstringRequired

Response

Reasonstring

Rebateslist of objects

PatientVerificationobject or null

3. Check Eligibility

🎨 How It Works

Authentication

Headers

Request

Response

🎨 How It Works