MediGap

ECLIPSE is an electronic Medicare and health fund claiming system integrated through a practice management system. It offers secure, fast connections between health professionals, Medicare, and private health insurers, enabling direct communication in one transaction. ECLIPSE can be used for both paid and unpaid inpatient medical claims.

Electronic claiming offers convenience with a 10-day processing turnaround, ensuring you get paid faster.  

The following options are available for submitting claims:

• Electronic submission using ECLIPSE: a secure and efficient way to submit claims, with real-time access to claim status updates.

• Electronic submission using ECLIPSE via Tyro Health Online (formerly MediPass): submit claims, manage patient information, and view payment information in one place. There will be no cost to providers submitting claims to nib via Tyro Health Online. Learn more about Tyro’s ECLIPSE integration., opens in a new tab

• Billing agent: if you prefer, you can engage the services of a billing agent to handle the electronic submission of your claims on your behalf.

For more details, view a list of software developers at Services Australia, opens in a new tab.

To process claims electronically as a contracted provider: 

• Ensure your bank account details are accurate and current with Honeysuckle Health. 

• Provide an email address for all communications with Honeysuckle Health. 

• Check that your software connects to the ECLIPSE hub. If you are unsure if it currently does, reach out to your software vendor, opens in a new tab. 

All electronic claims have a maximum 10-day turnaround, speeding up payments to you. 

To process claims electronically if you are not a contracted provider:

• Ensure your bank account details are accurate and current with nib and Medicare. 

• Provide an email address for all communications to nib and Medicare. 

• Check that your software connects to the ECLIPSE hub. If you are unsure if it currently does, reach out to your software vendor, opens in a new tab. 

All electronic claims have a maximum 10-day turnaround, speeding up payments to you.  

If you’re participating in MediGap and either do not charge the member a gap or charge a Known Gap up to $500, you should select Agreements (AG) or Scheme Claims (SC) when billing. When charging a discretionary Known Gap of up to $500, include the total fee (MediGap Benefit plus up to $500) on the invoice and claim. Providers can distribute the charge across all MBS items equally, apply it to just one MBS item or split it between several MBS items. However, it cannot be submitted as a separate line item. 

If you are not participating in MediGap and are charging more than the Known Gap (over $500), please select either Patient Claims (PC) or Billing Agent (MB). 

For more details on Simplified Billing and ECLIPSE, visit the Services Australia, opens in a new tab website or read the full MediGap terms and conditions, opens in a new tab.

Please be aware that nib does not accept manual claims. Services Australia has updated their software, and as a result, manual claims submissions for the nib MediGap network are no longer accepted.

When submitting a claim, please use the membership number located on a member’s nib card. 

Here's how members can find their correct membership number: 

1. Via the nib App, opens in a new tab

2. Physical card: The correct membership number is located on the back of the card under ‘Member number’.

Use the following process to claim for a patient who has cancelled their health insurance policy or is deceased:  

• Submit claims to nib and Medicare via ECLIPSE.  

• Ensure you provide the correct date of service when sending the Online Patient Verification (OPV) before submitting the full claim. If the date of service is not supplied, both nib and Medicare will assume the date of service of ‘today’ and the OPV will be rejected. 

• Contact your IT support if you encounter any issues. 

If the deceased patient was the primary policyholder, another member of their family may have become the primary policyholder and the policy number you will need to submit the claim may have changed. 

The number will not change if the deceased was the only member on the policy or was not the primary policyholder. 

To change your bank details or set up a new account, you will need to use our online form, opens in a new tab. This is required for processing MediGap claims and ensures quicker, more secure transactions.

Non-contracted direct billing medical providers should complete the direct billing form, opens in a new tab.

Specialists can check a patient's eligibility electronically via ECLIPSE. If you need further support, please contact nib on 1300 853 530, opens in a new tab. Since some health covers may have exclusions or restricted benefits, encourage members to check their eligibility to claim for medical procedures via nib’s Going to Hospital tool in their member account or in the nib App.