Medicare eligibility platform RebateRight says its software has prevented more than $25 million in Medicare claim rejections for Australian healthcare providers by identifying potentially unpayable claims before they are submitted.
The Sydney-based company’s platform checks claims against more than 300 Medicare rules before they are lodged, covering around 6,000 items in the Medicare Benefits Schedule (MBS).
RebateRight says the platform has also saved healthcare providers more than 60,000 hours of billing rework as of August 2026.
RebateRight co-founder Elizabeth Loughlin said the aim was to move Medicare eligibility checking to earlier in the patient journey.
“In most practices the first real test of whether Medicare will pay is the claim itself,” Ms Loughlin said.
“That is after the service, after the quote and after the patient has agreed. We are moving that question to the start, by providing eligibility intelligence, cost transparency for patients and healthcare providers before they book the appointment or claim the service.”
Ms Loughlin said RebateRight was designed to operate alongside existing healthcare software rather than replace it.
“Practice systems were built to record a service and transmit a claim, and they do that well,” she said.
“Deciding whether a claim is payable is a different job, and it must track an item and fee schedule that keeps changing.”
Available as a web application and an API for integration with practice management and clinical systems, the platform also allows providers to bulk upload batches of claims for checking before submission.
Its eligibility function allows healthcare providers, clinic and billing staff to check a patient against up to 50 MBS items at a time.
Checks include referrer and provider eligibility, patient age requirements, whether a rebate applies in or out of hospital, same-day item combinations and frequency of service limits.
Each item returns one of three results – eligible, not eligible or cannot determine – along with a reason, the benefit payable and the schedule fee.
The platform covers patient verification, eligibility checking, claiming and immunisation records and is listed on the Services Australia certified developer list.
RebateRight is also expanding its offering to include ready reckoner fee calculations, Monash area eligibility and MyMedicare.
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