Health Fund Registration & Resubmission Guide
Registration Overview
Providers are required to register with each Health Fund to be eligible to claim the higher Health Fund rebate for inpatient service claims processed through ECLIPSE.
ECLIPSE is an integrated electronic billing system where the money is paid directly to the doctor.
ECLIPSE is integrated with your Practice Management Software (PMS)
Claiming options are:
- No Gap (Agreement)
- Known Gap (Scheme)
- Patient Claim
If you choose not to register with health funds, your options are limited:
- To accept full payment for surgery before or after surgery OR
- To process the unpaid account as a Patient Claim and wait the 4 - 8 weeks for the patient to return the cheques from Medicare and the Health Fund to you. This is known as a Pay Doctor Via Claimant (PDVC) cheque.
The higher rebate will not be available to you and patients will have a higher out of pocket expense.
Resubmission - overview
When a claim is rejected through ECLIPSE, providers are required to resubmit an amended claim to receive payment. Fully rejected claims can be resubmitted via ECLIPSE, whereas partially rejected claims need to be submitted manually directly to the Health Fund. Reasons for rejecting claims may vary, so if the reason is unclear it is best to contact the Health Fund for further details.
Some Health Funds require the inclusion of the ECLIPSE adjustment claim form ( )
Medicare - PRODA
Providers must have a Medicare Provider Number to be able to register with Health Funds.
It is also recommended providers apply for a PRODA account.
Practice Managers and admin staff can apply for their own PRODA account then request delegations from their provider. This can assist them in managing online claims and new provider numbers, online bulk bill claims and
outpatient claims.
Fee Schedules - overview
Most Practice Management Software has the Health Fund Fee Schedules integrated and should be available for download.
Links
PRODA link
Medicare Forms
- https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/hw029
- https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/hw052
Resubmission
Consider setting up a template in your software to avoid filling the provider and practice details each time you need it.
Health Fund Groups
Groups or Alliances include a number of Health Funds under the one representative body.
Providers register with the Group, who then distribute their information out to all their associated Health Funds. This streamlines the registration process making it easier for providers to reach all Health Funds.
AHSA (*) Australian Health Services Alliance
Email: [email protected]
Access Gap Cover Freecall: 1800 664 277 (option 1)
Fax: 1800 670 898
Postal Address: 979 Burke Road, Camberwell VIC 3124
Provider Portal: https://www.ahsa.com.au/web/doctors
Registration: Email completed form to [email protected]
https://www.ahsa.com.au/web/doctors/forms/registration__direct_credit_authority
List of AHSA funds - https://www.ahsa.com.au/web/doctors/agc/participating_fund_contact_list
(download the PDF copy) https://www.ahsa.com.au/web/fundlist
Resubmission
AHSA Batch Header is required for AHSA associated Health Funds but the amended invoice and batch header form need to be delivered to the fund and NOT the AHSA
https://www.ahsa.com.au/web/doctors/forms/account_summary
ARHG(#) Australian Regional Hospitals Group
Email: [email protected]
Ph: N/A as of April 2021
Contact: https://arhg.com.au/contact-us/
Registration: https://providerregistration.arhg.com.au/
Funds: St Lukes, CDH, La Trobe, Mildura Health.
BUPA(^)
Email: Medical Gap Scheme - [email protected]
Ph: Providers 134 135 (For Providers, press 3)
Fax: 1300 130 623
Postal Address Medical Claims, GPO Box 9809, Brisbane QLD 4001
Partner Portal Access Form: https://partnerlogin.bupa.com.au/templates/BUP17214_Bupa%20Partner_Portal_Access_Form.pdf
Email to: [email protected]
For Providers: https://www.bupa.com.au/for-providers
Registration and Submission
Medical Gap Scheme:
https://www.bupa.com.au/-/media/dotcom/files/pdfs/08980-bupa-medical-gap-scheme-application-form.pdf
Phone:
Claim Payments enquiries 1300 367 877
8am-8pm Mon-Fri. Max 5 patient enquiries per call.
