This guide takes you through setting up all the permissions and information required for you to lodge ECLIPSE claims online.
ECLIPSE is an extension of Medicare online claiming that allows medical specialists and GPs to lodge in-hospital claims with private health insurers. In Halaxy, ECLIPSE claiming is fully integrated in the system, which means you can lodge claims straight from an invoice.
After following this setup guide, you'll be processing ECLIPSE claims instantly, with all the correct and required information automatically populated for you in every invoice.
Video tutorial
This checklist outlines all the requirements for your practice to be able to submit ECLIPSE claims on Halaxy.
For step-by-step guides for each of these checklist items, refer to the other sections in this article.
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Requirement |
What it does |
Details |
|---|---|---|
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Activates ECLIPSE claiming for eligible practitioners |
Where to set up: Settings > Users Perform once per practitioner |
|
Allows you to submit online claims on Halaxy for the hospital/s you practice at |
Where to set up: Personal > Locations Perform once per hospital |
|
Automatically sets up the correct billing and claiming structure in invoices containing fees linked to the funder |
Where to set up: Finances > Fees > Funders tab Perform once for your practice group |
|
Sets up your partner health funds, which you'll later add to individual patient claims for private health |
Where to set up: Contacts > Organisations Perform once per health fund, can also be done as needed when lodging claims |
|
|
Sets up all required IDs to automatically populate in invoices:
|
Where to set up:
Health fund IDs: Perform once per practitioner for each organisation (health fund) Funder IDs: Perform once per practitioner |
|
Adds the preset fees for different private health funds, to be added to invoices |
Where to set up: Finances > Fees Perform once for each fee, can also be done as needed when lodging claims |
|
Sets up the patient claim details for their private health fund to automatically populate in their invoices, and also verifies their membership |
Where to set up: Patient profile > Funding tab Perform once per patient, can also be done as needed when lodging claims |
When all your requirements are in place, you can lodge ECLIPSE claims.
Note
Are you new to Halaxy? You must have a verified profile before you can register for online claiming.
The first step is to activate ECLIPSE for practitioners who will be lodging ECLIPSE claims.
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On the sidebar, click Settings > Users.
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In the row for the relevant practitioner's name, click the
first aid kit icon.
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In the Medicare Settings pop-up:
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Tick the checkbox Enable Medicare ECLIPSE Billing.
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If you have a billing agent, enter their Billing Agent Provider Number. If not, leave this field blank.
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Click Save.
You have now enabled ECLIPSE claiming for this practitioner.
Note
Only practitioners with ECLIPSE enabled can submit ECLIPSE claims.
This step sets up each hospital you are lodging ECLIPSE claims from, which requires its business details and own Medicare Location ID. This registers your practice as eligible to submit online claims to Medicare using Halaxy.
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Click Personal > Locations.
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When you join Halaxy, your first location is already created for you. To set this up as a hospital location, click Edit. (If you already have existing practice locations, in the top right, click Add Location.)
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In the pop-up, enter the hospital's business details. You must include the address, contact details, and ABN.
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Click Save.
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Back in the Locations page, next to Facility ID for ECLIPSE, click the
edit icon. In the pop-up, enter this hospital's Medicare provider number then click Save. (You can search your hospital's provider number in this spreadsheet.)
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Click Request a Location ID to register this location for online claiming with Medicare. Make sure to follow our complete guide: Register for claims processing (Medicare, bulk bill, DVA, ECLIPSE). (While awaiting activation and verification of your Medicare Location ID/s, you can proceed to the next section of this guide.)
When the hospital's Medicare Location ID is activated and verified, the hospital becomes eligible for submitting ECLIPSE claims.
This step sets up the billing and claim structure for all invoices used for ECLIPSE claiming.
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Click Finances > Fees, then click the Funders tab.
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In the top right, click Add Funder.
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In Lookup, type Private Health Insurance and select it in the dropdown to import it. (This is different from the Private funder, which is used for private patient billing.)
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Under Payments, ensure that Payer is set to Patient. (This is because invoices for private health claims must be billed to the patient.)
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Click Save.
You have successfully imported the funder for ECLIPSE claims. Any invoice containing fees linked to this funder automatically follow this billing structure.
Note
If you haven't yet, you must also import the Medicare funder.
This step sets up private health funds as organisations, which you later set as the paying organisations in patient claims.
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Click Contacts > Organisations.
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In the top right, click Add Organisation.
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For Name, enter the private health fund's name. In the dropdown, select the health fund's name that is labeled with ECLIPSE.
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For Type, select Fund. Configure the rest of the health fund's details as needed.
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Click Save.
You have successfully set up the health fund. Repeat this step for every health fund where you are registered as a provider.
This step sets up your provider identification numbers with the imported health fund organisations (to certify you as a registered partner provider) and with the Private Health Insurance funder (to certify your eligibility to submit private health claims) .
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In this step, you must add your practitioner claim details for each health fund.
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Click Contacts > Organisations.
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In the list, click the health fund to open its profile.
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Under the Claim Details section, click Add New.
