This article contains additional information to help you with lodging your ECLIPSE claims.
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Claim Type Code: When entering your claim identification in the health fund's organisation profile, refer to this column for the correct Claim Type Code for the health fund.
Fee Schedule: When preparing your ECLIPSE claim, select the fee name labeled with the correct fee schedule for the patient's health fund. ((Important: All fees for ECLIPSE claiming must be under the Private Health Insurance funder.)
|
Health Fund Name |
Claim Type Code |
Fee Schedule |
|---|---|---|
|
ACA Health Benefits Fund |
Scheme |
AHSA |
|
AIA Health Insurance |
Scheme |
AHSA |
|
ANZ Health |
Scheme |
AHSA |
|
Allianz Global Assistance |
Scheme |
AHSA |
|
Australian Health Management |
Scheme |
Medibank Private |
|
Australian Unity Health Limited |
Scheme |
AHSA |
|
BUPA Australia |
Agreement |
BUPA |
|
BUPA Australia Defense Force |
Agreement |
BUPA |
|
Budget Direct Health Insurance |
Scheme |
AHSA |
|
CBH Health Fund Ltd |
Scheme |
AHSA |
|
CBHS Corporate Health Pty Ltd |
Scheme |
AHSA |
|
CDH Benefits Fund Limited |
Scheme |
AHSA |
|
Credicare Health Fund Limited |
Scheme |
AHSA |
|
Defence Health |
Scheme |
AHSA |
|
Emergency Services Health |
Scheme |
AHSA |
|
Fit Health Insurance |
Scheme |
AHSA |
|
Frank Health Insurance |
Scheme |
AHSA |
|
GMHBA Limited |
Scheme |
AHSA |
|
Grand United Corporate Health |
Scheme |
AHSA |
|
HBA |
Scheme |
BUPA |
|
HCF Of Australia Limited |
Scheme |
HCF |
|
Health Care Insurance Limited |
Scheme |
AHSA |
|
Health Cover Direct |
Scheme |
AHSA |
|
Health Insurance Fund Of WA |
Scheme |
AHSA |
|
Health Partners |
Scheme |
AHSA |
|
Health.Com.Au |
Scheme |
AHSA |
|
Hospital Benefits Fund Of WA (HBF) |
Agreement |
HBF |
|
Latrobe Health Services |
Scheme |
Medicare |
|
Peoplecare |
Scheme |
AHSA |
|
MBF |
Scheme |
BUPA |
|
MBF Alliances |
Scheme |
BUPA |
|
MO Health |
Scheme |
AHSA |
|
Medibank Private |
Scheme |
Medibank Private |
|
Medibank Private (Overseas Visitors) |
Scheme |
Medibank Private |
|
Mildura District Hospital Fund |
Scheme |
Mildura District Hospital Fund |
|
Mutual Community |
Scheme |
AHSA |
|
NIB Health Funds Limited |
Scheme |
NIB |
|
Navy Health Limited |
Scheme |
AHSA |
|
Nurses & Midwives Health Fund |
Scheme |
AHSA |
|
Onemedifund |
Scheme |
AHSA |
|
Phoenix Health Fund Ltd |
Scheme |
AHSA |
|
Queensland Country Health |
Scheme |
AHSA |
|
Queensland Teacher's Union |
Scheme |
AHSA |
|
RACT Health Insurance |
Scheme |
AHSA |
|
Railway and Transport Health |
Scheme |
AHSA |
|
Reserve Bank Health Society Ltd |
Scheme |
AHSA |
|
SA Police Employees Health |
Scheme |
AHSA |
|
St. Luke's Health |
Scheme |
St. Luke's Health |
|
Teachers Federation Health |
Scheme |
AHSA |
|
Territory Health Fund |
Scheme |
AHSA |
|
The Doctors' Health Fund Limited |
Scheme |
AHSA |
|
Transport Health |
Scheme |
AHSA |
|
Westfund Ltd |
Scheme |
AHSA |
|
Term |
Description |
|---|---|
|
Eligibility Check |
An online process to verify if the fees on the patient's claim is covered by Medicare or their health fund, and (if eligible) the benefit amount. |
|
Facility ID |
The hospital's provider number issued by Medicare. This information is added in the Identification page under the health fund's funder. |
|
Fund Payee ID |
The practitioner's identification number issued by the health fund. This information is added in the practitioner's claim details under the health fund's organisation profile. |
|
Known Gap / No Gap |
The gap specification for a fee. Some fees have different rebates depending if a practitioner charges a gap fee for it. If you are charging a gap fee, the fee labeled Known Gap must be selected. To add a gap fee, configure the fee's Amount value to be the Rebate plus the gap fee. For example: If you are charging a $25 gap for a fee with a $50 rebate, set the Amount to $75. Do NOT change the Rebate value. |
|
Provider Number |
The practitioner's provider number issued by Medicare. |
|
Verification |
An action on Halaxy that verifies the patient's claim to confirm their eligibility or membership with their health fund. This is identical to the Medicare OPV / OVV. |
Updated