Fee Schedules: Bupa Healthcare Management 1800 060 239
Provider Recognition:
https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/Application-for-Provider-Recognition-Form.pdf
Funds: BUPA, ANZ Health, HBA, Health Cover Direct, MBF, MBF Alliances
Submission: New claims unable to go via ECLIPSE must be sent by post or fax.
Resubmission: Call 134 135 (Press 3) and discuss the problem. BUPA will provide a claim ID that needs to be included in the subject line of the email.
Email: (for previously submitted claims only)
Subject Line: ECLIPSE MEDICARE adjustment
Body: Eg Item xxxxx accidentally left off original claim
Please send attached amended invoice to Medicare to reassess
Can take 3 - 6 months
Attach amended invoices with completed resubmission form https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/09140-06-1_provider-resubmission-form.pdf
Other Document Links
Medical Gap Scheme Batch Header https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/batch_h eader_form.pdf
Medical Gap Scheme Change of Details Form https://www.bupa.com.au/-/media/Dotcom/Files/pdf s/change_of_details.pdf
Medibank Private(+) (MBP)
Provider EFT - [email protected]
Ph: 1300 130 460 (Hospital & Provider Advocacy Team)
Postal Address:
Medical and Ancillary Adjustments and Registrations
GPO BOX 9999, Melbourne 3001 No Portal - they send statements
Registration
Adobe Reader DC is essential to complete the form https://www.medibank.com.au/providers/
GapCover Application & Change of Details Form can only be accessed from https://www.medibank.com.au/providers/messaging/
You will need your Provider Name, and Provider Number before the online messaging chat officer will send you the form.
Email to: [email protected]
Provider EFT Form: https://www.medibank.com.au/content/dam/medibank/docs/forms/eft-registration-form.pdf
Resubmission
https://www.medibank.com.au/providers/messaging/
Use Providers’ Messaging Service on the bottom right of the helpdesk screen. Information needed:
-
Provider number
-
Provider Name
-
Service Date
-
Problem
-
Patient membership number
-
Patient name
-
Patient DoB
Allow a minimum of 30 minutes for process. Wait for email. Check Junk Mail
OR after speaking to the helpdesk, email revised claim with reference number to providercases@ medibank.com.au
FYI Gentu is currently applying the incorrect fees for items 18264. A top-up is needed for the Provider to be paid correctly. Use the messaging to get the correct money for your provider.
Email: [email protected]
Provider Ph: 1300 853 530
Postal Address: NIB Health Funds, Locked Bag 2010, Newcastle NSW 2300
Provider Portal: https://www.nib.com.au/providers/hcp-portal/user/login
Registration https://www.nib.com.au/providers/medigap-form/#/
Resubmission Email [email protected] with amended invoice and https://www.nib.com.au/docs/provider-batch-header-form
Funds: AAMI, APIA, Suncorp, Honeysuckle, Qantas, TAL Health, GU Corp, IMAN Australia, ING
Health Fund Information
Australian Unity*
Code: AUF
Email: [email protected]
Ph: 1800 035 360
Open 8:30am-5pm Monday-Friday
Postal Address: Australian Unity Health, Reply Paid 91943, Melbourne VIC 3000
Provider Portal: https://www.australianunity.com.au/ProviderPortal/Account/LogOn
Call to register: 1800 035 360
Registration
See AHSA in the list above
Resubmission Via Provider Portal
Include Original & amended invoice required, no batch header required
AIA Health Insurance*
Code: MYO
Website: http://www.aia.com.au/
Phone: 1800 333 004 - Press 3
Postal Address: PO Box 7302, Melbourne VIC 3004
Registration See AHSA
Resubmission Email [email protected]
Include: https://www.ahsa.com.au/web/doctors/forms/account_summary
formerly MyOwn Health
AAMI~
AAMI Health Insurance is underwritten by NIB. Please see NIB for all contact, enquiries, registrations, and resubmissions details.
