Online claiming functions
The latest Medicare software releases have been developed as a collaborative effort between Medicare, private health funds, medical peak bodies, billing agents, hospitals, health departments and software vendors. The most recent release has been available since November 2005 and expands on the functions available, particularly with DVA claiming, online eligibility for in-hospital patients and pathology claims.
Online functionality offered by Medicare includes:
- eligibility/entitlement checks
- bulk bill claiming
- private patient claiming - patient claims can be lodged with Medicare at the practice saving patients from queuing at a Medicare office
- in-patient medical claiming (IMC) - for agreements and schemes
Private health funds/ECLIPSE
- patient verification
- in-patient medical claiming (gap cover arrangements)
- eligibility checking to estimate the out-of-pocket costs for hospital services and identify any known gap
Australian Childhood Immunisation Register
- notification of immunisation
Department of Veterans' Affairs
- claiming for medical and pathology with no paperwork needed to be mailed to Medicare
- checks to see if a patient is known to the Department of Veterans' Affairs
The latest release enables complex pathology claims to be lodged online. It has also expanded on the online patient verification by offering 1000 patient verifications to be done in batch mode.
Further advances to online claiming are planned to provide greater provider and consumer accessibility to Medicare and the health sector. Online options planned for the future include:
- Release 6 - hospital claiming and remittance advices, and prosthetic online eligibility checking;
- Release 7 - ancillary functionality including claiming and overseas patient claiming.
The latest release of online claiming, Release 6, includes all the features of previous releases of online claiming/ECLIPSE as well as new features that benefit practices and hospitals. The new features of Release 6 include:
- hospital claiming
- hospital eligibility checking
- overseas claiming
Make a request for more information, or to have a business development officer contact your practice.
Hospital claiming allows public and private hospitals and day facilities to lodge claims for a patient's hospital stay direct with the private health fund or DVA. This includes claims for accommodation, theatre, transfers, prosthetics and miscellaneous services. Hospital claiming also includes interim and final processing reports and electronic remittance advices. Find out more information about hospital claiming.
Online eligibility checking has been expanded to permit hospitals to obtain an estimate of a patient's likely out-of-pocket expenses (excess). This enables the patient to provide informed consent to the hospital, prior to proceeding with the procedure (known as informed financial consent).
Overseas medical claims from overseas students or overseas visitors holding overseas cover with a private health fund can be lodged direct with a participating private health fund. Claims can be made for both in-hospital and out of hospital services.
For more information about online claiming and ECLIPSE, call the Medicare eBusiness Centre on 1800 700 199 or email firstname.lastname@example.org.
Last updated: 25 September, 2013