Verify your patient's Medicare and Private Health Insurance - Hospital Cover - details prior to submitting claims through ECLIPSE. Overseas Student, Workers and Visitor Health Cover (OHC) memberships are also supported. This guide walks you through the verification process.
What can you verify?
Verify Medicare and Private Health Insurance patient details any time, such as:
At time of appointment booking
On creation of a patient account
On day of service
The service is generally available 24 hours a day, 365 days a year.
The service will validate multiple attributes of a Medicare or fund account, including:
First name
Last name
Date of birth
Medicare card number
Medicare individual reference
Medicare account status
Private Health Fund card details
Private Health Fund membership status
Overseas Health Cover membership
Concession status, if applicable
Understanding the difference between Patient validations and Eligibility checks
Patient validations
Confirms if Medicare and Private Health Insurance accounts are valid and active
Does not check service coverage or benefits
Quick process for verifying patient details
Required before submitting claims
Eligibility checks
Determines coverage for specific services and episodes of care
Checks Medicare and fund benefits payable
Identifies waiting periods, restrictions, or exclusions
Used for informed financial consent
See our article: Process an ECLIPSE Online Eligibility Check
Before you start
You'll need:
Patient's Medicare card
Patient's Private Health Insurance card (if applicable)
Access to the Tyro Health portal
At least one Medicare registered provider number must be active for the business
Quick reference: required information
Medicare Details | Private Health Insurance Details |
First name | First name (as registered with fund) |
Last name | Last name (as registered with fund) |
Date of birth | Date of birth |
Sex | Sex |
| Private health fund |
Medicare card number | Fund membership number |
Individual reference (IRN) | Fund patient reference (UPI) |
Steps
In the Tyro Health portal
Navigate to ECLIPSE → Online eligibility check or Inpatient medical claim
Select Agreements, Schemes or Patient Claims to validate both Medicare and fund details
for Overseas Hospital Student or Visitors Cover, select Overseas claim
Select existing patient or add a new patient
Enter Medicare details
Input all required Medicare information
For patients with only one name, enter it in the last name field and write "Onlyname" in the first name field
Enter Private Health Insurance details (if applicable)
Input all required fund information
Specify different names registered with the fund if they differ from Medicare details
Submit verification request
Click 'Verify ECLIPSE Details'
The system will check Medicare details first
If Medicare verification is successful, it will then check Private Health Insurance details
Review the verification response
Look for the verification status at the top of the response
Check for any suggested updates to patient details
Understanding responses
Medicare responses:
Details are valid: No action needed
Details not valid: Check against Medicare card and resubmit
Details need updating: Review suggested updates with patient
Note: Private Health Insurance account checks will only progress when Medicare details are valid.
Private Health Insurance responses:
Details are valid: No action needed
Details not valid: Check against health fund card and resubmit
Details need updating: Review suggested updates with patient
Common response codes can include:
Return code | Description |
9605 | Another Medicare card may have been issued to the patient or the details you entered do not match those held by Services Australia. Please update your records and resubmit the claim. |
9606 | Another Medicare card may have been issued to the claimant or the details you entered do not match those held by Services Australia. Please update your records and resubmit the claim. |
9626 | An informational response code from the Services Australia system to let the provider know that the patient is or was a reciprocal card holder (RHCA) which could cause issues with claiming. This is a valid check response and details do not need to be updated |
9650 | The card number and/or patient details submitted did not match Medicare checks. Please verify the details and resubmit with additional information if available. |
For a complete list of response codes and their meanings, see our article: Understanding Medicare response and return codes
Partial matches and updates
For close matches, we may return suggested changes or updates. This is based on matching logic managed by Medicare. As examples:
If the patient enters a first name of “Adrian” but Medicare has it registered as “Adriano”, our system may return a suggested first name of Adriano.
If the patient enters an old Medicare card number but all other details are correct, our system may return a suggested updated Medicare card number.
These responses do not need to be displayed to the patient but should be used to clarify details with the patient. If a suggested update is returned:
Check with the patient for clarification
Update the patient record with any corrected information
Proceed with eligibility checks or claims
Common issues and exception scenarios
If validation failed, be sure to double check:
Individual reference number / patient reference
Name spelling differences on membership card
Card expiry
Recent membership changes
Details are valid as at the date submitted. If you need to verify for a past date, enter at least one service item and date prior to submitting the verification.
Middle name is not used for account verification. The middle name or initial is not required.
Medicare’s patient verification system can be less strict than the one used to process a claim. It is rare, but possible, that a successful verification result could be denied at time of claim.
Some Medicare cards include prohibited characters. These are usually mistakes in the physical card embossing process. For example, some cards may appear to have a full stop “.” at end of name but this character type is not permitted by Medicare and the patient should contact Medicare for an updated card.
Patients under Reciprocal Health Care Agreements (RHCA), and issued a Medicare card, are also supported - just use their Medicare card details. RHCA accounts are not considered Overseas Health Cover Claims.
For Concession eligibility checks, no additional details are required - only valid Medicare details are needed. You can also check Concession status under Patients → Select or add new Patient → Medicare details → Concession holder: Yes. The check will verify concession status with Services Australia, including:
Health Care Card
Pensioner Concession Card
Repatriation Health Card (Specific or All Conditions)
Commonwealth Seniors Health Card
Repatriation Pharmaceutical Benefits Card
Safety Net Entitlement card
Safety Net Concession card
Ex-Carer Allowance (Child) Health Care Card
Foster Child Health Care Card
Low Income Health Care Card
Need help?
Chat with our support team using the pink chat bubble in the bottom right corner or email us at healthsupport@tyro.com
For Medicare-specific questions, contact Medicare Provider Enquiry Line on 132 150
For Private Health Fund responses and a specific patient questions, reference Private Healthcare Australia contacts or have the patient contact their fund