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.

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.