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:

1. No Gap (Agreement)
2. Known Gap (Scheme)
3. Patient Claim

https://www.servicesaustralia.gov.au/organisations/health-professionals/services/medicare/simpli
fied-billing-and-eclipse

If you choose not to register with health funds, your options are limited:

1. To accept full payment for surgery before or after surgery OR
   
2. 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.

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 ( )

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.

PRODA link

• https://proda.humanservices.gov.au/

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.

• https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/hw023

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 

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.

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

Email:            Gap Cover - [email protected]
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:

1. Provider number

2. Provider Name

3. Service Date

4. Problem

5. Patient membership number

6. Patient name

7. 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

NIB does not allow gaps to be charged for inpatient services

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

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-g ap-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 Dr.Billing@bu pa.com.au (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_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

Email:                        [email protected]

Ph:      1800 316 915

Invoices:   Email [email protected] if not submitted via iRBS

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

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

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

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

(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.

AAMI Health Insurance is underwritten by NIB. Please see NIB for all contact, enquiries, registrations, and resubmissions details.

Code:                     NIB

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

(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

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 

(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

(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’.

(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://providers.guhealth.com.au/register/#/ Batch Header/Account Form: https://providers.guhealth.com.au/docs/provider-batch-account-for

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

Code:                     HCF

Email:                       [email protected]

Ph:                          131 334 - Press 4

Postal Address:             PO Box 4242, Sydney NSW 2001

Provider Portals: https://www.hcf.com.au/provider-portals/

Registration Medicover: https://www.hcf.com.au/pdf/provider-portals/HCF_Medicover_How_to_register.pdf

Medicover Application Form:

https://www.hcf.com.au/pdf/provider-portals/HCF_Medicover_application_form_for_registering_pr ovider_locations.pdf

Email address for registration forms is [email protected] as of 7-9-2023 Resubmission

Invoice & letter of explanation posted to HCF Medical Claims PO Box 4242, Sydney NSW 2001