Simplified Billing and ECLIPSE
Simplified Billing aims to reduce the number of accounts a private patient receives after being in hospital. It is an initiative of the Australian Government Department of Health.
Along with private health insurers and billing agents, usually a hospital or day surgery centre, we have streamlined the way patients pay their bills, claim benefits from Medicare and their private health insurer. This allows patients to concentrate on improving their health or recuperating.
Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE) is an extension of Medicare Online claiming. It offers a secure connection between health professionals, public and private hospitals, billing agents, health professionals, private health insurers, the Department of Veterans' Affairs and us. It includes direct communication between health professionals with us and private health insurers in the 1 transaction.
ECLIPSE can be used for both paid and unpaid In-patient Medical Claims which can be lodged directly with us through practice management software. ECLIPSE can also be used to lodge In Hospital Claims from public and private hospitals and day facilities in relation to the patient's hospital stay. This includes claims for accommodation, transfers, and miscellaneous items like prosthetics.
Medical and eligibility user guide for medical practitioners
Some of the benefits of using ECLIPSE include:
- faster resolution of claims
- 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
- 1 system for all private health insurers
- no transaction costs for medical claiming
- all-in-1 area for claiming
- overseas claiming
- online eligibility check of the patient's status with Medicare and their private health insurer and to obtain an estimate of out-of-pocket expenses
Refer to the Medical and Eligibility User Guide for Medical Practitioners - ECLIPSE (9173) [rtf, 1.0mb] for further information.
Information about registering for Medicare Online and ECLIPSE to lodge electronic claims:
- apply for a Medicare PKI Site Certificate
- check your with your software vendor that your software is compatible
- register for online claiming
- submit online claiming provider agreement form
- submit the form for approval
- use the registration checklist
Individuals or companies wishing to register as a Billing Agent need to:
- fill in an Application to register as an Approved Billing Agent and ECLIPSE form
- complete and sign a statutory declaration
- complete and sign a deed poll in favour of us - 2 copies required
- include an application fee
- submit the form for approval
- use the registration application checklist
Medicare digital claiming return codes
When you lodge a claim for Medicare benefits, we use return codes to tell you why the claim was rejected or how the claim was assessed.
Simplified Billing and ECLIPSE forms
Use the Simplified Billing or ECLIPSE adjustment form (HW023) to request a latter day adjustment to a Simplified Billing or ECLIPSE claim.
Use the Hospital or Day Procedure Centre Registration for In Hospital Claiming form (HW025) to register a hospital a day procedure centre for In Hospital claiming.
Use the Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits form (HW026) to apply for the lodgement of a Simplified Billing claim for assigned Medicare benefits, which must be submitted to us through a nominated private health insurer or Billing Agent.
Approved Billing Agents
A list of approved Billing Agents and their details.
Health Fund Functionality and contact details
A list of provider details of functionality for each private health insurer involved in ECLIPSE.