Code: NIB
ACA*
Code: ACA
Email: [email protected] , [email protected]
Ph: 1300 368 390
Postal Address: Locked Bag 2014, Wahroonga, NSW, 2076
Registration See AHSA
Resubmission Ph As above to determine reason for rejection
Email: [email protected]
Include: https://www.ahsa.com.au/web/doctors/forms/account_summary
BUPA(^)
Email: Medical Gap Scheme - [email protected]
Ph: Providers 134 135 (For Providers, press 3)
Fax: 1300 130 623
Postal Address Medical Claims, GPO Box 9809, Brisbane QLD 4001
Email to: [email protected]
For Providers: https://www.bupa.com.au/for-providers
Registration and Submission
Medical Gap Scheme: https://www.bupa.com.au/-/media/dotcom/files/pdfs/08980-bupa-medical-gap-scheme-application-form.pdf
Ph: Claim Payments enquiries 1300 367 877
8am-8pm Mon-Fri. Max 5 patient enquiries per call.
Fee Schedules: Bupa Healthcare Management 1800 060 239
Funds: BUPA, ANZ Health, HBA, Health Cover Direct, MBF, MBF Alliances
Submission: New claims unable to go via ECLIPSE must be sent by post or fax.
All new accounts must be forwarded to [email protected] (one batch per email, maximum of 20 claims per batch)
Resubmission: Call 134 135 (Press 3) and discuss the problem. BUPA will provide a claim ID that needs to be included in the subject line of the email.
All reviews, adjustments or payment enquiries must be forwarded to [email protected] (maximum of five accounts per email)
Email: [email protected] (for previously submitted claims only)
Subject Line: ECLIPSE MEDICARE adjustment
Body: Eg Item xxxxx accidentally left off original claim
Please send attached amended invoice to Medicare to reassess
Can take 3 - 6 months
Attach amended invoices with completed resubmission form https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/09140-06-1_provider-resubmission-form.pdf
All Provider Registration, Change of Detail Forms, and Bupa Partner Portal Access queries must be forwarded to [email protected]
Please ensure all attachments are in a PDF format where possible, with a maximum file size of 4mb. Word documents will be accepted; however, any other file types will not be successful.
Other Document Links
Medical Gap Scheme Batch Header https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/batch_header_form.pdf
Medical Gap Scheme Change of Details Form https://www.bupa.com.au/-/media/Dotcom/Files/pdfs/change_of_details.pdf
BUPA ADF Health Services
Email: [email protected]
Ph: 1800 316 915
Invoices: Email [email protected] if not submitted via iRBS
CBHS Corporate Health Pty Ltd*
Code: CBC
Email: [email protected]
Ph: 1300 586 462 (Press 3)
Postal Address: CBHS Corporate Health, Attention: Provider Relations
Locked Bag 5098, Parramatta NSW 2124
Provider Centre: https://members.cbhscorporatehealth.com.au/providers
Registration See AHSA
Resubmission Phone 1300 586 462 (Press 3) to make enquiries Email: [email protected] with amended claim
CBHS Health Fund Limited*
Code: CBH
Email: [email protected]
Ph: 1300 654 123 (Press 2)
Postal Address: Locked Bag 5014, Parramatta NSW 2124
For Providers: https://members.cbhs.com.au/providers
Provider Claims: https://www.cbhs.com.au/for-providers/provider-claims Provider Benefit Statement Registration:
https://provider.cbhs.com.au/Home/ProviderBenefitStatementRegistration_fillable_v2.pdf
Registration See AHSA
Resubmission Call above phone number for enquiry
Email: [email protected] with amended claim
CUA*
Code: CHF
Email: [email protected]
Ph: 1300 499 260
Postal Address: GPO Box 100, Brisbane QLD 4001 Registration See AHSA
Resubmission Email [email protected]
Include https://www.ahsa.com.au/web/doctors/forms/account_summary
Defence Health*
(Previously: Army Health Benefits Society)
Takes 21 days to process payment
Code: DHF
Email: [email protected]
