Tyro Health Online’ 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.
No Gap or Known Gap program?
Our ECLIPSE service offers two claim options with various claim types, including Agreement (IMC-AG) and Scheme (IMC-SC) for No Gap and Known Gap programs.
In-patient medical claims (IMC)
This is an In-patient Medical Claim service (IMC) for lodging claims to Medicare and in most cases a private health insurer (PHI) on behalf of a patient for the provision of services. There are five types of IMC available:
IMCW Agreement (IMC AG): The provider has signed an Agreement with the PHI (of which the patient is a member) specified in the claim. Payment is sent from Medicare to PHI where the PHI makes a consolidated payment to the Provider.
IMCW Scheme (IMC SC): The provider is operating under a Scheme with the PHI (of which the patient is a member). Payment is sent from Medicare to PHI where the PHI makes a consolidated payment to the Provider.
IMCW Patient Claim (IMC PC): Patient is a member of the PHI specified in the claim. If the claim is paid in full, the payment from Medicare goes to the patient or claimant and payment from the PHI goes to the member. If the claim hasn’t been paid in full, the payment from Medicare and the PHI goes to the patient or claimant, via cheque (made out to the provider), who then passes it on to the provider.
IMCW Billing Agent, Medicare and Private Health Insurer (IMC MB): Payment from both Medicare and the PHI goes to the specified Billing Agent.
IMCW Medicare only (IMC MO – Medicare Only): Payment from Medicare goes to the specified Billing Agent. There is no PHI involvement.
Overseas claims (OVS)
This is an Overseas Claim service (OVS) for lodging claims to a PHI offering overseas insurance. Unlike IMC claims, OVS claims support either in-patient or out-patient services. OVS claims are only used to process Overseas Visitor and Overseas Student health cover claims in Australia and no part of the claim will be processed by Medicare. There are four types of OVSW available:
OVSW Agreement (OVS AG): The provider has signed an Agreement with the PHI (of which the patient is a member) specified in the claim. Payment is sent from the PHI to the Provider.
OVSW Scheme (OVS SC): The provider is operating under a Scheme with the PHI (of which the patient is a member). Payment is sent from the PHI to the Provider.
OVSW Patient Claim (OVS PC): Patient is a member of the PHI specified in the claim. If the claim has been paid in full, the payment from PHI goes to the patient and payment from the PHI goes to the member. If the claim hasn’t been paid in full, the payment from the PHI goes via cheque direct to the provider or via EFT to the provider.
OVSW Billing Agent, Private Health Insurer (OVS MB): Payment from the PHI goes to the specified Billing Agent.
Important notes
Patient claims are like Medicare Online patient claims where the benefit amount will be assigned to the patient rather than the provider. The patient is expected to pay the provider directly for these services.
Billing Agent claims require a registered Billing Agent and provider number.
If you have any questions, click on the pink chat bubble on our website or email our Customer Support team. Tyro Health Online also offers an extensive User Guide for ECLIPSE - you can also request this from our support team.