Provider Claims

CBHS Health Fund accepts electronic claims for medical services for admitted hospital patients from providers through HICAPS, HealthPoint  CSC for Extras and with ECLIPSE. 

Making Claims through HICAPS and HealthPoint
As a provider, you can register for electronic claims through the HICAPS and HealthPoint websites. Claims can be made through HICAPS and HealthPoint for the following services:
  • Acupuncture
  • Dental
  • Remedial Massage
  • Occupational Therapy
  • Osteopathic
  • Podiatry
  • Speech Therapy
  • Chiropractic
  • Dietitian
  • Naturopathy
  • Optical
  • Physiotherapy
  • Psychology
  • Myotherapy

Easy-to-Use Systems

Both claims systems are designed to be easy to use and to save providers time in processing claims by streamlining electronic claims and automating every possible step. Additionally, these services can be used to verify patient details and lodging claims with Medicare Australia.

Technical Support and Questions for HICAPS and HealthPoint

If you encounter any problems when using HICAPS or HealthPoint  CSC products, please feel free to contact our Member Care Centre by calling 1300 654 123.

 

 

Making Claims through ECLIPSE

Medical providers can use ECLIPSE (Medicare’s Electronic Claim Lodgement and Information Processing service Environment) to submit claims. ECLIPSE can be used to process claims with CBHS and Medicare in the one transaction, saving you time and administration costs.

What is ECLIPSE?

ECLIPSE is a part of Medicare’s online claiming solution and offers providers (including hospitals and medical practices), billing agents, Medicare, the Department of Veterans' Affairs and CBHS a direct medium for communication.

ECLIPSE allows you to lodge bulk-bill, private-patient and in-patient medical claims, among other types of claims. The system supports online claiming for paid and unpaid medical services. It can also be used to conduct online patient verification and entitlement checking. As a health care provider, you can use ECLIPSE to confirm details and calculate out-of-pocket costs for hospital stays.

CBHS accepts the following through ECLIPSE:

  • Online Patient Verification (OPV)
  • In-patient Medical Claiming (IMC)
  • ECLIPSE Remittance Advice (ERA)
  • Two-Way Claiming
  • In-patient Hospital Claiming (IHC)

Technical Support and Questions for ECLIPSE

You can find out more about signing up for and using ECLIPSE by visiting this page. If you have any problems or issues using ECLIPSE to process CBHS claims, please contact our Member Care Centre by calling 1300 654 123.

 

Provider Recognition Criteria

Please note that CBHS requires that providers meet CBHS’ Provider Recognition Criteria. Providers must comply with Rule 10 of the Private Health Insurance Accreditation Rules. Briefly, this means complementary or alternative therapy health care providers must be members of a professional organisation which covers health care practitioners who provide that type of treatment.

The professional organisation must be a national entity with membership requirements, and they must conduct assessments and implement continuing professional education schemes, among other criteria.


Additional sources:
http://www.medicareaustralia.gov.au/provider/business/online/eclipse/