Ph: 1800 656 329 for providers
Postal Address:
Claims Department,
PO Box 7518,
Melbourne VIC 3004
Registration See AHSA
Resubmission
For claim review:
Email: [email protected]
Include: https://www.ahsa.com.au/web/doctors/forms/account_summary
Doctors Health Fund Pty Ltd*
(Previously: AMA Health Fund)
Code: AMA
Email: [email protected]
Ph: 1800 226 586 - Press 2 (Hospital/Medical Claims)
Postal Address: PO Box Q1749, Queen Victoria Building, Sydney NEW 1230
Registration See AHSA
Resubmission Call 1800 226 586 - Press 2 To discuss rejections
DVA corrections
https://www.dva.gov.au/providers/claiming-and-compliance/provider-claims
Ph: Provider enquiries: 1800 550 457 (Confirming registration)
General enquiries: 1800 555 254
Payment confirmations: 1300 550 017 (Option 1)
Email: None provided as of April 2021
Postal Address: GPO Box 9869, Capital City, Postcode
Registration Apply for a Medicare Provider Number https://www.dva.gov.au/providers/become-dva-health-care-provider
Provider Forms: https://www.dva.gov.au/providers/provider-forms
Resubmission Invoicing & billing enquiries Ph: 1300 550 017
All GENTU resubmissions are processed through DVA Webclaims in PRODA
Submissions of MT04 numbers.
All GENTU custom item submissions are processed through DVA Webclaims in PRODA
Emergency Services Health*
(Operating under Police Health Limited)
Code: POL
Email: [email protected]
Ph: 1300 703 703 - Press 3
Postal Address: Reply Paid 6111 Halifax St, Adelaide SA 5000 Registration See AHSA
Resubmission Email [email protected]
Include: https://www.ahsa.com.au/web/doctors/forms/account_summary
Frank Health*
(Operating under GMHBA)
Code: GMH
Email: General enquiries: [email protected]
Ph: 1300 437 265 - Press 3
Postal Address: PO Box 69, Geelong VIC 3220 https://www.frankhealthinsurance.com.au/providers
Registration See AHSA
Resubmission Complete the account form linked below https://www.frankhealthinsurance.com.au/documents/GMHBA-Medical-Gap-Claim-Account-form.pdf
Include: Amended invoice
Email: [email protected]
Subject line: ‘Resubmission of rejected Eclipse claim’.
GU Health ~
(Underwritten by NIB)
Code: FAI
Email: [email protected]
Ph: 1800 411 633, registration, update details
1800 249 966, provider claims
Postal Address: GPO Box 2988, Melbourne Vic 8060
Registration
Online Form: https://register.honeysucklehealth.com.au/for-providers/medical-network-registration/
Provider Forms: https://www.guhealth.com.au/forms-and-publications/for-providers
Email Medical Gap Network Form: [email protected]
Postal Address for Medical Gap Network:
GU Health, Reply Paid 2988, Melbourne VIC 8060
Resubmission: Email: [email protected] with Membership Number in subject
GMHBA*
Code: GMH
Email: Medical Account & Billing: [email protected]
Ph: 1300 301 437
Postal Address: PO Box 761, Geelong VIC 3220
Registration See AHSA
Resubmission Submit amended invoice to [email protected]
Include: https://www.ahsa.com.au/web/doctors/forms/account_summary
HBF of WA*
HCF
HCI*
Health Partners*
health.com.au*
HIF *
Hunter Health #
IMAN Australian Health Plans~ (NIB)
Latrobe Health Services # (ARHG)
Mildura # (ARHG)
myOwn Health* See AIA
Navy Health * (AHSA)
NIB~
Nurses & Midwives Health* AHSA
onemedifund* AHSA
Peoplecare Health* AHSA
Phoenix Health Fund* AHSA
Police Health* AHSA
Qantas Assure~ NIB
Qld Country Health* AHSA
rtHealth (HCF)
Reserve Bank Health Society* AHSA
St Lukes # ARHG
Suncorp Health ~ NIB
Teachers Health * AHSA
Territory Health * AHSA
Transport Health
TUH * AHSA
UniHealth*
Westfund * AHSA
International Health Funds / Overseas Insurance - No Medicare
Overseas Student Health Cover OSHC
Overseas Visitor Health Cover OVHC
Cannot be submitted via ECLIPSE. Consider accepting payment as a deposit in full PRIOR to the appointments and surgery dates.
