Eligible
The patient is eligible to claim this item. The benefit is quoted in dollars.
Eligibility check
Eligibility,
Eligibility,
checked right.
Know the Medicare benefit before the patient consents.
Services Australia Certified
Used by GP, specialist, and diagnostic practices across Australia
Beyond the form
Training can’t fix what only Medicare knows.
Some Medicare rules can be learned from the form: the patient’s age, whether a referral is needed, which items cannot be claimed together. Others depend on how often Medicare has already paid that item for the same patient, and only Medicare holds that record. No training can show it to a booking officer. RebateRight asks Medicare before you submit, and returns the answer with the reason.
Not eligible
Already claimed within the past 12 months.
MBS12306 Bone density (DEXA)
$87.95
Caught before submission
What a check returns
Three possible answers.
Every item comes back with one of three answers. And the reason, in plain English.
Not eligible
The patient is not eligible. The reason is in plain English.
Cannot determine
The item couldn’t be checked for this patient. The reason says why.
When the details don’t match
Medicare corrects the record.
Medicare corrects the record.
The form fills itself.
Sometimes the name on the form isn’t the name Medicare has on record. We don’t reject the check. We return Medicare’s value, and the form’s corrected before the patient stands up.
Submitted
PETER
On record
CLINT
What we check
The whole check, in one call.
Identify the patient
- Verify the Medicare card against Medicare’s record, in real time
- Return Medicare’s value on any detail that differs
Check the rules
- 300+ Medicare rules per transaction, across the full ~6,000-item MBS
- The exact reason on a no, in plain English
- Up to 50 items per check, in one call
Calculate the benefit
- Schedule fee per item, current to the latest MBS release
- Benefit calculated at the right percentage for where the service is provided
A glimpse under the hood
A sample of the rules we check.
Six of the 300+ checks that run on every item, before you submit.
Referrer eligibility
The referring provider is recognised to refer the item.
Provider eligibility
The servicing provider is recognised to perform and claim it.
Patient age
The item’s age limits.
In or out of hospital
The setting the item allows.
Same-day item combinations
Items that can’t be claimed together.
Frequency of service limits
How often the item can be claimed.
Two ways to run a check
One at a time,
One at a time,
or ten thousand at once.
Single check
One patient, up to 50 MBS items per call. Real-time. Run it while the patient is at reception. The answer is back before they sit down.
- Run from the RebateRight web app, no integration required
- Call the API directly from your PMS, EMR, or workflow
- Per-item answers with the exact reason on a no
Bulk check
Upload a CSV with one row per request. Get a CSV back with per-item results. Built for the pre-claim sweep: a day’s claims checked before they go out.
- Available in the RebateRight web app, no integration required
- Download a sample CSV or upload your own
- Per-item results plus summary counts: eligible, not eligible, cannot determine, total rebate
“A claim had been rejected across all five items. Using RebateRight we were able to claim back $500 we would have lost.”
Who uses eligibility check
From the solo practice to the national network.
-
Pathology labs
Request panels, coning caught before lodging. Only the three highest-fee items are paid; you see which ones miss out upfront, not at reconciliation.
-
Radiology practices
Imaging eligibility, referral validity, frequency limits, and where the service must be performed, all checked while the patient is still at reception.
-
GP clinics
From a standard consult to a chronic disease management plan, every item checked at the desk before the bill is raised.
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Specialist clinics
Referral validation, attendance rules, frequency limits, surfaced at booking, not at the end of the quarter.
-
Allied health
Care-plan items, allied-health visit caps, and chronic disease item eligibility, all settled before the appointment starts.
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Medical billing services
Pre-claim validation across every downstream practice in your portfolio, on a single API key or web-app login.
Pricing
Eligibility check is in every plan.
You pick the volume you need. The features stay the same.
Eligibility questions
Answered, in full.
What does an eligibility check return?
The check returns two parts:
- PatientVerification: we check the patient’s details against Medicare’s records, and return the correct value for any field that doesn’t match.
- Rebates: one result for each MBS item you submit, up to 50 per call. Each result has:
- Result: eligible, not eligible, or cannot determine
- Reason: a plain-English explanation
- ReasonCode: the matching code for that reason
- Schedule fee: the standard fee for the item
- Benefit: the rebate amount
What does cannot determine mean?
The check couldn’t reach a definitive eligible or not eligible answer. Most often a required detail is missing, like the referring provider. Check the reason on the result, add what’s missing, and try again. One exception applies: items with a claim-frequency limit need the patient’s claim history to assess eligibility. Services Australia doesn’t share that data, so a retry won’t change the current result for those items.
Are there items you can’t check live?
Yes, some can’t be confirmed live. We run the same checks on every item: patient verification, age, referral, the item’s rules. Services Australia verifies most MBS items online, and there we confirm the result live. The rest we label indicative, our own assessment, not confirmed with Services Australia. The eligibility check coverage guide lists those items and what each result means.
Can I check multiple MBS items at once?
Yes. Up to 50 items for one patient in a single check, handy for a pathology request panel, an imaging service with several scans, or a consult with attached procedures. The whole check counts as one request. The full definition is in our Pricing Agreement.
Do I need anything before I can start?
No. Eligibility check needs no HW027 form, no clinic-level registration. We handle the full setup with Services Australia on your behalf. Sign up, get your API key (or open the web app), check your first patient in the same session.
What happens to patient data?
Zero Data Persistence. The request is processed in real time and discarded the moment the answer returns, so nothing is stored. Australian-hosted on Microsoft Azure’s Australia East region (IRAP PROTECTED). The only thing we keep is billing metadata (which endpoint, which MBS item, the outcome), never patient details.
Know before you submit.
14 days. No card.
Unlimited requests during the trial. The web app, the API, and the test environment.