o For Eclipse Claiming, ECG billing does not require a practitioner’s referral be submitted to Medicare Australia.
o To disable the referral prompt when issuing an invoice, the practitioner must have a Service Type of ‘General Services’ recorded in their settings.
o If the practitioner record is configured for multiple Service Types (including ‘General Services’), the Service Type must be specified when you create an invoice for them. This is set within the invoice itself.
This guide provides the steps for configuring the practitioner’s record with a Service Type of ‘General Services’, and then shows you how bill for ECG without a referral.
To disable the referral prompt when issuing an invoice, the practitioner must have a Service Type of ‘General Services’ recorded in their settings.
Setup > Practitioner > Practitioner
Details. Select the practitioner you wish to configure settings
for, and then select the General
2. Within the Service Types section, tick the General Services check box, and then click
More than one Service Type can be selected. If you do select more than one Service Type, you will be able to indicate which one is to be used for each invoice you create for this practitioner.
ECG invoices are issued as Eclipse Claims (IMC – Inpatient Medical Claim), allowing providers direct communication with Medicare and the Health Fund in one transaction. Eclipse Claim (no gap) amounts are as contracted with the Health Fund and the Practitioner.
The following steps are required for completing a claim and transmitting it to Medicare;
1. Search for the required patient
2. Search their existing Eclipse account (or create a new account for them)
3. Issue the ECG billing
4. IMC Submission to Medicare
MedicalDirector Blue Chip provides many Medicare Reports that can assist with your ECG claiming and reconciling. Three reports as a quick reference to assist with Eclipse Claims are:
o Debtor Detail Report: provides a summary and detailed breakdown of patient account balances by duration of time (ageing). This will generate the outstanding debit for Eclipse claim accounts
o Inpatient Medical Claim Processing Report: provides a list of unprocessed and processed Eclipse claims. In the Medicare module, these are the Eclipse claim statuses ‘Waiting Process Report’, ‘Waiting Payment Report’, ‘Ready to Receipt’, ‘Rejected’, ‘Finalised (Receipted)’, etc.
o Inpatient Medical Claim Payment Report: provides a summary and detailed list of processed Eclipse claims that generate the Medicare and Health Fund payment for the claims. This report can be used to reconcile the practitioner’s bank statement. In the Medicare module paid Eclipse claims generate the status of ‘Finalised (Receipted)’.
1. Within the Patient Details window, select the Accounts margin menu, and locate an existing Eclipse account.
o If one exists, double-click to open it. Proceed to Step 4.
o If one does not exist, create a new account by clicking the Create New Account button. Proceed to Step 2.
New Account window appears. Select
the required Practitioner, Class as Eclipse,
and then click
3. The Account Details window appears. Complete details if required, or click
o If either the Practitioner or Class has been selected incorrectly, click to display the New Account window again for correct selection.
o If a Health
Fund has been entered previously, it will automatically appear in the
Health Fund drop-down list. If creating a new account, click to verify the
4. Open the appropriate Account, and then click to begin issuing a new invoice.
5. The Medicare Verification window appears; click to verify.
6. Select a Service Type of ‘General Services’, if required; there will only be multiple service types to select from if you have pre-configured this in the practitioner’s setup.
the appropriate Service Date and Service
(11700) as required. The Duplicate
Item Number window appears.
the required Health Fund Fee List,
and then click
This will automatically populate the fee within the new invoice
9. Tab to the Service Text field, and double-click onto the field to reveal the button. Click it to add text for Medicare if required, and then click
Repeat steps 7-9 if additional Service Items are required.
on the New Invoice window, tick
the Hospital Services check box,
and select Hospital (if not already
selected), and then click
11. You will be prompted to enter the date-of-issue for the invoice. The default is the current date, click
12. Click The New Inpatient Medical Claiming window appears.
13. For the question ‘Has the patient/Health Fund member been provided with informed financial content’, select the option ‘Yes – Written’.
14. Click to transmit the claim to Medicare. This claim transfers to the Medicare Australia waiting for payment.
o If a Practice is setup as ‘Agreement’, there will be two options for Has the patient/Health Fund member been provided with informed financial consent; Yes – Written or Yes Verbal.
o To ensure all Eclipse claims have been IMC submitted to Medicare, refer to the Unclaimed Invoice Report. This report lists any issued invoices/claims that have not yet been submitted or batched to Medicare per Practitioner. To access the report; either click the button or select Reports > Audit Trail Reports Printer > Unclaimed Invoices Report.
This invoice has now generated to the (IMC) Inpatient Medical Claim Processing Report for tracking purposes.
Ensure the Medicare Australia module is displayed to access the Medicare report; either click on the button or select the Reports > Medicare Payment & Processing Reports > Inpatient Medical Claim Processing Report.