In November 2011, AHM merged with Medibank Private. They have remained two separate entities but their claiming through ECLIPSE must be sent using the Medibank Private rules as set out below.
The transmission of No Gap claims for these funds is slightly different to the way No Gap claims are done for every other fund, depending on whether you have a Medicare Purchaser Provider Agreement (MPPA) for either AHM or Medibank Private or not. Most practices would not have an MPPA.
The below article outlines the instructions for setup and transmitting claims for practices that do not have an MPPA.
Before you begin
Before billing, you will need to ensure whether or not you have a Medicare Purchaser Provider Agreement (MPPA) for either AHM or Medibank Private.
Note: If you do have an MPPA Agreement with AHM or Medibank Private the claim transmission type will be ‘Agreement (No Gap)’ as usual.
1. Go to File > All User Preferences
2. Double-click on each billing provider in turn and go into the ECLIPSE tab
3. In the Claim Type column change the selection for AHM and Medibank Private to Scheme by clicking and selecting this option from the dropdown
No Gap claims for AHM and Medibank Private need to be submitted as a Scheme (Known Gap) claim without a gap added.
Note: The transmission process for ‘Known Gap’ claims for AHM and Medibank Private has not changed
1. Open the IMC Invoice Wizard via Billing> IMC Invoice Wizard
2. Scheme (Known Gap) should be selected by default
3. Select the Site of Service
4. Tick Financial Interest Disclosed
5. Click Next to proceed to the voucher window
6. Informed Financial Consent on a Known Gap Claim must be Written or Not Obtained
7. In the voucher window make sure Charge Gap is unticked
Note: In previous versions, this checkbox was labelled Auto Charge Maximum Gap.
8. Click the blue plus button to add items
9. Type in the Item Number and press the Tab key on your keyboard
10. The fee will default to the private fee. Click the word Fund Rebate to override this with the correct No Gap Fee
11. Save and enter all other items in the same manner
12. Upon saving the voucher, if prompted to add an assist fee, action this as normal
13. Add on any other vouchers and items using the same method as above
14. Once complete, click Next to proceed past the voucher window
15. In the Make Any Payments window confirm that the 'Patient to Pay' amount is $0.00. If not, go back and fix the fees
16. If everything looks correct, click Next to proceed past the Make Any Payments window
17. Transmit the claim as normal
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