If the patient does not have a Medicare card, remember that you cannot bulk bill. You would need to take payment in full for the service.
Allianz Global Assistance OVHC
Email: [email protected]
Ph: 1800 884 526
Postal Address: Allianz Care
OVHC Provider Billing
Locked Bag 3004
Toowong QLD 4066
Registration: https://www.allianzcare.com.au/en/medical-provider.html
https://www.allianzcare.com.au/en/medical-provider/join-our-medical-network.html
Submission:
Email [email protected] with member number in the subject line. No batch header required but explanation preferred.
Attach the invoice.
Resubmission: Provider Portal:
Allianz Overseas Student OSHC
Email: [email protected]
Ph: 1800 884 526
Postal Address: Allianz Care
OSHC Provider Billing
Locked Bag 3001
Toowong QLD 4066
Registration: https://www.allianzcare.com.au/en/medical-provider.html
https://www.allianzcare.com.au/en/medical-provider/join-our-medical-network.html
Resubmission: Provider Portal:
BUPA Global ^
Email: [email protected]
General enquiry: [email protected]
Ph: New customers: 1800 287 141
Existing & further info: +44 (0) 1273 323 563
Postal Address: Bupa Global, Victory House, Trafalgar Place Brighton, BN1 4FY,
United Kingdom
Provider Portal: https://www.bupaglobal.com/en/provider
Registration
Email above to register interest and for further correspondence
https://www.bupaglobal.com/en/provider/working-with-bupa
Submission/Resubmission
Access 24-hour customer service in regards to your claims
BUPA OSHC ^
A Direct Billing provider provides inpatient and outpatient services for Overseas Health Cover members.
The invoice is sent to BUPA OSHC and then payment will follow in the weeks to come.
Check the contract that your provider has set up with BUPA OSHC - request Direct Billing for both Inpatient and Outpatient [email protected]
It is better for the doctor to expect full payment from the patient and to NOT participate in direct billing.
The patient can claim their reimbursement from BUPA OSHC at their convenience. Otherwise remove any Medicare
Reference and email with Batch Header to [email protected]
Ph: 1800 888 942 - Press 3 (Provider Operations is the destination)
NIB OSHC/OSVC ~
NIB OSHC is underwritten by NIB. Please see NIB for all contact, enquiries, registration, and resubmission details.
Code: NIB
Ph: 1800 775 204
02 4914 1245
Use the online claim form batch header and email to [email protected]
The invoice is sent to NIB OSHC/OSVC and then payment will follow in the weeks to come.
Check the contract that your provider has set up with NIB OSHC/OSVC - request Direct Billing for both Inpatient and Outpatient [email protected]
It is better for the doctor to expect full payment from the patient and to NOT participate in direct billing.
The patient can claim their reimbursement from NIB OSHC/OSVC at their convenience.
UnitedHealthcare Global~
UnitedHealthcare Global is underwritten by NIB.
Please see NIB for all contact, enquiries, registration, and resubmission details.
Code: NIB
Workcover/3rd Party
ADF Health Services
Email: [email protected]
Phone: 1800 316 915
Allianz
Email: [email protected]
Phone: 03 9224 3379
EML
Email: [email protected]
Phone:
EnAble
Email: [email protected]
Phone:
Gallagher Bassett
Email: [email protected]
Phone:
QBE
Email: [email protected]
Phone:
SA Health
Email: [email protected]
Phone: 1800 317 333
