Submission and management of claims directly to participating private health insurers, where the doctor or practice has appropriate arrangements in place. This may include in-hospital medical claims, known gap or no-gap billing, and claims involving both Medicare and the patient’s private health fund.

Where available, claims can be lodged electronically through approved claiming channels such as ECLIPSE, which is designed to streamline Medicare, DVA and private health insurer claiming for in-patient and hospital-related services. 

Preparation and submission of accounts for compensable patients, including Department of Veterans’ Affairs, TAC and WorkCover matters. This includes checking eligibility or claim details where required, ensuring invoices contain the correct claim numbers, approval details, provider information and item descriptions, and following payer-specific billing requirements.

Processing Medicare bulk bill claims where the provider accepts the Medicare benefit as full payment for the service. This includes preparing and submitting claims, checking assignment of benefit requirements, reviewing claim rejections, correcting errors and resubmitting where needed.

When bulk billed, the patient has no out-of-pocket cost and the Medicare benefit is paid directly to the provider.  

Ongoing monitoring and follow-up of unpaid patient, insurer, Medicare, DVA, TAC and WorkCover accounts. This includes identifying overdue invoices, sending reminders, contacting patients or third-party payers, resolving rejected or unpaid claims, and escalating aged debts.

The aim is to improve cash flow, reduce debtor days, and ensure accounts do not remain unresolved due to missing information, claim errors or payer delays. 

Daily or regular allocation and reconciliation of payments received from patients, Medicare, private health funds and third-party payers. This includes matching receipts to invoices, identifying short-paid or duplicate payments, banking of cheques and manual payments, and flagging any unreconciled amounts.

Preparation of fortnightly payment summaries for doctors, showing payments received, adjustments, and refunds.

Preparation of quarterly payment reports to assist with BAS reconciliation and accounting review. The objective is to provide the accountant or bookkeeper with clear supporting data each quarter.

Use of ECLIPSE where appropriate to submit eligible in-patient medical claims electronically to Medicare, DVA and private health insurers. ECLIPSE provides a secure electronic claiming pathway and helps streamline communication between Services Australia, hospitals, private health insurers and DVA.

This can reduce manual paperwork, minimise claim handling delays, improve tracking of claims, and support faster payment compared with manual billing processes.