Many specialists and hospital facilities use the more common features of ECLIPSE to claim in-patient medical services. But 2 extended ECLIPSE claiming features are not as widely used.
In-Hospital Claiming & Overseas Claiming are less commonly used. In-Hospital claiming can only used by private and public hospitals and day facilities.
In this article, we’ll break down both of these features and how they help healthcare organisations.
For a more detailed recap of ECLIPSE claiming, visit our Understanding ECLIPSE article.
What Is ECLIPSE Claiming?
ECLIPSE claiming allows specialist providers and hospitals to send in-patient medical claims (IMC) to participating health funds. This is done electronically via a secure internet connection.
The Department of Human Services (previously known as Medicare Australia) provides and maintains ECLIPSE.
Transmissions are encrypted for maximum security and privacy of information.
ECLIPSE is only available through Practice Management Software which has undergone rigorous integration testing. These software vendors are then provided a Notice of Integration from Department of Human Services. You can see all vendors that have been approved on this list provided by the Department of Human Service: http://www.humanservices.gov.au/health-professionals/services/vendors-offering-medicare-online-claiming/
The Department of Human Services does not charge for transmissions via ECLIPSE, yet you may have to pay your software vendor for the ECLIPSE functionality.
With ECLIPSE, you are only able to send claims that are up to 2 years old from the current date.
ECLIPSE Features Explained
As you can see on the Department of Human Services website, there are a number of different features.
The following 2 extended ECLIPSE claiming features will be covered below:
- IHC – In-Hospital Claiming; and
- OVS – Overseas Claims
The Department of Human Services web page above does not go into any depth on any of these features. Below is a brief explanation of each to help you when looking at different software or the efficiency of your current software.
FYI – there are also commonly used features of ECLIPSE claiming that might interest your healthcare organisation. You can find an explanation of what these are in this article.
IHC – In-Hospital Claims
This feature is only relevant for public and private hospitals and day facilities.
IHC allows these facility to submit a claim relating to the patient’s hospital stay (accommodation) to health funds. It allows facilities to create estimates, as well as raise invoices for a patient’s stay.
OVS – Overseas Claims
This feature allows practices to claim medical services for a patient which IS NOT eligible for any Medicare benefits but has special Health Fund coverage to cover costs.
These medical services can be either in-patient or out-patient services.
More Information about ECLIPSE
While this article focuses on the features that are not as commonly used within ECLIPSE, if you would like a more comprehensive article on ECLIPSE, we would recommend that you check out our Understanding ECLIPSE article. This goes into depth about what ECLIPSE is, how it works and why you should consider it for your practice.
In The End…..
You need to decide if the benefits of implementing extended ECLIPSE claiming outweighs any short term costs to your pocket and time.
And if you don’t want to handle your billing, there are billing agents throughout Australia. These agents process your claims for you and are essentially your outsourced billing staff. They have their own software so you don’t need to learn anything but still benefit from faster turnaround times. This is a fee for service type business.
Still on the fence about extended ECLIPSE claiming and have a specific question? Why not contact us and select blog question. We will answer your questions without any obligation.