THELMA Web Services API

Last updated: Sep 11th, 2018

Overview

Use THELMA web services to integrate to Medicare/ECLIPSE for all your patient checking and billing. Why go through the rigorous accreditation process required by Medicare (and maintain that accreditation) when we can take care of that for you. We provide an easy to use and comprehensive API to Medicare/ECLIPSE via our award-winning THELMA portal that has been successfully used by our clients for over 10 years. Features include:

  • Eligibility checking to all ECLIPSE enabled funds and to Australian Unity (who are not ECLIPSE enabled)
  • Batchwise claim submission to the THELMA portal enables transmission of hundreds of claims in one webservice request.
  • Claims are validated using our powerful THELMA validation engine which applies all Medicare rules to each claim and includes auto-correction of patient details.
  • Auto-cancellation option operates on failed claims in a batch. This important in Bulk Bill and DVA batchwise medical claiming as it allows the remainder of the batch to still be transmitted to Medicare.
  • Asynchronous claims are held in the THELMA portal and transmitted to Medicare/ECLIPSE after COB giving users the flexibility to logon and modify a batch (eg cancel claim or entire batch) during business hours.
  • Design allows “hybrid” implementations combining the web-services API and the THELMA web GUI. Eg deliver claims to THELMA using web-services but manage reports using THELMA web GUI

Patient Checking

These are all synchronous transactions – the result of the check is returned as an immediate response to the request.

Eligibility Service

OEC (online eligibility check). Checks a patient’s hospital cover with a health fund

SOAP Request

<soapenv:Envelope xmlns:soapenv="http://schemas.xmlsoap.org/soap/envelope/" xmlns:ws1="http://ws1.thelma.com.au" xmlns:impl="http://impl.ws1.thelma.com.au">
   <soapenv:Header/>
   <soapenv:Body>
      <ws1:submitEligibilityType1>
         <ws1:request>
            <impl:accidentIndicator>0</impl:accidentIndicator>
            <impl:admissionDate>2018-02-24T00:00:00.000</impl:admissionDate>
            <impl:fundAbbreviation>BUP</impl:fundAbbreviation>
            <impl:lengthOfStay>0</impl:lengthOfStay>
            <impl:patientDob>1974-06-23T00:00:00.000</impl:patientDob>
            <impl:patientFirstname>GRACE</impl:patientFirstname>
            <impl:patientLastname>HENDRICKS</impl:patientLastname>
            <impl:patientNumber>08591919</impl:patientNumber>
            <impl:serviceCode>35627</impl:serviceCode>
            <impl:sender></impl:sender>
         </ws1:request>
      </ws1:submitEligibilityType1>
   </soapenv:Body>
</soapenv:Envelope>
										
SOAP Response

<soap:Envelope xmlns:soap="http://schemas.xmlsoap.org/soap/envelope/" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
   <soap:Body>
      <ns1:submitEligibilityType1Response xmlns:ns1="http://ws1.thelma.com.au">
         <ns1:out>
            <benefitLimitationDescription xsi:nil="true"/>
            <coPayment>0.0</coPayment>
            <coPaymentDaysRemaining>0</coPaymentDaysRemaining>
            <coPaymentDescription>Co-payment not Applicable</coPaymentDescription>
            <dateOfAdmission>2018-02-24T00:00:00+11:00</dateOfAdmission>
            <excess>100.0</excess>
            <excessBonus>150.0</excessBonus>
            <excessDescription>Excess Bonus used to reduce excess amount payable. Capped each calendar year at once per adult when amount has been met in full. The excess does not apply on admissions for services with a minimum benefit, approved hospital ambulatory programs or to approved psychiatric and rehabilitation day programs in private hospitals only. Excess will apply for all overnight and day services in a public hospital. The excess does not apply to any child dependant covered on the membership.</excessDescription>
            <exclusionDescription xsi:nil="true"/>
            <financialStatusIndicator>Y</financialStatusIndicator>
            <fundMembershipId>08591919</fundMembershipId>
            <fundName>BUPA Australia</fundName>
            <fundReferenceNumber>2979185</fundReferenceNumber>
            <fundTableDescription>**Members First Network Hospitals**: Full cover for hospital accommodation and theatre fees.**Public Hospitals**: Minimum Benefits for shared room accommodation, as set by the Australian government plus a fixed benefit per day for private overnight room accommodation.**All hospitals**: Excluded Services, including cosmetic surgery that is not clinically required, receive no benefits. Minimum Benefit services, including surgery by podiatrists,receive share room rate Minimum Benefits for accommodation. If Minimum benefit (shared room rate) is paid, excess is not deducted. Excess does not apply for children. Special Benefits that help pay for certain in-hospital parent/partner accommodation or meals apply.</fundTableDescription>
            <fundTableName>Top Hospital with $250 Excess and General Extras</fundTableName>
            <fundTableScale>FAMILY</fundTableScale>
            <lengthOfStay>0</lengthOfStay>
            <patientDateOfBirth>1974-06-23T00:00:00+10:00</patientDateOfBirth>
            <patientName>GRACE HENDRICKS</patientName>
            <preExistingConditionIndicator>N</preExistingConditionIndicator>
            <providerId>0065050H</providerId>
            <providerName>Sun Hill Hospital</providerName>
            <responseCode>12000</responseCode>
            <responseDescription>Eligibility successful - Please retain Ref #</responseDescription>
            <resultOfAccidentIndicator>N</resultOfAccidentIndicator>
            <senderReferenceId>GRACE HENDRICKS</senderReferenceId>
            <serviceCodeDescription xsi:nil="true"/>
            <status>0</status>
            <statusDescription>eligibility submission successful</statusDescription>
            <supplementaryDetail>
               <SupplementaryDetail>
                  <supplementaryDetailCode>1101</supplementaryDetailCode>
                  <supplementaryDetailDescription>ELIGIBLE FOR SERVICE SELECTED</supplementaryDetailDescription>
               </SupplementaryDetail>
            </supplementaryDetail>
            <timeReceived>2018-02-23T11:22:06.581+11:00</timeReceived>
            <timeSent>2018-02-23T11:22:00+11:00</timeSent>
            <transactionId>15788506</transactionId>
         </ns1:out>
      </ns1:submitEligibilityType1Response>
   </soap:Body>
</soap:Envelope>

