Lodge an ECLIPSE claim

Who can do this?

*Credits will only be charged for successful transactions.

After completing the setup requirements for ECLIPSE claiming, you can now prepare your claims to send to ECLIPSE.

To lodge an ECLIPSE claim, all you need to do is create a patient invoice, add the fees, and submit!

Lodging an ECLIPSE claim in Halaxy costs 1 Halaxy credit.

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.

Tip

Before you lodge, you can perform an eligibility check to get a approximate quote on what the health fund will (or will not) cover.

Submit an ECLIPSE claim

  1. Create a patient invoice and add the private health fees.

  2. Review the invoice to ensure it contains all the correct required information:

    ECLIPSE-Claim-02.png

    Example of an invoice ready to be submitted as a claim via ECLIPSE

    • Practitioner details

      • The practitioner's name

      • The hospital address and ABN

    • Provider identification

      • The practitioner's Medicare provider number

      • Facility ID (the hospital's Medicare provider number - not visible on invoice)

      • Fund Payee ID (the practitioner's provider identification added to the health fund's organisation profile - not visible on invoice)

    • Patient and health fund details

      • Patient name

      • Patient's health fund as the paying organisation

      • Patient claim information with their health fund

      • Patient referral details - required for attendance fees (i.e. professional attendance at consulting rooms or hospital)

    • Fee details

      • Date of the service

      • Item code of the service with the health fund

      • The fee is linked to the Private Health Insurance funder

      • The fee is labeled with the correct fee schedule (see our reference guide for the correct fee schedule for your health fund)

    If you are missing some information on your invoice for claiming, check our ECLIPSE setup guide for detailed instructions on how and where to add them.

  3. When you are ready to submit, under the Payments section:

    ECLIPSE-Claim-03.png
    • If you are lodging an in-patient claim: Click In-patient Claim.

    • If you are lodging an overseas claim: Next to In-patient Claim, click the down arrow, then click Overseas Claim.

  4. In the pop-up, depending on the fee/s in your invoice, you may need to configure your Service Type Code before submitting. Click Additional Information to expand claim details and select the correct Service Type Code for your fee/s:

    • General: For operation and procedure fees

    • Pathology services: For pathology fees

    • Specialist: For attendance fees (consulting rooms or hospital)

  5. Click Process.

Your claim has been submitted to ECLIPSE.

If the claim information is valid, ECLIPSE sends the claim to the paying organisation (health fund) for approval.

Note

Charging a gap fee? Lodge the claim first, then charge the outstanding amount on the invoice (i.e. gap) to the patient.

Confirm ECLIPSE claim status and rebate payment

To monitor the status of your claim, you can view claim history or request an ECLIPSE Processing & Payments Report.

  1. Open the invoice.

  2. Under the Payments section: next to the submitted ECLIPSE claim, click Request Report or View Report.

    ECLIPSE-Claim-05.png
    • To view claim history on this invoice: Click the Submitted status.

    • To request the claim report: Click Get Report.

When the report is ready, it displays information on:

ECLIPSE-Claim-06.png

Example of a report for a claim rejected by Medicare ECLIPSE

  • The reference number of the claim

  • The status of the report (if Medicare has generated a report)

  • The status of the claim (if it has been approved or rejected by the health fund)

  • The status of payment (if the rebate has been paid to your registered bank account)

  • The total benefit to be paid (for approved claims)

  • Payment transaction details (for successful claims)

  • The error code and reason why the claim was rejected (for rejected claims)

Note

The claim status typically updates within 7 days. Payment to the registered bank account is usually made within 21 days. If you do not receive any updates within these timeframes, please contact the health fund and provide the claim reference number.

Updated

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