8 Key FAQS about ECLIPSE claiming

ECLIPSE claiming is set to impact thousands of specialist providers in Australia. In this article, we answer some common questions about ECLIPSE and how you can use it to turnaround health fund claims faster, reduce admin time and boost efficiency in your specialist practice.

1. What is ECLIPSE?

Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE), is an extension of Medicare Online claiming.

ECLIPSE allows specialist providers and hospitals to send in-patient medical claims (IMC) and In Hospital Claiming (IHC), in one transaction to participating private health insurers, electronically via a secure Internet connection.

According to the Department of Human Services, it offers a secure connection between:

Health professionals
Public and private hospitals
Billing agents
Private health insurers
The Department of Veterans’ Affairs
The Department of Human Services

Essentially, ECLIPSE provides a ‘one-stop shop’ for electronic health business transactions, giving you access to Human Services, DVA, Australian Childhood Immunisation Register (ACIR) and PHI – all in in one product.

2. How can I use ECLIPSE?

With ECLIPSE, you can lodge paid and unpaid in-patient medical claims with The Department of Human Services through your practice management software, like Bluechip, which has already undergone rigorous integration testing.

ECLIPSE can also be used to lodge in hospital claims from public and private hospitals and day facilities in relation to the patient’s hospital stay. This includes claims for accommodation, transfers, and miscellaneous items like prosthetics.

3. Is there a fee or charge for using ECLIPSE?

The Department of Human Services does not charge for electronic transmissions via ECLIPSE.

4. Is there a limitation period for using ECLIPSE?

ECLIPSE allows you to send claims that are up to 2 years old from their current date.

5. What are all the ECLIPSE features?

The Department of Human Services lists the following ECLIPSE features:

OPV PVM – Online Patient Verification Patient Verification Medicare: allows you to quickly check your patient’s Medicare card information in your practice management software is correct, against the information held by Medicare.
OPV PVF – Online Patient Verification Patient Verification Fund: enables you to check your patient’s health fund information against their health fund provider. This particularly useful as it reduces the risk of claim rejection at the point of care, as it can quickly identify whether a patient has an invalid policy.
OEC ECM – Enterprise Patient Verification Patient Verification Medicare: let you to see which Medicare benefit is payable to a patient for medical services or hospital stay. You can also generate a report (which usually takes around 20 minutes and accessible for 7 days) and use it as a basis for the patient’s informed financial consent.
OEC ECF – Enterprise Patient Verification Patient Verification Fund: helps you estimate out-of-pocket expenses in advance of your patient’s admission date. You can also generate a report (which usually takes around 20 minutes and accessible for 7 days) and use it as a basis for the patient’s informed financial consent.
IMC – In-Patient Medical Claims: allows you to send a claim for a patient’s completed medical services to Medicare and their health fund. Practice management software like Bluechip allows you to easily send these claims digitally via ECLIPSE.
ERA – ECLIPSE Remittance Advice: outlines how much you have been paid for the IMC claim. Practice management software like Bluechip, will pick up this ERA and allocate it against your claim.
IHC- In Hospital Claiming: Health Sector Entities (HSEs) can use ECLIPSE for the communication of health information, eligibility checks, and hospital and medical claims between connected entities. Bluechip version 3.18 also facilitates this, enabling a more streamlined claiming process for hospitals in Australia.

6. Is ECLIPSE claiming faster that manual paper processing?

Manually sending claims in paper form to health funds can take at least 4 weeks. With ECLIPSE, the turnaround can be as fast as 7 days. And faster processing means better cashflow management, less admin burden and easier reporting, for a more financially empowered specialist practice.

7. What are some key benefits of using ECLIPSE?

According to the Department of Human Resources, ECLIPSE allows public and private hospitals, including day facilities, to submit claims securely over the internet to private health insurers, which helps save time and money. The range of benefits include:

reduction in the use of paper
quicker processing times
reduction in administration time, which results in reduced management costs
faster resolution of complex claims
better data quality with fewer errors and quicker resolutions
ECLIPSE Remittance Advice from PHI and DVA, allowing efficient reconciliation of your accounts.