										

Patient Verification Service

PVM (Patient Verification Fund). Patient details check to Medicare.

PVV (Patient Verification DVA). Patient details check to Dept. of Veteran Affairs.

PVF (Patient Verification Fund). Patient details check to health fund.

SOAP Request

<soapenv:Envelope xmlns:soapenv="http://schemas.xmlsoap.org/soap/envelope/" xmlns:ws2="http://ws2.thelma.com.au" xmlns:pvf="http://pvf.ws1.thelma.icsglobal.net">
   <soapenv:Header/>
   <soapenv:Body>
      <ws2:requestPvf>
         <ws2:in0>
            <pvf:fundId>BUP</pvf:fundId>
            <pvf:patientDateOfBirthDay>15</pvf:patientDateOfBirthDay>
            <pvf:patientDateOfBirthMonth>07</pvf:patientDateOfBirthMonth>
            <pvf:patientDateOfBirthYear>1998</pvf:patientDateOfBirthYear>
            <pvf:patientFirstName>MANUEL</pvf:patientFirstName>
            <pvf:patientFundMembershipNumber>96639663</pvf:patientFundMembershipNumber>
            <pvf:patientFundUpi></pvf:patientFundUpi>
            <pvf:patientGender></pvf:patientGender>
            <pvf:patientSurname>HARRELL</pvf:patientSurname>
            <pvf:servicingProviderNumber>2407431K</pvf:servicingProviderNumber>
            <pvf:requestId>2346</pvf:requestId>
            <pvf:sender>THELMA</pvf:sender>
         </ws2:in0>
      </ws2:requestPvf>
   </soapenv:Body>
</soapenv:Envelope>
												
SOAP Response

<soap:Envelope xmlns:soap="http://schemas.xmlsoap.org/soap/envelope/" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
   <soap:Body>
      <ns1:requestPvfResponse>
         <ns1:out>
            <thelmaTransactionId>16448810</thelmaTransactionId>
            <requestId>2346</requestId>
            <responseId>2346</responseId>
            <status>0</status>
            <statusDescription>Eligibility successful - Please retain Ref #</statusDescription>
            <systemName>THELMA</systemName>
            <timeStamp>20180312152957</timeStamp>
         </ns1:out>
      </ns1:requestPvfResponse>
   </soap:Body>
</soap:Envelope>
												

Claiming

Thelma Webservice API supports the following Medical claims and Hospital claims;

  • Bulk Bill claims
  • IMC (In-patient Medical Claim)
  • DVA Medical Claims
  • PCI (Patient Claim Interactive)
  • IHC (In-patient Hospital Claim)

Medical Claims Service

OMC (Bulk Bill claim) is an asynchronous transaction. The result of the claim is made available later through retrieved reports

