In-Hospital Claiming (IHC)

Available for both eClaims® Interface and SimDay®.

The latest release of online claiming now offers hospital claims.

The latest release of online claiming, Release 6, includes all the features of previous releases of online claiming/ECLIPSE as well as new features that benefit practices and hospitals. The new features of Release 6 include:

  • hospital claiming
  • hospital eligibility checking

Hospital claims

Hospital claiming allows public and private hospitals and day facilities to lodge claims for a patient's hospital stay direct with the private health fund or DVA. This includes claims for accommodation, theatre, transfers, prosthetics and miscellaneous services. Hospital claiming also includes interim and final processing reports and electronic remittance advices. Find out more information about hospital claiming.

Hospital eligibility checking

Online eligibility checking has been expanded to permit hospitals to obtain an estimate of a patient's likely out-of-pocket expenses (excess). This enables the patient to provide informed consent to the hospital, prior to proceeding with the procedure (known as informed financial consent).

Hospital Claiming

Available for both eClaims® Interface and SimDay®.

ECLIPSE is an extension to Medicare Australia's online claiming solutions

  • offers a secure connection between practices, public and private hospitals, billing agents, Medicare and Department of Veterans' Affairs and health funds.
  • incorporates direct communication for providers with Medicare and health funds, all in the one transaction.

Online claiming can be used for both paid and unpaid medical claims— they are lodged directly to Medicare through the practice management software. The name ECLIPSE is an industry coined acronym, and stands for: Electronic Claim Lodgment and Information Processing Service Environment

Features

  1. Online patient verification (OPV)
    Check the validity of patient details with Medicare or a health fund. This can be done in real time and allows for the provision of aliases which cuts down on mismatches.
  2. In-patient medical claiming (IMC)
    • submit an in-patient medical claim to both Medicare and the health fund with a single click
    • fewer errors and fast return of incorrect Medicare details
    • available for all claims made under schemes and agreements, and those not made under a scheme or agreement
    • improved processing times—from weeks to days.
  3. Online eligibility checking (OEC)
    • check the eligibility of a patient for both Medicare and health fund benefits
    • estimate the out-of-pocket costs for hospital services and any known medical gaps
    • obtain informed financial consent.
  4. ECLIPSE remittance advice (ERA) Match your ECLIPSE claims to the deposits made into your bank accounts allowing for automated reconciliation.
  5. Claim status Check the status of an in-patient medical claim at any time. You will always have a clear view of where your claim is up to in the process.
  6. Online security
    Everyone—patients and staff—can feel confident that all information is transmitted securely using public key infrastructure (PKI) encryption.

What are the benefits?

  • Faster resolution of claims and faster payment times
  • Less manual intervention - fewer errors, speedier resolutions
  • Clearer error messages with a single point of contact for problem resolution
  • Online patient verification of Medicare enrolment and health fund membership
  • No more claims batching
  • One system for all health funds
  • No transaction costs for medical claiming
  • A one stop shop for claiming

For more information

If you'd like to find out more about ECLIPSE call 1300 788 005 to talk to one of our consultants.