An Online Eligibility Checks (OEC) help to determine a patient’s out-of-pocket expenses for In-patient Medical Scheme and Agreement claims - it may be required as part of Informed Financial Consent disclosures.
Patient Verification
Tyro Health Online OECs also support verification of Medicare and PHI account details as part of ECLIPSE - known as 'Patient Verification' which are completed in three places:
On creation of a new patient record when the provider requests verification,
On creation of an OEC or claim in the patient details section when the provider requests verification, and
On submission of an OEC or claim if not already explicitly verified by the provider.
For each of these, we verify account details with Services Australia and a successful response indicates that the patient and/or claimant has an active account. If Medicare or PHI details are incorrect, you will receive an error on submission.
Online Eligibility Check
In addition to Patient Verification, the results of an OEC provide an estimate of the full cost of the episode of care from all relevant service providers included in a check, including how much of that cost the patient and/or claimant will be expected to pay out-of-pocket plus details of the patient and/or claimant's hospital cover and restrictions including:
level of cover
financial membership
pre-existing condition indicators
excess amounts
bonus amounts
co-payments
benefit limitations
exclusions
Disclaimer: the information received from an OEC is not confirmation that the fund will pay the claim.
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.