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 charge a gap, this must be processed separately and cannot be "added" onto the MBS fee.

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 programs, the fee amount entered should also 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, excluding the gap which must be processed separately and not added onto the scheduled benefit amount in the claim submission.

For example, an item code has an MBS fee of $1,229.35 and your Known Gap program entitles you to a schedule amount of $1,336.35 and you can charge a gap up to $400 - this is a total of $1,736.35. In order to receive the full $1,736.35, you need to input the schedule benefit amount of $1,336.35 as the item fee for the claim submission (to be paid by the Funds) and then process the $400 separately.

To find out more about submitting claims for No Gap and Known Gap programs, please check out this help article.

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.