Claim API

Essential reading 

Claim API - User Interface Support Material

Claim API - Specification

Claim API - Mapping

Design

View the claim API design here

Comments

To comment or give feedback on our Claim API go to the Claim API forum.

Summary

This API allows software vendors to create a new claim with ACC.

Registered providers can lodge claims on behalf of their patient if they think they have an injury ACC covers. The claim also can be used by the provider to:

  • Refer the patient to other providers. eg a GP might require x-rays and / or require their patient to undertake rehabilitation using a physio.
  • Advise a level of fitness for work of less than 100%, which then results in approval of weekly compensation. Note that only GPs and Nurse Practitioners can undertake this.

The claim also can be used to provide the patient with a document for their records or a third party.

There must be a registered claim before ACC can start a patient's rehabilitation.

Benefits

  • Makes it easier for the provider to do things right first time.
  • Allows the software vendor to add value:
    • Provides 'interactions' in a way that flow within your application
    • Extracts and automate an API request from your stored database.

Authentication and access

This API needs an API key as well as a valid Health Secure Digital Certificate to submit requests in production and compliance environments. The Health Secure Digital Certificate is the same certificate providers use to submit payloads using the SOAP service. This certificate is used to authenticate who the user submitting the request is. We need to authorise the certificate, contact Digital Operations to make sure the certificate is set up.

Specific terms of use

Any registered health practitioner with ACC can submit a claim, however for a claim to be registered the practioner must be qualified. More information on who can register claims can be found here

Throttling and non-functional requirements

1. We've applied throttling to this API to protect against DDoS attacks. We've applied a limit of 30 requests per second per API key.

2. The Claim API will be available 23.5 x 6.5 which is figurative only and indicates that there's some time needed for planned maintenance windows and emergency fixes.

3. A user should have the ablity to save/park a claim in your application without having to send to ACC.

Testing

To obtain an appropriate set of claim numbers to enter into your solution:

  • For testing claim numbers– Contact Digital Operations via the Contact page, select 'Request numbers for testing' from the drop down.

  • For production claim numbers per Clinic– Contact the ACC Provider Helpline at 0800 222 070.

 

Your application should allocate the next number in sequence when the claim is sent to us.

  • A simple formula for determining a claim form number based on the previous one should be used.

  • Also a claim number should be able to be copied from a paper claim form and entered into your application to be used as the electronic claim number.

Suggested scenarios to test

Under construction - Scenarios will be made available when the API is released

Production requirements

Contact Digital Operations via the Contact page, select 'Request production access' from the drop down. They'll confirm that your app meets production requirements and issue you with a production API key.

Mapping

Refer to the "Claim API - Mapping" located at the top of this page.