Simplified Billing or ECLIPSE adjustment claim form (HW023)

Use this form to adjust a previously processed claim which needs to be amended with new or altered information.

This form should be used by medical practices, providers, private health insurers and billing agents.

ECLIPSE is the Electronic Claim Lodgement and Information Processing Service Environment.

 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
This information was printed Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/hw023 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: 1 March 2019