SOAP Request

<?xml version="1.0" encoding="UTF-8"?>
<soapenv:Envelope xmlns:soapenv="http://schemas.xmlsoap.org/soap/envelope/" xmlns:ws2="http://ws2.thelma.com.au">
   <soapenv:Header />
   <soapenv:Body>
      <ws2:submitOutpatientMedicalClaimBatch>
         <ws2:guid>60D1024F-1980-7116-4B33-994C75E77E73</ws2:guid>
         <ws2:clientBatchId>20282</ws2:clientBatchId>
         <ws2:claimData><![CDATA[<MCV Version="1.14" Timestamp="2018-03-03T12:00:00" SenderID="3531390Y" ContactName="John Smith" ContactPhone="99995555">
					<Header>
						<TransactionType>OMC</TransactionType>
						<BatchID>20282</BatchID>
						<TotalInvoiceCount>1</TotalInvoiceCount>
						<TotalInvoiceAmount>1000</TotalInvoiceAmount>
					</Header>
					<Invoice>
						<ClaimType>BB</ClaimType>
						<ServiceType>O</ServiceType>
						<BatchID>T0001</BatchID>
						<AccountReferenceID>321321</AccountReferenceID>
						<ServiceCount>1</ServiceCount>
						<ChargeAmount>1000</ChargeAmount>
						<BenefitAssignmentInd>Y</BenefitAssignmentInd>
						<Insurer>
							<InsurerID>HIC</InsurerID>
						</Insurer>
						<Payee>
							<ProviderID>2146761K</ProviderID>
							<ProviderName>Dr Hugh Slastonae</ProviderName>
						</Payee>
						<Patient>
							<MedicareCardNumber>6950445631</MedicareCardNumber>
							<MedicareCardSubnumerate>3</MedicareCardSubnumerate>
							<MedicalRecordID>224466</MedicalRecordID>
							<FirstName>GRACE</FirstName>
							<LastName>HENDRICKS</LastName>
							<DateOfBirth>1974-06-23</DateOfBirth>
							<Gender>2</Gender>
						</Patient>
						<Service>
							<ProviderID>2101201T</ProviderID>
							<ProviderName>DR IKE CHEMEISSE</ProviderName>
							<ItemNumber>23</ItemNumber>
							<ChargeAmount>1000</ChargeAmount>
							<Date>2018-01-16</Date>
							<Time>13:20:00</Time>
							<SelfDeemedCode>N</SelfDeemedCode>
						</Service>
					</Invoice>
				</MCV>]]></ws2:claimData>
      </ws2:submitOutpatientMedicalClaimBatch>
   </soapenv:Body>
</soapenv:Envelope>
											
SOAP Response

<soap:Envelope xmlns:soap="http://schemas.xmlsoap.org/soap/envelope/" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
   <soap:Body>
      <ns1:submitOutpatientMedicalClaimBatchResponse xmlns:ns1="http://ws2.thelma.com.au">
         <ns1:out>
            <clientBatchId xmlns="http://impl.ws1.thelma.icsglobal.net">20282</clientBatchId>
            <guid xmlns="http://impl.ws1.thelma.icsglobal.net">D839E565-4F6D-5D39-2BF6-3D4C20D5D6A4</guid>
            <status xmlns="http://impl.ws1.thelma.icsglobal.net">0</status>
            <statusDescription xmlns="http://impl.ws1.thelma.icsglobal.net">claim submission successful</statusDescription>
            <thelmaBatchId xmlns="http://impl.ws1.thelma.icsglobal.net">16442420</thelmaBatchId>
            <timestamp xmlns="http://impl.ws1.thelma.icsglobal.net">2018-03-03T12:30:24.673+11:00</timestamp>
         </ns1:out>
      </ns1:submitOutpatientMedicalClaimBatchResponse>
   </soap:Body>
</soap:Envelope>
											

IMC (In-patient Medical Claim) is an asynchronous claim transaction. The result of the claim is made available later through retrieved reports

DVAC (Medical Claims (Medical Paperless Streamlined) is an asynchronous claim transaction. The result of the claim is made available later through retrieved reports

PCI (Patient Claim Interactive) is a synchronous claim transaction, the results are made available immediately in the response.

SOAP Request

												
SOAP Response

												

Hospital Claims Service

IHC (In-patient Hospital Claim) is an asynchronous transaction. The result of the claim is made available later through retrieved reports

SOAP Request

											
SOAP Response

											

Reporting

Transaction Retrieval Service

The results of asynchronous claims are retrieved in reports when they are made available by Medicare/ECLIPSE. All asynchronous transaction types receive an assessment report (or statement of benefit) and a remittance report. Eg An IHC claim will receive a statement of benefit report IHCSOB and a remittance report IHCRMT.

IHCSOB
SOAP Request

											
SOAP Response

											
IHCRMT
SOAP Request

											
SOAP Response

											
Available reports are:
  • OMCSOB, OMCRMT
  • IMCSOB, IMCRMT,
  • DVACSOB, DVACRMT
  • IHCSOB, IHCRMT

Status Checking

Claim Status Service

Allows the checking of the status of individual claims within a batch after claim submission to THELMA.

SOAP Request

											
SOAP Response

											

Claim Cancellation

Claim Cancellation Service

PCI claims transmitted to Medicare can be cancelled on the same day. This is a synchronous transaction.

SOAP Request

											
SOAP Response

											

Interested in more information?

The above overview and examples are intended to give the developer a feel for the THELMA APIs available. Full API documentation and an end-to-end test environment are available on request. We will also give assistance for all integration projects.

For assistance please contact the helpdesk on 02 9199 8000 or thelma.helpdesk@ehealthwise.com.au