Insurance Guide Part 2 (Australia): Client insurance setup

With Tyro Health connected (see Insurance Guide Part 1 (Australia)), you record each patient’s funder and Medicare details on their record. This is what lets Pabau pre-fill the claim so you’re not re-typing card numbers every visit.

Step 1: Open the Patient’s Insurance Tab

Open the patient’s record and select the Insurance tab on the left of the client card.

Step 2: Add a Funder

Click New Policy. Australian clinics choose from three fixed funders rather than searching an insurer directory:

• Medicare: bulk-bill and patient claims
• DVA: Department of Veterans’ Affairs
• Private Health (HealthPoint): the patient’s private health fund

Choose the funder the patient’s claims will go to

Step 3: Record the Medicare Number and IRN

After you pick Medicare, enter:

1. Medicare number: the 10-digit number on the front of the card.
2. Reference number (IRN): the single digit (1–9) beside this person’s name on the card. It tells Medicare which family member the claim is for.

Enter the Medicare number and the patient’s IRN

For DVA, record the patient’s DVA file number in the same field. For Private Health (HealthPoint), record their fund member number. Click Save (or Create) to store the policy.

Step 4: Verify the Card With Medicare (Optional)

On a Medicare policy, a Verify with Medicare button appears when Tyro Health is connected. Once the 10-digit card number and IRN are filled in, click it and Pabau checks the patient’s name, date of birth and card details directly with Medicare through Tyro Health (the same check Tyro’s own portal runs), so you catch a wrong digit before any claim is lodged.

Verify with Medicare sits under the card details

• A green result such as Medicare verified these details. means the card matches Medicare’s record.
• An amber result such as Medicare could not verify these details. shows Medicare’s own reason when it gives one (for example an invalid reference number), so you can correct it on the spot.
• If Medicare holds different details for the patient, for example because a new card has been issued, the result adds Medicare holds different details for this patient — ask them to check their record.

Use the Number Medicare Sends Back

Under the result, Pabau can also show the extra detail Medicare returned:

• Medicare status code followed by a number: Medicare’s own code for the result. Quote it if you contact Tyro Health or Services Australia about the check.
• Medicare’s current card number for this patient and Medicare’s current IRN for this patient: shown when Medicare returns the card number or reference number it currently holds, for example after a new card has been issued.

When Medicare returns a current number:

1. Confirm it with the patient if you can (for example, ask to see their new card).
2. Click Use returned number. Pabau copies the card number and IRN Medicare returned (whichever it sent) into the policy’s Medicare number and Reference number (IRN) fields.
3. Click Save (or Create on a new policy) to keep the new details. Nothing changes on the policy until you do.

Medicare’s current card details, ready to copy into the policy

What's next?

The patient is now ready to claim. Next, see how an appointment and its invoice feed the claim:

• Insurance Guide Part 3 (Australia): Connect appointments to insurance
• Insurance Guide Part 4 (Australia): Submit and track claims with Tyro Health