Eligibility Check

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What's Included

Behind the scenes, we utilise Medicare Patient Verification, Medicare Eligibility Check, and RebateRight Rules Engine to instantly confirm if your patient is eligible to claim the items you are billing.

One of a Kind

We offer the only Medicare eligibility integration that goes beyond basic checks allowing you to instantly verify your patient’s eligibility, rebate entitlements, and service limits in real time.

Age Eligibility

Real-time Medicare eligibility checks based on the patient's age and the items you are billing.

Same-Day Eligibility

We check same-day MBS item restrictions and instantly alert you if items can’t be billed together.

Episode Cone

We notify you when Episode Coning is applied to pathology items and show you which items attract a rebate.

Latest MBS Updates

We maintain the latest MBS data, ensuring you're always up to date.

Frequency of Service

We review the patient's claim history and notify you if service limits are exceeded, eliminating the need for manual PRODA checks

ln & Out of Hospital

Instantly verify eligibility based on the patient’s hospital status and item-specific claiming restrictions..

Servicing Provider

We instantly verify that the healthcare professional performing the service is eligible to claim it from Medicare.

Fees & rebates

We provide the schedule fee, patient rebate amount, and the reason for the benefit.

Web-based App

Use the RebateRight web-based application to start eligibility checking today, available on desktop and mobile- no IT setup required.

Referrer Eligibility

Because many MBS items restrict who can refer, we instantly validate eligibility using the referrer’s provider number — including alerts when the provider is closed.

Details Verification

We check the patient's information you have matches Medicare's records, and let you know if we've found a mismatch.

335 Rejection Reasons

There are hundreds of reasons Medicare may reject a claim — we check most of them upfront and give you instant eligibility results.

Entire MBS

Comprehensive access to over 6,000 MBS items across every category, enriched with the MBS notes and rules.

API Integration

The RebateRight Eligibility Check API seamlessly integrates with any healthcare system.

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

Response

Medicare Eligible: No
Reason: The maximum number of services for this item has been paid.

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

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

View API Documentation

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

Choose Your Subscription

Choose the subscription that bests suits you 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.

Get Started Here > Book a Call

Eligibility Check

What's Included

Behind the scenes, we utilise Medicare Patient Verification, Medicare Eligibility Check, and RebateRight Rules Engine to instantly confirm if your patient is eligible to claim the items you are billing.

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

Response

Medicare Eligible: No Reason: The maximum number of services for this item has been paid.

​

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

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

How to Get Started

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.

Choose Your Subscription Choose the subscription that bests suits you 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.

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

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

Medicare Eligible: No
Reason: The maximum number of services for this item has been paid.

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

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

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.

Choose Your Subscription

Choose the subscription that bests suits you 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.

Get Connected

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