Overview

Tyro health supports ECLIPSE services for validating patient account details, processing claims and eligibility checks. Electronic Claim Lodgement and Information Processing Service Environment (ECLIPSE) is an extension of Medicare Online claiming and operated by Services Australia. It offers a secure connection between practices, public and private hospitals, billing agents, Medicare, health care providers, private health insurers and the Department of Veterans' Affairs (DVA). The system allows hospitals, billing agents and providers to lodge in-patient medical claims and in-hospital claims directly to Medicare and the private health insurers in one simple transaction.

ECLIPSE allows healthcare providers and billing agents to submit claims securely over the internet to Medicare and private health insurers, saving time and money. There are many benefits for health care providers:

• easier way to obtain informed financial consent from patients
• paperless interaction with Medicare and private health insurers
• quicker processing times—reduction from weeks to days
• reduced administration time resulting in reduced management costs
• faster resolution of complex claims
• better data quality with fewer errors and speedier resolutions
• ne system for all private health insurers
• electronic remittance advice from private health insurers resulting in efficient reconciliation of your accounts

With Tyro health, ECLIPSE transactions can be interactively created and viewed using:

• the Tyro health (formerly Medipass) web portal
• as batched claims via our bulk file submission tools
• partner systems and PMS using approved integrations

The service is available 24x365 and requires nothing more than modern web browser. Our service has been designed to support complex healthcare business organisations with one or more practice/hospital locations, one or more supported healthcare service providers and can optionally support third party billing agents acting on behalf of providers.

ECLIPSE is made up of several related modules:

• An Online Patient Verification (OPVW) service to validate Medicare and PHI account details.
• An Online Eligibility Check service (OECW) to determine coverage, limits and benefit amounts from Medicare and PHI.
• An In-patient Medical Claim service (IMCW) to lodge financial claims against Medicare and in most cases a PHI.
• An Overseas Claim service (OVSW) to lodge financial claims against a PHI offering overseas insurance.
• An ECLIPSE Remittance Advice service (ERAW) to report on financial settlements from Medicare and PHIs.

A separate Hospital Claiming service (IHCW) is utilised by hospital or day surgery staff to lodge supporting claims, births, deaths and accommodation details. IHCW is not covered by this user guide.

ECLIPSE scope of use and limitations

ECLIPSE is primary designed for in-hospital (admitted) patient experiences. However, the overseas claiming module also supports certain outpatient claims.

For most scenarios, outpatient, allied health and general practice claims are not typically processed in ECLIPSE. Claims for those scenarios are handled by Medicare Online, Medicare Easyclaim, DVA or private health insurance funding options which are separate products but also supported by Tyro Health.

Services Australia advises that participating health professionals may utilise the ECLIPSE service and information provided, including personal information, only in accordance with national (Privacy Act 1988, Health Insurance Act 1973, Private Health Insurance Act 2007, Dental Benefits Act 2008 and other relevant legislation), state or territory legislation, policy and guidelines.

Participating health professionals are advised to verify that their intended use of services and information does not contravene any applicable legislation or regulations or is inconsistent with any applicable policy or guidance. Providers may also need to retain appropriate records of services as provided by Medicare and private health insurers rules and regulations.

Supported providers and scenarios

ECLIPSE is primary designed for in-hospital (admitted) patient experiences. However, the overseas claiming module also supports certain outpatient claims.

For most scenarios, outpatient, allied health and general practice claims are not typically processed in ECLIPSE. Claims for those scenarios are handled by Medicare Online, Medicare Easyclaim, DVA or private health insurance funding options which are separate products but also supported by Tyro Health.

Services Australia advises that participating health professionals may utilise the ECLIPSE service and information provided, including personal information, only in accordance with national (Privacy Act 1988, Health Insurance Act 1973, Private Health Insurance Act 2007, Dental Benefits Act 2008 and other relevant legislation), state or territory legislation, policy and guidelines.

Participating health professionals are advised to verify that their intended use of services and information does not contravene any applicable legislation or regulations or is inconsistent with any applicable policy or guidance. Providers may also need to retain appropriate records of services as provided by Medicare and private health insurers rules and regulations.

Medicare

ECLIPSE can be used to determine account status, verify eligibility and to lodge claims with Medicare eligible patients. This includes any individual with a Medicare issued card. Further, the service can be used by those on international reciprocal health care arrangements, providing the patient has been issued a Medicare card number. This may include patients from:

• Belgium
• Finland
• Italy
• Malta
• Netherlands
• New Zealand
• Norway
• Republic of Ireland
• Slovenia
• Sweden
• United Kingdom

Importantly, for patients using the reciprocal health care arrangement, those patients must have a valid Medicare issued card number. For purposes of ECLISPE, reciprocal health care claims are run as in-patient medical claims - not overseas claims.

Private Health Insurers

At present, 36 PHIs support some form of ECLIPSE functionality. Not all ECLIPSE functions are supported by all funds.

The list of private health funds and supported features changes dynamically. Supporting features and funds are automatically checked by the Tyro Health platform with functions automatically enabled or disabled as applicable by fund.

As at publication of this document, the following funds and features are supported:

Claim type / processing class key:

• AG: Agreements
• SC: Schemes
• PC: Patient Claim
• MB: Billing Agent

* Note: Tyro health additionally supports NIB overseas health claims for both inpatient and outpatient scenarios via a direct integration to NIB. However, these are not ECLIPSE claims and payments for approved claims are made next business day by Tyro health rather than via the health fund as with ECLIPSE.