Medicare Ordering

Eirly supports Medicare ordering alongside our existing commercial testing. This lets practitioners order eligible pathology tests under a doctor’s provider number and claim them against Medicare, rather than billed to your organisation.

There are two ways to place Medicare orders:

• On the platform — using the bundle creator and ordering directly for a patient.
• Via the API — for organisations with an API integration (see REST API → Medicare ordering).

Both paths share one fundamental rule.

The one rule that governs everything

A Medicare order must be placed under a doctor’s provider number that is already registered — with a signature on file — against your organisation. The provider’s number, name, address, and signature are printed on the Medicare referral.

How it works

There are two separate things to set up, and it matters that you keep them apart:

1. Permission to order — a role with the Medicare ordering capability, a provider number, and a signature. Until all three are in place, no Medicare order can be placed at all.
2. Result routing — telling each pathology laboratory that this doctor is now ordering through Eirly, so their Medicare results come back to you. This is advisory, never blocking: you can order the moment step 1 is done, but until a laboratory confirms the link, results from that laboratory won’t find their way back automatically.

flowchart TD
    subgraph setup["1 · Permission to order"]
        direction TB
        A["Medicare ordering enabled<br/>for your organisation"]
        B["Owner creates a role with<br/>Order with Medicare provider number"]
        C["Owner assigns that role to the doctor"]
        D["Doctor adds their provider number<br/>Settings → Provider Numbers"]
        E["Doctor draws a signature,<br/>or re-uses their profile signature"]
        A --> B --> C --> D --> E
    end

    E --> F{"Provider number<br/>AND signature<br/>on file?"}
    F -- "No" --> D
    F -- "Yes" --> G["Ordering works<br/>in the app and via the REST API"]

    subgraph routing["2 · Result routing — advisory, never blocks ordering"]
        direction TB
        H["Doctor opens Settings → Result routing<br/>and presses Notify labs"]
        I["Doctor checks their disclosed details<br/>and consents to the disclosure"]
        J["Eirly emails each selected laboratory,<br/>CC'ing the doctor and your routing recipients"]
        K["Laboratory status: Pending confirmation"]
        L["Laboratory replies"]
        M["Status: Connected"]
        N["Status: Action needed"]
        H --> I --> J --> K --> L
        L -- "Link established" --> M
        L -- "Blocked, e.g. number registered<br/>to another practice" --> N
        N --> H
    end

    G --> H
    G --> O["Place Medicare orders now.<br/>Every order tells you whether results<br/>will route back, and from which labs"]
    M --> P["Medicare results route back<br/>into your organisation automatically"]
    O --> P

You never have to wait for the labs

Ordering and routing are independent. A Medicare order placed before any laboratory has confirmed is a perfectly valid order — the patient can attend a collection centre and the test is claimed against Medicare exactly the same. The only difference is how the result gets back to you: automatically once a laboratory is Connected, and by the usual manual means until then. Every order — on the platform and through the API — tells you which it will be.

Who does which step

Deliberately, no single person can do the whole thing. Notifying a laboratory discloses the doctor’s own details, so it has to come from their account — an owner or administrator can see and prepare everything, but cannot notify or sign on someone else’s behalf.

Step	Who
Enable Medicare ordering for the organisation	Eirly
Create the role and assign it	Owner
Add / correct a provider number	The doctor, for their own — or an owner/administrator on their behalf
Apply the signature	The doctor only
Notify a laboratory / consent to the disclosure	The doctor only
Stop routing at a laboratory	The doctor, or an owner/administrator
Confirm a laboratory’s reply	Eirly, against written evidence from the lab

The per-laboratory lifecycle

Each laboratory is tracked separately for each provider number, so a doctor can be connected at one laboratory while another is still being set up.

