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Health funds that support ECLIPSE

List of all health insurers and supporting features

Nick avatar
Written by Nick
Updated over a week ago

Private / Overseas health fund setup and registration

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.

To register for these programs, providers need to reach out directly to the health funds, including: AHSA funds, ARHG funds, Bupa, Medibank and AHM, HBF, and NIB.

Private Health Insurers ECLIPSE functions

36 PHIs support some form of ECLIPSE functionality, but not all ECLIPSE functions are supported by all funds. The list of private health funds and supported features changes dynamically. Supported funds and functionality is automatically checked by Tyro Health Online and is automatically enabled or disabled as applicable by fund.

In-patient Medical and Overseas claiming functions

All funds listed below support patient verification and remittance advice (except CDH Benefits Fund). However, for funds that support In-patient Medical and/or Overseas claims, they may only be processed using certain claim types ubmitting a claim using the incorrect processing class may result in a declined claim.

Health fund

In-patient Medical

Overseas

API/batch code

AAMI

AAMI

ACA

ACA

AIA

MYO

AHM

AHM

Australian Unity

AUF

APIA

APIA

Bupa Australia

BUP

CBHS Corporate

CBH

CBHS Health

CBH

CDH Benefits Fund

CDH

CUA Health

CPS

Defence Health

AHB

Doctors’ Health Fund

AMA

GMHBA

GMH

GU Corporate Health

GUH

HCF

HCF

Health Care Insurance

HCI

HIF

HIF

Health Partners

HPI

HBF

HBF

Latrobe Health

LHS

Medibank Private

MBP

Mildura Health Fund

MDH

Navy Health

NHB

nib

NIB

Nurses & Midwives

NMW

onemedifund

OMF

Peoplecare Health

LHM

Phoenix Health Fund

PWA

Police Health

PHF

Qantas Insurance

NIB

Queensland Country

QCH

rt Health

RTE

Reserve Bank Health

RBH

St Luke’s Health

STL

Suncorp

NIB

Teachers Federation

TFH

Teachers Union

QTU

Transport Health

TFS

Westfund

WFD

As per the above table, the following funds do support In-patient Medical and/or Overseas claims, but not from the below claim types (check out the alternative claim types that can be used):

  • IMC-MB not available for Australian Unity, CBHS Corporate, CBHS Health, Doctors’ Health Fund, GU Corporate Health.

  • IMC-SC not available for Bupa and HBF.

  • IMC-PC not available for Defence Health.

  • OVS-SC or OVS-PC not available or Bupa.

Online Eligibility Check functions

All funds listed below support patient verification and the ECM: Medicare Only eligibility check type. However, for funds that support OECs, they may only be processed using certain eligibility check types - submitting an OEC using the incorrect eligibility check type may result in a declined OEC.

Health fund

Medicare + PHI

(OEC)

Fund Only
(ECF)

Overseas

(ECO)

AAMI

ACA

AIA

AHM

Australian Unity

APIA

Bupa Australia

CBHS Corporate

CBHS Health

CDH Benefits Fund

CUA Health

Defence Health

Doctors’ Health Fund

GMHBA

GU Corporate Health

HCF

Health Care Insurance

HIF

Health Partners

HBF

Latrobe Health

Medibank Private

Mildura Health Fund

Navy Health

nib

Nurses & Midwives

onemedifund

Peoplecare Health

Phoenix Health Fund

Police Health

Qantas Insurance

Queensland Country

rt Health

Reserve Bank Health

St Luke’s Health

Suncorp

Teachers Federation

Teachers Union

Transport Health

Westfund


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.

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