Eclipse Claiming (Gap) with Bluechip

Before you begin

*Claims not compliant with the Health Fund Contract

Eclipse Claims with a gap (out-of-pocket expense) is not compliant with a contracted amount with the Health Fund, and is a workaround.

It requires two accounts:
  • An Eclipse account to claim to Medicare, and
  • A Private account for the gap amount to the Patient.

Procedure

  1. From the Patient Details screen, select the Accounts menu item, and locate an existing Eclipse account.
    • If an Eclipse account exists, right-click it and select Open > Account. Proceed now to step 6, to issue the invoice to bill the Patient.
    • If an Eclipse account does not exist, create a new Eclipse account. Continue now to Step 2.
  2. Click the New button. The New > Account window appears. Select the required Practitioner, Class as Eclipse and click OK.
  3. The Account > Details window appears.
    • Select Health Fund Membership as New.
    • For the Health > Fund field, either enter or click into the list to select the required fund.
    • Enter the Account > Name as on the health card. If the name differs, select the option above Health Fund.
    • Enter the Membership No. , Ref No. and select the Default > Membership option. This will generate the details onto the Patient Details screen.


      Note: If a Health Fund has been previously entered, it will automatically appear in the Health Fund drop down list.
  4. Click Verify Now to verity the Health Fund, clicking OK through the prompts, and then click OK to save the account.
  5. If a Private > Account does not exist, create a second account. Click New, ensure that the required Practitioner is selected and the Class is Private. Click OK and OK again.
  6. Open the Eclipse account; right click and select Open > Account.
  7. Issue an invoice for the Eclipse claim.
    • Click the New Invoice button,
    • Click OK or Continue to the verification prompt.
    • Enter Item numbers required to populate total amounts.
    • Tick Hospital > Services and select Hospital.
    • Click Issue, select Referral, and OK for date.
  8. Click the IMC > Submission button to display the New Inpatient Medical Claiming window.
  9. Always; select Yes – Written when prompted 'Has the patient/Health Fund member been provided with informed financial consent', and then click Send to transmit the claim to Medicare.Note: If a Practice is setup as Agreement, there will be two options for Has the patient/Health Fund member been provided with informed financial consent. Yes – Written or Yes Verbal.
  10. Open the Private account, by selecting Accounts from the margin menu; double clicking on Private account or, highlight and click on the Open Existing Account button.
  11. Issue an invoice for the Patients gap.
    • Click New Invoice.
    • Enter Item number which will auto-populate an amount (if setup) or manually enter the amount.
    • Click Add Receipt.
    • Select Referral, and click OK to the date.
  12. The New Receipt window appears. Select a payment Type from the drop down menu, enter the amount, and allocate the invoice amount to the receipt amount by clicking the open box (right of amount). This will display a tick, click Issue, click OK to date; select receipt and File or Print.

What to do next

Access the Eclipse report - Inpatient Medical Claim Report