If you've got a specific question about your Health Funds, you may find a quick answer below in our commonly received questions.
Before you begin
If you can't find your question below, or the information doesn't answer your question, please contact our Support Team who will be happy to look into this for you.
If you're looking for more general information regarding Health Funds, you may find the Billing and Financials section of our Knowledgebase has some helpful articles for you.
If you're setting up a new patient record and can't find the right health fund in the Private Fund drop-down, it's possible that the health fund doesn't yet exist in your Genie.
To confirm, navigate to Open > Billing Items. Select the Health Funds option in the top right corner and scroll through the list to ensure your fund isn't there. Some funds may include 'The' at the start, or be under a different name, so they may not be exactly where you think they might be.
If you still can't find your fund in here, you may need to add a new one. To do this, please follow the instructions in Configuring Health Funds in Genie.
Some health funds will have their own Fee Schedules such as Medibank Private, HBF or Mildura Health Fund. If the health fund has supplied Genie with the Fee Schedule, it will be available for download from Special > Software Updates. If these Fee Schedules are reviewed and updated by the fund, Genie will make these available to download once we have received the Fee Schedule from the fund and it has gone through the appropriate testing. For an up-to-date list of schedules available within Genie, please see our Fee Schedule Status article.
Some other funds will fall under one of the larger Fee Schedules such as AHSA or BUPA. To confirm if your fund falls under AHSA, please refer to the AHSA Fund List. To confirm if your fund falls under BUPA, please contact the fund directly. Genie is currently aware that the following funds fall under BUPA:
- Health Cover Direct
- MBF Alliances
- Mutual Community
Other funds such as Budget Direct Health Insurance, CDH Benefits Fund, Frank and Latrobe use the Medicare schedule plus an additional percentage. For more information on how to set up these funds, please contact Genie Support.
For more information on fee schedules, please refer to the Updating Fee Schedules article.
You may find that Genie is crashing when you try to verify a patient with RT Health, but no other health funds are affected. This may be due to a delayed response time by the RT health servers. To confirm that this is the case, please upload your HIC Logs by going to File > Maintenance and Reports > Administrator > Upload HIC Online Logs. Please then contact Genie Support who will review the logs for you and advise how to proceed.
If your practice is in WA, you may notice that there are two fee schedules available for HBF in the Special > Software Updates > Fee Schedules window. This is because there are two separate schedules used by HBF providers, depending on your agreement with the fund. Before downloading either of these fee schedules you will need to confirm with the fund what agreement your doctors hold.
For more information on HBF, please refer to the HBF in WA article.
QANTAS Assure, APIA, Suncorp and AAMI are all NIB Subsidiary funds. To bill patients through ECLIPSE for these funds, there are two options:
1. Select NIB as the health fund for the patient and bill to this fund instead.
2. Set the new fund up with the NIB Brand ID and Fee Schedule. To do this, please refer to the NIB Subsidiaries article.
If you've tried to download a fee schedule, you may be prompted to choose the fund that it belongs to. If Genie asks you to do this but the fund isn't available in the list, it may be ticked to use either AHSA or BUPA fee schedules.
To get the fund back in the list, please navigate to Open> Billing Items and select Health Funds in the top right corner. Search for your fund and double click to open the fund profile. Ensure that AHSA and BUPA are both unticked and save.
Attempt to download your fee schedule again and the fund should now show in the list of available funds.
If the fund is still not showing in the list please contact Genie Support for assistance.
HCF Known Gap and No Gap billing can be done by setting up two separate funds via Open > Billing Items > Health Funds, one called HCF Known Gap the other HCF No Gap. If you already have a fund called HCF, you can choose to rename this to either HCF Known Gap or No Gap, then add the second fund using the Add button.
If you would like to use both funds for ECLIPSE, you can double click on the fund to edit. In the next window, hold down the Alt key on your keyboard, then right click into the Brand ID box (in the ECLIPSE Capabilities section at the bottom). A list of funds will appear, where you can select the HCF option then click OK.
Once these have been setup, you can navigate to Special > Software Updates > Fee Schedules and download both the HCF Known Gap and No Gap fees. When downloading these you will be asked which fund you would like to apply the fees to. Select the fund that aligns with the fee schedule (e.g. Known Gap fees with HCF Known Gap, No Gap fees with HCF No Gap).
Finally, when billing a patient for either fund, you can select the correct option in the Private Fund drop down menu in the patient's demographics window depending on if you are charging the patient a gap or not.
If you are unsure which option to select, you may need to check with the doctor to confirm if they have a Known Gap or No Gap agreement with the fund.