Simplified Billing and ECLIPSE online claims

ECLIPSE (Electronic Claim Lodgement and Information Processing Environment) is an initiative of the Department of Health, Australian Government. It facilitates streamlined payment of Medicare, DVA and private health insurer claims. ECLIPSE is an extension of Medicare Online claiming that is used to lodge inpatient claims from public and private hospitals, and related facilities such as accommodation and transfers.

It provides a secure connection between:

  • health professionals
  • public and private hospitals
  • billing agents
  • private health insurers
  • Department of Veterans’ Affairs (DVA)
  • Medicare

Benefits of using ECLIPSE in your practice

The benefits of using ECLIPSE over traditional claim processes include:

  • faster resolution of claims
  • online patient verification of Medicare enrollment and private health insurer membership
  • a single system for all private health insurers
  • overseas claiming
  • clearer error messages with a single point of contact for fixing problems

ECLIPSE eligibility checks and consent

Claims may only be lodged through ECLIPSE with the consent of the patient or other lawfully authorised person (such as guardian or power of attorney appointee). An eligibility check may be submitted for an anticipated hospital admission up to 12 months in advance, or up to seven days in the past (for an emergency admission).

How do I register for ECLIPSE and Medicare Online?

Registering for ECLIPSE and Medicare Online to lodge electronic claims involves the following steps:

How does Medicare Online help providers manage claim errors?

When an online claim is rejected by Medicare, a return code is used to identify the reason for the rejection or assessment. The return code includes a message to enable providers or billing agents to:

  • identify the claiming error
  • make corrections and resubmit claims
  • keep a reference of the rejected claim

Claim rejection codes are used by Department of Veterans’ Affairs (DVA) when a DVA claim is rejected. The codes are accompanied by a brief explanation. The full list of DVA reason codes is available online.

ECLIPSE and Simplified Billing forms

Forms that relate to ECLIPSE and Simplified Billing can be found online at Medicare’s website. These include registration forms, Manual Claims batch header form and application for late lodgement form.

Visit Medicare to see the full list of Simplified Billing and ECLIPSE forms.

 

Envisage Practice Management provides medical billing services to medical specialists. For more information about our billing services, see Medical Billing.