stateDiagram-v2
    [*] --> NotSubmitted : provider number and signature on file
    NotSubmitted --> PendingConfirmation : doctor consents, we email the lab
    PendingConfirmation --> Connected : lab confirms in writing
    PendingConfirmation --> ActionNeeded : lab reports a problem
    ActionNeeded --> PendingConfirmation : doctor resolves and re-notifies
    Connected --> StopRequested : doctor asks us to stop at this lab
    ActionNeeded --> StopRequested : doctor asks us to stop at this lab
    StopRequested --> NotSubmitted : we confirm the lab has reverted

    note right of Connected
        Results from this lab now
        route back automatically
    end note
    note right of ActionNeeded
        Not the same as "not set up" —
        results may be going elsewhere
    end note

A status only reaches Connected when we hold the laboratory’s written confirmation on file — it is never a toggle someone flips. The doctor is emailed whenever a laboratory’s status changes, with the full picture of where every laboratory stands.

Action needed is not the same as not set up

Not set up means results have no automatic destination. Action needed means routing was attempted and came back blocked — most often because the provider number is already registered to another practice — so results from that laboratory may be going somewhere else. Only the second is a reason to stop and check.

Key concepts

A few things to understand before you begin:

• Pathology only. Only pathology (blood) tests can be ordered under Medicare. DNA, imaging, and other test types cannot be.
• Not billed to you. Medicare tests are claimed against Medicare, not billed to your organisation — a Medicare-only order incurs no charge to you. This is not a guarantee that the patient pays nothing: whether Medicare covers a test in full is decided by the collecting laboratory and the patient’s Medicare eligibility, and a gap or full fee may still apply to them.
• Bundles can mix billing types. A bundle can contain commercial-only tests, Medicare-only tests, or a combination of both.
• Commercial and Medicare tests are split into separate referrals. If an order contains both, the patient receives two referrals — one commercial and one Medicare — because pathology labs process the two streams separately. A single-type order produces a single referral.

Getting set up: registering a provider

Before any Medicare test can be ordered, the ordering doctor must have their provider details and signature on file for the organisation. This is a one-time setup per practitioner, per organisation.

1. Join the organisation, with a role that permits Medicare ordering

The practitioner is invited into the organisation as a member. A doctor can belong to more than one organisation, and holds a separate provider number in each.

Ordering under Medicare is opt-in: no built-in role grants it, not even Admin. An owner creates a role carrying the Order with Medicare provider number capability and assigns it to the doctor — on its own, or alongside their existing role. See Letting a doctor order under Medicare for the exact steps.

Removing the capability

Taking that role away also retires the doctor’s provider record and clears their signature for the organisation — they’d add both again if it’s restored. If they still have live routing at any laboratory, the change is blocked until that routing has been stopped and confirmed, so routing is never torn down silently.

2. Add a provider number

Provider details live in two places, depending on who is doing the work:

• The practitioner, for their own record — their personal Settings → Provider Numbers.
• An owner or administrator, on a practitioner’s behalf — the organisation’s Settings → Result routing.

Either way, the record holds:

• Provider Number — validated on entry; an invalid number is rejected.
• Provider Name — as it should appear on referrals.
• Provider Address — pre-filled from the organisation’s default practice address, and editable.

One provider number per organisation

A provider number is unique per practitioner per organisation. The same doctor can hold a different provider number in each organisation they belong to.

3. Add a signature

Immediately after adding a provider number, the practitioner is prompted to add their signature. Signatures are drawn on-screen (on a signature pad, using a mouse or touch), not uploaded. The practitioner can either:

• Draw a new signature just for that organisation, or
• Reuse their profile signature — a single signature they draw once and save to their personal profile.

Signatures are captured per organisation

Each organisation keeps its own independent copy of the signature at the time it is applied. Updating a profile signature later does not retroactively change organisations that are already set up — the practitioner re-applies it per organisation if they want it updated.

Once a provider number and a signature are both on file for the organisation, that provider can order Medicare tests.

Ordering on the platform

Building a bundle with Medicare tests

The bundle creator lets a practitioner hand-pick tests. When choosing tests, a billing-mode toggle offers two modes:

• Commercially billed — all test types available, with prices shown.
• Medicare — filtered to eligible pathology tests only, with no prices.

Selections in each mode are tracked independently, so a bundle can be commercial-only, Medicare-only, or a mix of both.

