Query claims can be split into two categories. They are claims/summary and claims/status.
- Claims/summary queries – used to check the submission status of a claim which has been submitted to ACC. Endpoints are:
The claims/summary queries are used to identify the status of a submission e.g. receipted / failed. If your application already captures the claim submission status using the response message, then this query isn’t necessary. Additionally, the query is limited to the submissions made by the same organisation. i.e. a clinic/practice cannot query a claim submitted by a different organisation.
- Claims/status queries – used to check the cover status of a claim which has been received/processed by ACC. Endpoints are:
The claims/status queries allows you to query the cover status (processed claim), this is to identify whether ACC has accepted or declined the clients cover. It also provides information on the diagnosis details. This query can be used to query any claim – even if it was submitted by a different organisation, this proves quite useful for claims which were referred.
The different types of cover status are below:
- Null – claim is either; not registered at ACC, or recently submitted and yet to be processed
- Accept – cover has been accepted
- Decline – cover has been declined
- Held – claim received, and requires assessment before a cover decision is made on the claim (to either accept or decline it)
- Accredited Employer – claim is being managed by an accredited employer (third party)