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Health funds that support ECLIPSE

List of all health insurers and supporting features

Written by Nick

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 enroll 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 (Note: submitting a claim using the incorrect processing class may result in a declined claim).

Find out more about the ECLIPSE claim types

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.

Find out more about eligibility checks

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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