What's new?

July 2014

Improvements will be made to the way some PBS medicines are processed under the Highly Specialised Drugs Programme from 1 July 2015.

Simplified Billing (ECLIPSE)

Simplified Billing

Simplified billing is an initiative of the Australian Government Department of Health. The goal of Simplified Billing is to reduce the number of accounts a private patient receives after being in hospital.

By working together, Department of Human Services (Human Services), private health insurers and billing agents (usually a hospital or day surgery centre) are streamlining the way patients pay their bills and claim benefits from Medicare and their private health insurer, leaving them free to concentrate on recuperating.

ECLIPSE

Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE) is an extension of Medicare Online claiming.  It offers a secure connection between practices, public and private hospitals, billing agents Human Services, health care providers, private health insurers and the Department of Veterans' Affairs (DVA). It includes direct communication for providers with Human Services and private health insurers in the one transaction.

ECLIPSE can be used for both paid and unpaid in-patient medical claims and in-hospital claims - which can be lodged directly to Human Services through practice management software.
 

Medical and Eligibility User Guide

Refer to the Medical and Eligibility User guide.

Benefits

  • Faster resolution of claims and quicker payment times.
  • Less manual intervention - fewer errors, quicker resolutions.
  • Clearer error messages with a single point of contact for fixing problems.
  • Online patient verification of Medicare enrolment and private health insurer membership.
  • No more claims batching.
  • One system for all private health insurers.
  • No transaction costs for medical claiming.
  • All in one area for claiming.

Private health insurers involved

For the individual functionality and contact details of each private health insurer involved in ECLIPSE, please see the Health Fund Functionality and Contact Details [PDF, 189Kb]PDF reader required, and Health Fund Functionality and Contact Details documents [RTF, 591Kb].

Simplified Billing and ECLIPSE forms

Use this form to request a latter day adjustment to a Simplified Billing or ECLIPSE claim.

To register a Hospital or Day Procedure Centre for In-Hospital Claiming (IHC) complete:

Application for late lodgment of a Simplified Billing claim for assigned Medicare benefits form must be submitted to Human Services through a nominated private health insurer or billing agent.

Billing Agent

Human Services is required under legislation to consider applications for registration as a Simplified Billing agent and is also responsible for auditing them.

A billing agent must be approved by Human Services and can be a corporation, partnership, individual or body.

What is an Approved Billing Agent?

Billing agents act on the patient’s behalf to claim Medicare and private health insurance medical benefits. The patient need not be involved unless there is an agreed out-of-pocket expense.

Billing agents are entitled to collect the gap benefit from the private health insurer, on behalf of the provider, when the private health insurer and provider have a gap cover/scheme arrangement.

Billing Agent Registration

Individuals or companies wishing to establish a billing agency need to download the Billing Agent Registration Kit below.  For more information email simplified.billing@humanservices.gov.auEmail or call 02 6143 7557 

Billing Agent Registration Kit

The Billing Agent Registration Kit [ZIP, 404Kb] includes:

  • Application to register as an approved Billing Agent and ECLIPSE form
  • Statutory Declaration
  • Deed Poll in favour of Department of Human Services (2 copies required you retain one copy)
  • Deed Poll  instructions
  • Billing Agent Registration check list

Approved Billing Agents

The current list of approved billing agents and their contact details is attached below.

Contact us

For more information on ECLIPSE call the eBusiness Service Centre on 1800 700 199 or refer to the Medical and Eligibility User guide.

Some documents on this page may require the free Adobe PDF reader.

Last updated: 17 July, 2014