Australian claiming works differently from most markets. This article explains the funders Pabau supports through Tyro Health, and the few concepts worth knowing before you start.
The three fundersMedicare
Australia’s universal government scheme. There are two ways to claim:
- Bulk bill — you accept the Medicare benefit as full payment. The patient pays nothing and the benefit is paid to the practice.
- Patient claim — the patient pays your fee and Medicare reimburses them the benefit. A gap is the difference between your fee and the benefit.
DVA (Department of Veterans’ Affairs)
Covers eligible veterans. Claiming is similar to Medicare bulk bill — the patient isn’t charged for covered services — but the patient is identified by a DVA file number rather than a Medicare card.
Private health (HealthPoint)
The patient’s private health fund. Through HealthPoint, the claim is assessed at the point of service and the fund pays its benefit; the patient covers any gap.
What you need to claim
- A provider number for the practitioner — issued by Services Australia, per practitioner and per location (see Part 1).
- The patient’s details — Medicare number + IRN, DVA file number, or fund member number (see Part 2).
- An MBS item number on the service for Medicare/DVA (see MBS item codes in Pabau).
NOTE: Pabau captures and pre-fills this information; the actual verification and lodgement happen inside Tyro Health’s secure window. Anything you haven’t recorded in Pabau is simply prompted there at submission — so you’re never blocked.
- Pabau stores your setup and the patient’s details, attaches the right MBS item to the service, builds the claim from the invoice, and tracks the outcome to payment.
- Tyro Health verifies the patient, takes consent, and lodges the claim with Medicare / DVA / the fund, returning the result.
TIP: Card payments and EFTPOS terminals are a separate part of Tyro Health and aren’t covered by this workflow — these guides are about lodging and tracking claims.