About Health Funds

There are over 80 Health Funds in Australia the majority of which are members of the Fund Group Australian Health Service Alliance (AHSA).

Each Group has various billing rules that need to be followed if the Practitioner has entered into an Agreement with them and some Funds have setup their own Fee Structures and have their own Group.

If you need to contact a Fund or to Register with a Fund, you can find a list of them here http://www.privatehealthcareaustralia.org.au/for-providers/contacts-for-providers/

Other Groups are:

  • BUPA
  • Medibank Private
  • GMHBA
  • HCF
  • NIB
  • St. Lukes
  • HBF
  • ARHG

The Australian Regional Health Group (ARHG) have a number of Regional Funds as members. This group does not have a Fee Schedule for Medical Billing. They do, however, enter into Contract fees for Hospital Billing.

The majority of Funds also participate in Direct Billing. This is known as ECLIPSE for Medical Billing and In Hospital Claiming (IHC) for Hospital Stays.

Stay Up-To-Date

Take time to update the Contact Management – Insurers/Companies table. Health Funds are being taken over and merging and it is hard to keep up. On your first installation of Direct CONTROL™ the Insurers/Companies table contains Health Fund detail for you to maintain and ensure the detail is relevant to you. Direct CONTROL™ software updates do not change this table. Go to http://www.medicareaustralia.gov.au/provider/business/online/eclipse/files/health-fund-functionality-and-contact-details.pdf

You also need to know that GU Corporate (ex Grand United) only looks after corporate health funds and they do not ECLIPSE. There are over 300 of these funds and include Boeing Australia, Cadbury Schweppes, Caltex, Caterpillar, FAI, Kraft, Motorola and Rockwell to name a few). Grand United non-corporate funds are now Australian Unity.

Better Health no longer exists. Use AHM

Not all Health Funds have Agreements with Hospitals. You will find Hospital Agreement details here:

http://www.privatehealth.gov.au/dynamic/healthfundlist.aspx

Participants IDs

Also known as Fund Brand IDs and on the link above they reference ATO IDs that may differ from the Particpant ID. All very confusing and sometimes there is a typo in the documentation provided! Some funds actually have one ID for ECLIPSE and another Statutory Reporting ... just to keep us on our toes. So Direct CONTROL allows for three Fields to store these IDs being:

  • MED for Doctors Medical Billing
  • IHC for Hospital Medial Billing
  • HCP for Hosptial Casemix Reporting
Category: 

Direct CONTROL Blog

27/08/2015 - 12:13pm

Eliminate more data entry by using a Card Reader to swipe Medicare Cards and Credit or Debit Cards. USB plug and play. Cost $250 plus postage.

11/08/2015 - 2:58pm

From 1 October 2015, security controls will be strengthened in line with government security standards.

11/08/2015 - 10:00am

We look forward to catching up throughout the year

17/06/2015 - 10:08am

17/06/2015 - 10:07am

23/02/2015 - 11:53am

Appointments

23/02/2015 - 11:52am

Bad Debts can be avoided by:

23/02/2015 - 11:52am

Bad Debts can be avoided by:

23/02/2015 - 11:49am

There are over 80 Health Funds in Australia the majority of which are members of the Fund Group Australian Health Service Alliance (AHSA).

23/02/2015 - 11:47am

Tasks you should complete at the end of each working day:

23/02/2015 - 11:44am

Ratio What does it do?

23/02/2015 - 11:42am

Direct Control supports BPAY payment processing and generates (CRN) Customer Reference Numbers on your Remittances.

23/02/2015 - 11:42am

Direct Control supports BPAY payment processing and generates (CRN) Customer Reference Numbers on your Remittances.