Depending on how you charge for your in-patient services, including whether you're enrolled in any No Gap or Known Gap programs, the fee amount you set for an item in Tyro Health Online (ECLIPSE) may differ.

After selecting an item code in Tyro Health Online (for ECLIPSE) the fee amount that will be automatically populated is the MBS fee amount. If you are enrolled with a private health fund Agreement or Schedule program, the fee should align to that specified by the program and may differ from the MBS fee amount.

For No Gap programs, the fee amount you enter should be the scheduled benefit amount as advised by the Funds. This is the total amount you can expect to be paid by Medicare and the private health fund.

For example, an item code has an MBS fee of $46.15 and your No Gap program entitles you to a schedule amount of $74.40, so in order to receive the full $74.40 you need to input $74.40 as the fee.

For Known Gap claims, the fee amount you enter may differ depending on the patient's health fund. For example, a fund may require you to enter a total amount that includes the scheduled benefit amount and maximum known gap amount.

Please confirm with a patient's health fund on the correct way to process any out-of-pocket expense (gap) before submitting the claim.

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.