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Add the practitioner's details as a provider for this private health fund, including:
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Claim Type Code: Select the correct claim type code for this health fund. (You can find the correct claim type code for your health fund in this Claim Type Codes table.)
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Fund Payee ID: Enter your unique ID issued by this health fund that identifies you as a partner provider (e.g. BUPA Practice ID). If your health fund doesn't issue this, enter your Medicare provider number.
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Click Save.
Whenever this health fund is selected as a paying organisation for an invoice, your provider identification is automatically added.
Repeat this step for every health fund (organisation) where you are a registered provider.
Caution
Make sure to check your bank account details! The ECLIPSE claim rebate is automatically paid to the bank account registered to your Fund Payee ID / Provider Number with the health fund. If the registered bank account belongs to your billing agent or another practitioner, you will need to send a request to the health fund to change this to your bank account. Halaxy and ECLIPSE cannot verify this for you.
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For the Private Health Insurance funder you imported, you must add your Medicare provider number for each hospital (location).
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Click Finances > Fees, then click the Identifications tab.
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In the top right, click Edit. (If you are adding identification for another practitioner, select the practitioner's name in the Practitioner dropdown.)
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In the Private Health Insurance row, enter your Provider Number from Medicare. (If you are lodging ECLIPSE claims from multiple locations, make sure to enter the IDs under each location column.)
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If you haven't yet, in the Medicare row, add your Medicare provider number.
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Click Save.
Whenever you create an invoice with fees under the Private Health Insurance funder, your Medicare practitioner provider number is automatically added.
Note
Remember to add funder identification again whenever you add a new hospital (location).
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This step adds the correct fees (with their item codes and pricing) for private health funds. If you have completed all the previous sections in this setup guide, this step can be done as needed when preparing ECLIPSE claims.
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From the calendar, create a patient appointment on the date and time of the service provided.
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For Name, enter the patient's name. (If it is a new patient, add them as a new one from the dropdown.)
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For Fees, enter the name or item code of the fee you are claiming, then click the fee to import it. To select the correct fee, note the following:
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Check the funder: The fee you are selecting must be linked to the Private Health Insurance funder.
Example of fees with the same item code from different funders (click to expand)
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Check the fee schedule: The fee name is labeled with the correct fee schedule for the health fund. (Refer to our reference guide for the correct fee schedule for your health fund.)
Example of fees with the same item code under different fee schedules (click to expand)
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Check if there is a gap specification: Some fees under the same fee schedule and item code may be specified for whether you are charging a gap fee (Known Gap) or not (No Gap). If you are charging a gap fee, select the fee with the Known Gap label. If a fee does not have any gap label, you can charge a gap fee on it.
Example of fees with the same item code and fee schedule but differ in rebate amount due to gap preference (click to expand)
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(Optional) In the Import Fee pop-up, if you are charging a gap fee, edit the Amount value so that Amount is equal to the Rebate plus the gap. Do NOT edit the Rebate value.
Example of changing the fee Amount to include a $75 gap fee
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Click Import Fee. You have added the fee to your practice's Fees List. The fee can be selected again for future claims.
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To add multiple fees to a claim, click Add Another Fee and repeat step 3 and 4.
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Click Save to create the appointment and automatically generate the invoice. (In the newly created appointment, click Invoice to open it.)
You have created an invoice with the eligible ECLIPSE fees.
Note
If the fees you are claiming are not locked to appointments, you can manually create an invoice and import fees from there.
Tip
To import all the fees you'll be using in your practice, you can also import fees ahead in the Fees List. See related article: Add fees and services
This step sets up the patient's claim for their health fund and verifies their eligibility. If you have completed all the previous sections in this setup guide, this step can be done as needed when preparing ECLIPSE claims.
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To enter the patient's claim details, you can do it in two ways:
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From the calendar: Under Private Health Insurance Claim, click the
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From the invoice: Under the Patient Details section, under Private Health Insurance Claim, click the
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In the pop-up, configure your patient's claim.
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Paying Organisation: Enter the patient's health fund's name and select it from the dropdown. (If it is a new organisation, click to import it - make sure it is labeled for ECLIPSE. See the previous section on how to import health funds as organisations.)
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Invoice Schedule (optional): Select a schedule for collating fees onto a single invoice at a specified frequency, such as Weekly or Monthly. Learn more about invoice schedules.
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Member Number: Enter the patient's member number with this health fund.
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Member Reference Number: Enter the patient's member reference number (MRN). This is the number to the left of their name on their health fund membership card.
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Expiry: If the patient's fund membership has an expiry date, enter it. If they don't, leave this field blank.
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Payer: Select Patient.
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Click Save.
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The claim is successfully added to the invoice and in the patient's profile. Verify the patient's claim by clicking the
unverified icon next to their member number.
When the verified icon appears, the patient's claim with their health fund is ready and verified.
If you've completed all the steps in this setup guide up to here, you can now begin lodging ECLIPSE claims in Halaxy!
Note
For in-patient claims, you must also add the patient's Medicare card details in their patient profile. Overseas claims do not require Medicare.
Tip
You can also set up patient claims from the funding tab of the patient profile.
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