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 | 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.