Servicing Provider Eligibility

Know the provider may claim the item.

Send a provider number and an MBS item number. RebateRight answers whether the provider may render the item before the claim is lodged, with the reason in plain words.

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Servicing provider check 3 lines
  • 23 General PractitionerMBS Group A1, general practitioner attendances Eligible
  • 10952 AudiologistAudiology service, rendered by an audiologist Eligible
  • 30071 PhysiotherapistNo servicing-provider restriction for this group Eligible

Each provider may render the item on their line.

Three lines of a batch, checked before they are lodged.
How it works

Type the provider and the item. RebateRight gives the answer.

Watch a provider and an item checked, from the first number typed to the answer and its reason.

  1. Type the provider number and the item number.

  2. Click Check Provider.

  3. Get the answer and its reason.

The answer

Every answer carries its reason.

An eligible answer names the specialty that qualifies. A not eligible answer shows the provider’s specialties beside the ones the item needs.

  • Eligible

    Item 10952 · Audiologist

    An audiologist may render this Medicare item.

    MBS item 10952, audiology service, rendered by an audiologist.

  • Eligible

    Item 30071 · Physiotherapist

    Any provider may render this Medicare item.

    No servicing-provider restriction is recorded for this item’s MBS group.

  • Not eligible

    Item 23 · Physiotherapist

    The provider is not eligible to render this Medicare item.

    Provider
    Physiotherapist
    Eligible to render
    General Practitioner

    MBS Category 1, Group A1, general practitioner attendances.

What decides it

Four sources decide who may render an item.

  • Provider recognitions

    The specialties, fields and credentials Medicare recognises for the provider. A rule that allows a broad class, such as a specialist, covers every sub-specialty beneath it.

  • MBS item structure

    The item’s category, group and sub-group, each mapped to the specialties that may render its items. The item’s own descriptor can be tighter or broader than its group.

  • Legislative determinations

    The Diagnostic Imaging, Pathology and General Medical Services Tables, which set item by item who may render and bill a service.

  • MBS explanatory notes

    Conditions a specialty cannot show, such as supervision or MRI licensing. The reason names each one, with its MBS reference, for you to confirm.

The answer is advisory. Medicare makes the binding decision when it assesses the claim.

Where it fits

Check every line of a batch.

Two numbers, no patient

The check needs only a provider number and an item number. It runs within RebateRight, so it is fast enough to check every line of a batch before you lodge it.

Beside the eligibility check

An eligibility check answers whether Medicare pays for one patient’s items. Servicing Provider Eligibility answers whether this provider may render the item at all.

Pricing

Servicing Provider Eligibility is in every plan.

You pick the volume you need. The features stay the same.

See all plans

Servicing provider questions

Answered, in full.

Does the check need patient details?

No. The check needs only a provider number and an MBS item number.

What if RebateRight cannot tell?

RebateRight gives no verdict, and the reason names the provider’s recognition that may make them eligible. An example is a doctor on a general practice training placement, who bills as a general practitioner only at their placement.

Is the answer final?

The answer is advisory. Medicare makes the binding decision when it assesses the claim. Where an item has a condition a provider number cannot show, such as supervision or the practice’s equipment, the reason names it and who to confirm it with.

Where can I use it?

Servicing Provider Eligibility is part of the RebateRight API. The docs show the request and every answer.

Catch the wrong provider before Medicare does.

For 14 days you have the API, the web app and the test environment, with unlimited requests and no card.

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