Understanding how to manage your ECLIPSE claims

Please note; Before you can mange your Eclipse claims you must have

1. Created the relevant invoice Eclipse invoice No Gap or Known Gap 

2. Submitted your claims/batch through Eclipse 

To manage your Eclipse claims

Go to Claiming and click ECLIPSE

  


Overview of the different sections of Eclipse billing (see below for a detailed overview of each section) 

 

How does it work?

Once the claims are submitted through Clinic to Cloud they will travel through the tabs within Clinic to Cloud depending on their status. (see info graphic above for details on each tab) 

Waiting Status

When a claim is in Waiting, it means that you have submitted your claims. At this point the claims are waiting for acknowledgement from Medicare and the nominated health fund.
Generally, ECLIPSE claims should not stay in this status for any longer than 2-3 business days, however you must allow for up to 14 business days before taking action to troubleshoot.

If the claims are in the 'Waiting' status for longer than expected, one of two things could be happening.

1. The provider under which the claims are submitted has not registered him or herself as a preferred provider with the respective health fund(s). Please call the health fund(s) to troubleshoot this issue.

2. The practice has not completed the process to register this location with Medicare. 

In the case where you have completed your registration forms please email Medicare at provider.forms@humanservices.gov.au to confirm this was successful. Once this is confirmed, you can resubmit your Eclipse claims

Exceptions status (previously 'Processing report')

If you find claims in the Exceptions tab, this means that Medicare and the health fund have assessed it and have returned it to you with some sort of rejection. You will see one of two scenarios:

1. They have returned it with an amount that they are willing to pay, if it differs from the original amount claimed. At this point there are one of two steps forward.

- Accept the amount by clicking the tick icon which will write off any variances and move your claim to the ERA tab (see below for more detail on the ERA)

- To refute the payment amount. The best way to do this is to call the respective health fund directly and discuss it with them. If a top up of any variance is provided to you, use the credit card (add manual payment) icon to add this amount onto your claim 

2. They have returned it to you with a message or what we refer to as an 'error code'. In most cases, the fund will reply with an error code. (hover over the error for more details)
If Medicare or the Health Fund has requested additional details click the arrow icon to restore your invoice back into edit mode, make changes accordingly to the error code and resubmit your claim. (see above details to resubmit) 

If the error code message is not clear, please call the respective health fund and discuss it directly with them.

Accepted status

Claims that appear in the Accepted status simply reflect claims have been approved and accepted by the health fund, meaning they will pay in full the amount originally claimed. They remain in this status until payment has been made and the remittance advice becomes available.

ERA status (Electronic Remittance Advice) 

The remittance advice is now available. Medicare and the health fund have made payment into the nominated bank account as provided by the practice.

 

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