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Eligibility Check

Prevent Medicare Claim Rejections Before They Happen 

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Checks that go beyond the basics

​​​​​Instantly verify patient eligibility, rebate entitlements, and service limits — so you can catch issues before they become rejected claims.

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​​​​​​​​​​​​What you can verify instantly
 

Patient eligibility
Confirm whether a service is covered before billing
 

Rebate entitlements
Understand what Medicare will pay
 

Service limits
Check frequency, usage caps, and restrictions
 

Claiming rules
Validate requirements that impact claim success

Most eligibility issues aren’t complex — they’re just missed upfront

​​​​​Most claim rejections come from:

 

  • Ineligible services

  • Exceeded limits

  • Incorrect assumptions about rebates

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These lead to:

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  • Resubmissions

  • Admin rework

  • Delayed payments

Real results for healthcare providers

12,000+
Hours saved on Medicare claim rejections, and counting.

4M+
Dollars in claim rejections prevented, and counting. 

What's Included

Eligibility checks help catch issues before the claim is submitted​. Unlike standard checks, RebateRight's rules engine provides deeper Medicare logic — giving you visibility into the checks that actually impact whether a claim will succeed.

​​​​​​​​​​​​We instantly check
 

  • Patient eligibility

  • Rebate entitlements

  • Service limits

  • Claiming rules

Provider & referral validation
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  • Referrer eligibility

  • Servicing provider checks

Workflow & access
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  • Bulk eligibility checks

  • API integration

  • Web app

  • Certified by Services Australia​

Advanced Medicare rules
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  • Same-day item restrictions

  • Episode coning

  • Frequency of service limits

  • In/out of hospital restrictions

Data & Coverage
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  • Entire MBS

  • Fees & rebates

  • Latest updates

Fully Certified​​

Fully certified by Services Australia for secure, compliant integrations.

How Eligibility Checking Works

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Enter Details

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300+ Rules Checked

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Instant Results

Sample Eligibility Checks

You Provide

Patient Name: John Doe
Date of Birth: 01/01/1960
Medicare #: 1234567890
Bulkbill Status: Yes
In Hospital: No
Provider #: 0000000X
Medicare Item/s: 55141
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Response

Medicare Eligible: No
Reason: The maximum number of services for this item has been paid.
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Medicare Fee: $461.15
Patient Rebate: $0.00

 

You Provide

Bulkbill Status: Yes
Date of Birth: 05/04/1987
In Hospital: No
Provider #: 0000000X
Medicare Item: 66523
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Response

Medicare Eligible: No
Reason: A 'General Practitioner' is not eligible to refer this Medicare item. The following specialties can refer this item: 'Specialist gastroenterologist and hepatologist'.
 
Medicare Fee: $75.00
Patient Rebate: $0.00

14-Day Free Trial

Try everything we have to offer for 14 days completely FREE, with unlimited API requests.

Start for free
Book a demo

How to Get Started

Step 1

Initiate a call with us

To explore all the benefits we offer, simply initiate a call with us. Our team is ready to walk you through the steps, address any questions, and ensure you’re set up smoothly for a seamless experience.

Step 2

Activate Your Free Trial

Activate your free trial and decide how you’d like to connect — via our browser-based app or through API integration. We’ll help you find the best option for your workflow.

Step 3

Get Connected

We’ll guide you through connecting your system, setting up user access, and completing initial configuration so you can start with confidence.

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