Set up ECLIPSE online claiming

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

The ECLIPSE setup checklist

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.

Requirement

What it does

Details

  • Enable ECLIPSE in your practice

Activates ECLIPSE claiming for eligible practitioners

Where to set up: Settings > Users

Perform once per practitioner

  • Set up hospitals as practice locations

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

  • Import the Private Health Insurance funder

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

  • Import and set up health funds as organisations

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

  • Add required identifications

Sets up all required IDs to automatically populate in invoices:

  • Health fund identification: Certifies you as a registered provider with the health fund

  • Funder identifications: Certifies your eligibility (practitioner provider number) and the hospital's eligibility (Facility ID) to submit claims to Medicare

Where to set up:

  • Health fund identifications: Contacts > Organisations

  • Funder identifications: Finances > Fees > Identifications tab (Private Health Insurance)

Health fund IDs: Perform once per practitioner for each organisation (health fund)

Funder IDs: Perform once per practitioner

  • Import private health fees

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

  • Set up the patient claim

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.

Enable ECLIPSE claiming in your practice

The first step is to activate ECLIPSE for practitioners who will be lodging ECLIPSE claims.

  1. On the sidebar, click Settings > Users.

  2. In the row for the relevant practitioner's name, click the Icon-First-Aid.svg first aid kit icon.

  3. In the Medicare Settings pop-up:

    ECLIPSE-Setup-01.png
    • Tick the checkbox Enable Medicare ECLIPSE Billing.

    • If you have a billing agent, enter their Billing Agent Provider Number. If not, leave this field blank.

  4. Click Save.

You have now enabled ECLIPSE claiming for this practitioner.

Note

Only practitioners with ECLIPSE enabled can submit ECLIPSE claims.

Set up hospitals as locations

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.

  1. Click Personal > Locations.

  2. 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.)

    ECLIPSE-Setup-02a.png
  3. In the pop-up, enter the hospital's business details. You must include the address, contact details, and ABN.

    ECLIPSE-Setup-02b.png
  4. Click Save.

  5. Back in the Locations page, next to Facility ID for ECLIPSE, click the Icon-Edit.svg 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.)

    ECLIPSE-Setup-02d.png
  6. 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.)

    ECLIPSE-Setup-02c.png

When the hospital's Medicare Location ID is activated and verified, the hospital becomes eligible for submitting ECLIPSE claims.

Import the preset Private Health Insurance funder

This step sets up the billing and claim structure for all invoices used for ECLIPSE claiming.

  1. Click Finances > Fees, then click the Funders tab.

  2. In the top right, click Add Funder.

  3. 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.)

    ECLIPSE-Setup-03.png
  4. Under Payments, ensure that Payer is set to Patient. (This is because invoices for private health claims must be billed to the patient.)

    ECLIPSE-Setup-03c.png
  5. Click Save.

You have successfully imported the funder for ECLIPSE claims. Any invoice containing fees linked to this funder automatically follow this billing structure.

Import and set up health funds as organisations

This step sets up private health funds as organisations, which you later set as the paying organisations in patient claims.

  1. Click Contacts > Organisations.

  2. In the top right, click Add Organisation.

  3. For Name, enter the private health fund's name. In the dropdown, select the health fund's name that is labeled with ECLIPSE.

    ECLIPSE-Setup-04.png
  4. For Type, select Fund. Configure the rest of the health fund's details as needed.

  5. Click Save.

You have successfully set up the health fund. Repeat this step for every health fund where you are registered as a provider.

Add required identifications

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) .

  • Health fund identification

    In this step, you must add your practitioner claim details for each health fund.

    1. Click Contacts > Organisations.

    2. In the list, click the health fund to open its profile.

    3. Under the Claim Details section, click Add New.

      ECLIPSE-Setup-05b.png
    4. Add the practitioner's details as a provider for this private health fund, including:

      ECLIPSE-Setup-05c.png
      • 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.)

      • 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.

    5. 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.

  • Funder identification

    For the Private Health Insurance funder you imported, you must add your Medicare provider number for each hospital (location).

    1. Click Finances > Fees, then click the Identifications tab.

    2. In the top right, click Edit. (If you are adding identification for another practitioner, select the practitioner's name in the Practitioner dropdown.)

    3. 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.)

      ECLIPSE-Setup-05a.png
    4. 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).

Import private health fees and services

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.

  1. From the calendar, create a patient appointment on the date and time of the service provided.

  2. For Name, enter the patient's name. (If it is a new patient, add them as a new one from the dropdown.)

  3. 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:

    • Check the funder: The fee you are selecting must be linked to the Private Health Insurance funder.

      ECLIPSE-Setup-07a.png

      Example of fees with the same item code from different funders (click to expand)

    • 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.)

      ECLIPSE-Setup-07b.png

      Example of fees with the same item code under different fee schedules (click to expand)

    • 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.

      ECLIPSE-Setup-07c.png

      Example of fees with the same item code and fee schedule but differ in rebate amount due to gap preference (click to expand)

  4. (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.

    ECLIPSE-Setup-07d.png

    Example of changing the fee Amount to include a $75 gap fee

  5. Click Import Fee. You have added the fee to your practice's Fees List. The fee can be selected again for future claims.

  6. To add multiple fees to a claim, click Add Another Fee and repeat step 3 and 4.

  7. 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

Set up patient claim for their private health fund

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.

  1. To enter the patient's claim details, you can do it in two ways:

    • From the calendar: Under Private Health Insurance Claim, click the Icon-Edit.svg edit icon.

      ECLIPSE-Claim-04.png
    • From the invoice: Under the Patient Details section, under Private Health Insurance Claim, click the Icon-Edit.svg edit icon.

      ECLIPSE-Setup-06d.png
  2. In the pop-up, configure your patient's claim.

    ECLIPSE-Setup-06e.png
    • 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.)

    • 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.

    • Member Number: Enter the patient's member number with this health fund.

    • 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.

    • Expiry: If the patient's fund membership has an expiry date, enter it. If they don't, leave this field blank.

    • Payer: Select Patient.

  3. Click Save.

  4. The claim is successfully added to the invoice and in the patient's profile. Verify the patient's claim by clicking the Icon-Unverified.svg unverified icon next to their member number.

    ECLIPSE-Setup-06c.png

When the Icon-Verified.svg 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.

Updated

Was this article helpful?