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The AHSA Access Gap Cover (AGC) maximum co-payment changes from 1 July 2020.

From this date, each provider will be able to charge the patient a gap of up to $500 per episode.

Please refer to the AHSA website for their Terms and Conditions and their Billing Guide.

Please note that if you choose to use AGC you must not charge any non-clinical fees to your patient such as ‘Booking Fees’, ‘Administration Fees’ etc.  This includes any hidden fees not being a professional service described by an MBS item number.

Please refer to the AHSA web site for a list of participating funds:

To change the Gap Limits in the Incisive application go to Setup > Contacts > Health Funds and complete the following:

  1. Edit each fund in turn.
  2. Select Policy Names.
  3. Edit each entry in the list of Fund / Insurance Policy Names.
  4. Set the Gap Limits as follows:
  • Policy Type: Gap Cover
  • Gap Limit:   $ Value
  • $amount:    500