Education guide - Medicare Online and ECLIPSE data elements

Explanations about common data elements or fields in Medicare Online and ECLIPSE that you might need to enter as part of a claim. Entering them correctly streamlines the claiming process.

Common data elements or field terms

This table explains common data elements or field terms and who can use them to make claims.

Different practice management software packages may have different data element or field names and locations to enter claiming data. Ask your software vendor or check your software help guide to find out more about how to enter data to lodge claims.

    Health professional claim type where you should use the field or data element
Data element or field Description and usage GP Specialist Radiology Allied Health
Service text or Free text

Only use this field when you need more information to support the claim for assessment. The field limit is 50 characters for Medicare claims. The limit for DVA claims is 100.

Check the table below for text field abbreviations. You can use the abbreviations if you’re running out of space.

Number of patients seen

This field indicates the number of patients a health professional has seen at a location. It includes patient visits to homes, hospitals, institutions or nursing homes. Use this for group attendance items, such as counselling.

You must supply this when you claim. If you don’t, you’ll get overpaid.

Duplicate service override indicator

This field indicates whether multiple services performed on the same day by the same health professional are separate services.

Set values:

  • Y - not a duplicate service
    • either set time of service or include information in the service text field to support your payment
  • N - duplicate service.

Referral issue date

This is the date the referral was issued or written by the referring health professional. Use DDMMYYYY format.

Referral period type code

This code indicates the length of the referral period. The set values are:

  • S - standard referral period is
    • 12 months for GPs
    • 3 months for specialists
  • N - non-standard period
    • enter the time the referral is valid for in months - must be between 1 and 98
  • I - indefinite period.

Referral override type code

This code indicates why referral services were provided without a referral from another health professional.

The indicators or codes are:

  • H - Hospital
    • H is an in-hospital referral - for a privately admitted patient, generated in a hospital for a service in that hospital
    • for these claim types, referred within and facility ID data will populate automatically. You don’t have to enter these details in the service text
    • for other online claim types you need to enter either the hospital provider number (facility ID) or the hospital name in the service text
  • L - Lost
    • L is a lost, stolen or destroyed referral. This applies to initial attendance items only and a referral is needed for subsequent attendances
  • E - Emergency
    • E is a referral in an emergency situation. This applies to initial attendance items only, and a referral is needed for subsequent attendances
  • N - Not required (Non-referred)
  • R - Remote Exemption (DVA only).

Claim types for ECLIPSE in-patient medical claims (IMC) are:

  • Agreements (AG)
  • Schemes (SC)
  • billing agent, Medicare and private health insurer (MB)
  • billing agent, Medicare only (MO).

Request issue date

This is the date the requesting health professional wrote the request. Use DDMMYYYY format.

Self-deemed

Self-deemed codes indicate that a health professional has provided a service that would usually be a referred service without a referral or request.

There are 3 self-deemed codes:

  • SD - self-deemed
    • SD is a service provided by a consultant physician or specialist as an additional service to a valid request.
  • SS - substituted service
    • SS is a service provided that has replaced the original service requested
  • N - not self-deemed.

Submit all self-deemed diagnostic imaging services without additional service text. If you need to add more text, begin the service text field with 'Self-deemed'.

Equipment ID

Use this field for radiology and radiation oncology services - Medicare Benefits Schedule Group T2 services.

The ID provides:

  • details of equipment used during radiation oncology treatment. This includes the equipment ID number - allocated by the Department of Health. Equipment IDs must be in the format E01234
  • the Location Specific Practice Number (LSPN) - registered practice site or mobile equipment base identification number.

Field quantity

Use this field for radiation oncology services - Medicare Benefits Schedule Group T2 services.

It’s used to provide the number of fields of treatment delivered to the treatment site or the quantity of time blocks for services.

If you don’t supply this information when claiming, you may get underpaid.

SCPId

Use the Specimen Collection Point (SCPId) to identify the site where the pathology specimen was collected.

Abbreviations for text fields

If you need to provide more information about a service, use an abbreviation in place of the full description, where you can.

Ask your software vendor or check your software help guide to find out how to add more information to claims.

Code Description
HGL Left
HGR Right
HOL Left eye
HOR Right eye
HU2 Non-contiguous body areas
HU3 Contiguous body area with different setup required
HX1 Not for comparison
HX2 All x-rays specifically requested
HX4 Hand, wrist and forearm
HX5 Forearm and elbow
HX6 Elbow and humerus
HX7 Foot and ankle
HX8 Ankle and leg
HX9 Leg and knee
HXA Knee and Femur

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This information was printed Sunday 19 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/enablers/education-guide-medicare-online-and-eclipse-data-elements It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 5 April 2019