Medicare & Billing
Medicare claiming integration
Most healthcare businesses already record their services in one system and claim Medicare in another. We connect the two, so a completed service becomes a validated claim, the claim becomes a payment, and the payment is matched back to the service.
There are two ways to claim. A claiming intermediary such as Tyro Health has already certified with Medicare, so you can be claiming within days. Direct Medicare Web Services access through PRODA gives you full control but comes with Services Australia onboarding and integration testing. We help you pick the right route for your volume and timeline, and we've built both.
Common challenges
What teams struggle with
Manual double entry
Staff copy each service from the operations system into a claiming portal by hand, which is slow and error-prone, and the backlog grows whenever someone is away.
Rejections found days later
Bad card numbers, expired referrals and annual caps are only discovered when Medicare declines the claim.
No link from claim to payment
Nobody can easily say which services have been paid, which were declined, and which were never claimed.
Channel choice
Intermediary or direct Medicare Web Services, CSV batches or an API. Each has different costs, timelines and certification requirements.
How we help
Practical solutions that ship
Claims from your existing data
We map the services, patients and practitioners already in your platform to claims, with no re-keying.
Validation before submission
Medicare number and provider number check digits, referral validity, entitlement caps and duplicate checks run before anything leaves your system.
Staged delivery
Batch claiming first to restore cash flow, then one-click export, then direct API integration, each stage useful on its own.
Reconciliation
Results are matched back to each service automatically, with declines in worklists and private billing as a fallback.
Frequently asked
Questions about medicare claiming integration
Do we need to certify with Medicare to automate claiming?
Not if you claim through an intermediary like Tyro Health, which has already certified. Direct Medicare Web Services integration does need Services Australia registration and integration testing for each claim channel.
Can you add claiming to an app built with Lovable, Bubble or similar?
Yes. We've built Medicare claiming into an existing Lovable and Supabase operations platform, and the business owns all of the code.
How long does it take?
Batch claiming through Tyro Health usually takes a couple of weeks once the account and practitioner enrolments are active. Third-party onboarding is usually the slowest part.
Deep dive
Read the technical guide
Medicare Batch Claiming Through Tyro Health
Moving from manual Medicare entry to batch claiming through Tyro Health: the CSV format, stable invoice references, pre-export validation, reconciliation, and when to move to the API.
Integration guideMedicare Web Services Integration: PRODA and B2B
The PRODA B2B device model, what actually changed when the client adaptor died, the claiming channels available, and the operational gotchas at customer sites.
Related guides
You might also need
Tyro Health Integration
Tyro Health (Medipass) integration for Medicare bulk billing. Batch CSV generation, invoice references, transaction report reconciliation, and direct API integration.
Medicare & BillingMedicare Billing Automation
Automate Medicare billing and replace manual PRODA or portal claim entry. One-click claim export, validation, and reconciliation from the systems you already use.
Medicare & BillingMedicare Claim Reconciliation Software
Reconcile Medicare claims to services automatically. Transaction report imports, full-payment checks, duplicate detection, matching hand-lodged claims, and billing status rollups.
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