Code

User assigned code, up to six characters. This will display in the Transactions screen etc. when invoicing the fund.
This code must be unique.

Company Name

Enter the name in full.

Address

Type the full postal address where correspondence or invoices are to be sent.

Contact Name

Record a Contact Name if required.

Phone

Record a Phone number if required.

Fax

Record a Fax number if required.

Email

Record an email address if required.
This email address will be used to email invoices if not being submitted electronically via Eclipse.

DX Number

Record a DX if required.

Consolidate Emails

Not applicable.

Health Fund / Insurer

This is selected by default when added via the Health Fund tab. If selected then the entry will be available for selection in the Health Fund selection in Patient Registration.
If the tick is removed, then the Contact will appear in Invoicing / Reports tab.

Heading

Not applicable for the setup of a Health Fund.

EDI Account

Not applicable for the setup of a Health Fund.

Assist Multiplier

If the Health Fund has a multiplier for the calculation of Assistants fees for item number 51303, then enter the multiplier here. These are published by the fund and may change when the funds adjust their schedule of fees annually.

i.e. if the % Benefit is 145.10 then enter this as 1.4510

HIC Participant

If the fund is Eclipse enabled, select the relevant entry from the drop down list.
If the fund does not appear in the list and you know that they are Eclipse enabled, then you will need to run the Get HIC Participants option (Setup > HIC _ HIC Participants).

HIC Fund ID

This is a display field only and is populated based on the HIC Participant selected above. Ensure that this code (also referred to as the Eclipse Code), is correct.

HCP Fund Code

Hospital Casemix Protocol (HCP) - for Hospitals only.
All hospitals must report via HCP data all 'admitted' episodes of hospital treatment. This code is used to transmit the data.

HCP Umbrella

For Hospitals only.
Select from the drop down list.

No Gap example

Known Gap example

Fund / Insurer

This is the name of the Health Fund entered on the first screen.

Name

Give the policy / Gap Cover arrangement a name, even a generic one, i.e. Access Gap Cover (for an AHSA participant).

Gap Cover Schedule

Select the Gap Cover Schedule from the drop down list.
These are added and maintained via Setup – Financial – Charges – Health Fund Schedules (System).

Policy Type

Select from either No Gap or Gap Cover.
Please refer to information published by the various funds for this information.

Gap Limits

The sections below are where the Known Gap information is configured. It is not active if No Gap is selected.
You must familiarise yourself with the Terms and Conditions of each fund around a Known Gap. Particularly the requirement to include the total fee charged (inclusive of any gap) on the invoice or claim.

No Maximum

If there is no limit as to how much over and above the GapCover schedule you can charge as the Known Gap then select this No Maximum.

$ Value

If the fund has a Known Gap scheme and publishes an amount select this option.

% Above Health Fund Schedule

Enter the percentage if applicable.

$

Enter the value for the fund if applicable:
Bupa - $500 per episode of care
AHSA - $400 per item

Limit is per item (scaled)

If the Known Gap amount is per item scaled, select this option. This applies to most funds that participate in AHSA Access Gap Cover.

Limit to AMA Rate (e.g. AHSA Access Gap)

Select this option if the Known Gap is limited to the lesser of the amount entered above or the difference between the AMA rate and the Fund Schedule.