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.

Page last updated: 27 August 2017