Education guide - Medicare Online and ECLIPSE data elements

Common data elements or fields used in Medicare Online and ECLIPSE claims to provide additional service related information to help streamline claims processing and payment timelines.

Table of common data elements

The table below outlines the common data elements or fields and the type of health professionals that may use them for their claims.

Different software packages may vary, including names and locations of fields in your practice management software (PMS) used to enter claiming data. Refer to your software vendor or software help guide for more information on data elements or fields and how you should use them for lodging claims.

Data element or field Description and usage GP Specialist Radiology Allied Health
Service text or Free text Only to be used when additional information is required to support the claim for claim assessment purposes. Field limit of up to 50 characters with the exception of DVA which allows 100.

Refer to the table below on abbreviations for text fields.
Number of patients seen This is used to indicate the number of patients seen by the provider at a location such as patient visits to homes, hospitals, institutions or nursing homes. It must be used for group attendance items such as counselling.

If this information is not supplied at the time of claiming it will result in an overpayment of Medicare benefit.
Duplicate service override indicator Set values:
  • Y - not a duplicate service
    • this requires either time of the service to be set or service text information in support of the payment
  • N - duplicate service
Referral issue date This is the date that the referral was issued or written by the referring provider. It must be in the format of DDMMYYYY.
Referral period type code Set values:
  • S – standard referral period is:
    • 12 months for GPs
    • 3 months for specialists
  • N – non-standard period
    • This requires the number of months the referral is valid for (a value to be set between 1 and 98)
  • I – indefinite period
Referral override type code Indicates why referral services were provided without referral from another provider.

Indicators or codes:
  • H – Hospital
    • H indicates an in-hospital referral where a referral for a privately admitted patient is generated in a hospital for a service in that hospital

For ECLIPSE In-patient Medical Claims (IMC) claim types – Agreements (AG), Schemes (SC), billing agent Medicare and private health insurer (MB) or billing agent Medicare only (MO) are set, the referred within: <Facility Id> data will be automatically populated in the claim. You don’t have to enter these details in the service text.

For other online claim types this requires either the ‘hospital provider number (facility ID)’ or ‘the hospital name’ details in the service text.

  • L – Lost
    • L indicates a lost, stolen or destroyed referral. This applies to initial attendance items only and a referral should be obtained for subsequent attendances
  • E – Emergency
    • E indicates referral in an emergency situation. This applies to initial attendance items only, and a referral should be obtained for subsequent attendances
  • N – Not required (Non-referred)
  • R – Remote Exemption (DVA only)
Request issue date This is the date the request was issued or written by the requesting provider. It must be in the format of DDMMYYYY.
Request override type code Indicators or codes:
  • L - Lost
    • L indicates a lost, stolen or destroyed request
  • E - Emergency
    • E indicates a service requested in an emergency situation
Self-deemed There are 3 self-deemed codes:
  • SD – self-deemed
    • 'SD' indicates a service provided by a consultant physician or specialist other than a specialist in diagnostic radiology or a self-deemed service by a radiologist as an additional service to a valid requested service
  • SS – substituted service
    • ‘SS’ indicates a service provided that has replaced the original service requested
  • N – not self-deemed

All self-deemed diagnostic imaging services should be submitted without additional service text. If additional service text must be included then the text field should begin with 'Self Deemed'.

Equipment ID

Must be used for Radiology and Radiation Oncology services - Medicare Benefits Schedule Group T2 services.

Used to provide:

  • details of equipment used during radiation oncology treatment such as the equipment ID number - allocated by the Department of Health. Equipment ID must be in the format E01234

Location Specific Practice Number (LSPN) - registered practice site or mobile equipment base identification number. LSPN is 6 numeric characters.

Field quantity May be used for Radiation Oncology services - Medicare Benefits Schedule Group T2 services.

Used to provide number of fields of treatment delivered to the treatment site.

If this information is not supplied at the time of claiming, it may result in an underpayment of Medicare benefit.

Abbreviations for text fields

Where additional information about a service is required, enter the abbreviation in place of the full description, where applicable.

Refer to your software vendor or software help guide on how additional information can be lodged for 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

More information

Online:

Contact us:

View Software vendors offering online claiming.

For more information on ECLIPSE refer to the Medical and Eligibility User Guide for Medical Practitioners - ECLIPSE

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Page last updated: 19 October 2017