Who can see the Medicare option

The Medicare option in the bundle creator is only available to practitioners who have a provider number on file for that organisation. A practitioner without one simply won’t see the Medicare toggle — the bundle creator behaves as commercial-only until they’ve completed their provider setup in Settings → Provider Numbers.

Placing the order

For any bundle that contains Medicare tests, ordering works slightly differently from commercial bundles:

• The practitioner orders it directly for a patient — using “Buy for…” (mixed commercial + Medicare bundles) or “Order for…” (Medicare-only bundles, where there’s nothing to charge).
• Self-serve sharing is disabled for bundles containing Medicare tests — public share links and “Copy Bundle URL” are not available, because a Medicare order must be placed by the ordering practitioner.
• The patient’s Medicare number is required, including the IRN — 11 digits — before the order can be submitted. The 10 digits printed across the top of the card identify the card, which everyone named on it shares; the IRN is the single digit printed beside each person’s name and is the only part that says which of them the order is for. You’ll find it immediately to the left of the patient’s name on their card.
• Clinical notes can be added and will appear on the Medicare referral.

Once submitted, the patient receives their referral(s) by email along with an account sign-up link. The provider’s number, name, address, and signature on file are printed on the Medicare referral.

Getting results back: result routing

When a doctor orders under their own provider number, the collecting laboratory sends the result to whatever destination that provider number is registered against — which, historically, wasn’t us. Settings → Result routing is where you fix that, once per doctor per laboratory.

The board lists every practitioner in the organisation who has a provider number, and the state of each laboratory for that number. From it, the doctor can:

• Notify labs — select the laboratories to notify, review the details being disclosed (title, name, provider number, address, phone, email, and their signature), correct anything that’s wrong, and consent. We email each selected laboratory, CC’ing the doctor and the organisation’s result-routing recipients so everyone has a record of exactly what was disclosed.
• Watch each laboratory confirm — the status moves to Pending confirmation on send, and to Connected once we hold the laboratory’s written reply.
• Stop routing at a single laboratory — without affecting the others. We tell the laboratory to revert and record their reply before marking it stopped.

Owners and administrators can see the whole board and prepare provider details, but notifying and signing must come from the doctor’s own account — it is their personal information being disclosed.

Every Medicare order then reports its own routing position: on the platform when you place the order, and in the API response as routingMessage. It names the laboratories a result will route back from, flags any that are still being set up, and calls out any that need attention. It never blocks the order.

Ordering via the API

Medicare ordering is available through the existing Create Referral endpoint (POST /v1/referrals) and requires API version 1.1.0 or higher.

The same registration rule applies: the provider number you send in the request must already be registered against your organisation, with a signature on file. This is configured on the platform (Settings → Provider Numbers, or the organisation’s Settings → Result routing) — the API does not accept an arbitrary provider number.

For the full request and response shapes, field tables, and validation rules, see the REST API reference → Medicare ordering.

Summary checklist

To order Medicare tests, you’ll need to:

1. Have the ordering doctor join your organisation.
2. Create a role with Order with Medicare provider number and assign it to them — no built-in role grants it.
3. Have them add their provider number in Settings → Provider Numbers.
4. Have them add (draw) their signature.
5. Order — either by building a bundle and using Buy / Order for… on the platform, or by calling the Create Referral API (v1.1.0+) with the registered provider number and the patient’s Medicare number.

And, so results come back to you automatically:

6. Have them press Notify labs in Settings → Result routing and consent to the disclosure.
7. Wait for each laboratory to confirm — they’ll be emailed as each one lands on Connected.

Remember:

• Only pathology tests are Medicare-eligible.
• Commercial and Medicare tests always produce separate referrals.
• Medicare tests are billed to Medicare, not to you.
• The Medicare option only appears — on-platform and via the API — for provider numbers that are fully registered (number and signature) against your organisation.
• Result routing is advisory: you can order before any laboratory has confirmed, and every order tells you whether the result will route back.

Need a hand? Contact the Eirly team.