Tyro Health’s ECLIPSE integration enables health professionals to process online eligibility checks and submit both in-patients medical and Overseas Visitors (in and out of hospital services) claims via Services Australia.
Enabled providers and scenarios
Our ECLIPSE service has been designed to support registered medical providers providing in-patient services, including:
Medical specialists, such as General Surgery, Cardiology, Oncology, Obstetrics and consulting physicians
General medical, including General Practitioners
Diagnostic Imaging, such as Diagnostic Radiology, Nuclear Medicine, Radiation Oncology
Anesthesiology
Pathology
Use our ECLIPSE, not nib Direct integration for MediGap claims; and process in-patient DVA via our Medicare Online integration.
Supported Private Health Funds
36 private health insurers (PHI) support some form of ECLIPSE functionality, but not all ECLIPSE functions are supported by all funds. Supporting features and funds are automatically checked by Tyro Health with functions automatically enabled or disabled as applicable by fund.
Whilst the Services Australia – Medicare Online registration will enable a provider to submit claims to Medicare, DVA and PHIs, it does not automatically enrol providers for health fund Scheme, Agreement or other No Gap / Known Gap arrangements.
For private health insurance claims, providers will need to register with health funds to access No Gap or Known Gap programs.
Modules available via Tyro Health Online
Our ECLIPSE service contains several related modules:
An Online Patient Verification (OPV) service to validate Medicare and PHI account details.
An Online Eligibility Check service (OEC) to determine coverage, limits and benefit amounts from Medicare and PHI.
An In-patient Medical Claim service (IMC) for lodging claims to Medicare and in most cases a PHI.
An Overseas Claim service (OVS) for lodging claims to a PHI offering overseas insurance.
An ECLIPSE Remittance Advice service (ERA) to report on financial settlements from Medicare and PHIs.
A separate Hospital Claiming service (IHC) is utilised by hospital or day surgery staff to lodge supporting claims, births, deaths and accommodation details. IHC is not available via Tyro Health Online at this time.
Claim types and processing methods
You can process claims individually or using our batch upload feature - export your invoice's claim information and upload the data into Tyro Health Online to be submitted digitally, our solution will automatically convert the CSV file into individual digital invoices, ready for you to validate and submit.
Our ECLIPSE solution supports all claim types for the IMC and OVS claiming modules - check out the full list and more information on which to use.
ECLIPSE pricing
ECLIPSE is a paid feature, so you’ll be asked to add a credit card which will be used for billing purposes - for full details, check out the pricing article.
Claims submitted for patients where the private health fund selected is either “nib” or “GU Health” will not incur the standard Fee for ECLIPSE.
Payment for approved ECLIPSE claims and gap payments
Tyro Health doesn’t manage the settlement of funds for ECLIPSE claims, including in-patient medical claims and overseas claims - these must be set and validated with Medicare / Funds directly.
While Tyro Health doesn't manage settlement for ECLIPSE claims, we do provide remittance reports - find out more about our remittance feature which includes filters specific to ECLIPSE.
For most claims, a principal provider is required which will direct financial payments for approved claims to settle to that provider's bank account as registered with Medicare and the private health insurers.
Billing Agent details can be set on certain ECLIPSE claims. When set, financial settlements for approved claims will be directed to the nominated Billing Agent bank trust account on record with Medicare.
Some organisations may offer billing agent like services, but only those registered, recognised by, and issued with a Medicare Billing Agent Provider Number should be set as such in an ECLIPSE claim.
If Tyro Health Online Payments is used for processing gap payments, Tyro Health will manage the settlement of these funds - find out more about settlement.
How to set up ECLIPSE
Check out our step-by-step guide for setting up ECLIPSE and find out more about setting up Tyro Health Online for multiple providers.
PMS integration
As with all Tyro Health Online functionality, ECLIPSE will be available to be accessed directly on Tyro Health Online, at tyrohealth.com. We are working with our PMS partners to also have this functionality available in their software, and we will be sharing more information about this shortly.
If you have any questions, click on the pink chat bubble on our website or email our Customer Support team. Tyro Health also offers an extensive User Guide for ECLIPSE - you can also request this from our support team.