ECLIPSE Billing for Specialists: User Guide

ECLIPSE Billing lets specialists submit claims for hospital-based services electronically to Medicare and Health Funds, using claim types such as Agreement, Scheme, Scheme-AGC, and Patient Claim. It's accessed through the In-Patient Invoice and In-Patient Quote screens, which are the only invoice types that support ECLIPSE transmission. This guide covers the full workflow from creating an invoice through to claim submission and reconciliation, along with the prerequisites needed before ECLIPSE Billing can be used. It's worth checking the section below before you continue, since a standard Invoice can still be used for hospital-based services in some cases.

Contents:

1. How ECLIPSE Billing Differs from Standard Invoicing
2. Prerequisites & Configuration
3. Creating an In-Patient Invoice or Quote
   • Entry Points
   • Key Fields
4. The Claiming Workflow

How ECLIPSE Billing Differs from Standard Invoicing

A service performed for a patient admitted to hospital is still billed using the In-Patient Invoice or In-Patient Quote screen, not a standard Invoice, since Health Fund is not a Bill To option on a standard Invoice. However, the In-Patient Invoice doesn't always have to be transmitted through ECLIPSE. If the patient's Health Fund isn't set up for ECLIPSE claiming, or a claim needs to be handled outside ECLIPSE for another reason, select (Manual) [Health Fund Name] at Bill To instead of the plain Health Fund name. This creates the invoice on the same screen with the same fields, but the claim is paid and reconciled manually using More Pay, rather than submitted and reconciled through the Unclaimed grid. See Manual Invoicing - Medicare, DVA & ECLIPSE: Quick Guide for the full steps.

Aside from the manual Bill To option above, ECLIPSE claiming on the In-Patient Invoice and In-Patient Quote screens differs from standard invoicing in several other ways:

• It uses ECLIPSE claim types (Agreement, Scheme, Scheme-AGC, or Patient Claim) rather than standard MBS, DVA, or private billing
• It calculates a Medicare Rebate and Health Fund Rebate separately, rather than a single rebate amount
• It's only available to users with a Specialist Subscription, and only once practice-level ECLIPSE and PRODA configuration is complete
• It's submitted and reconciled through the Unclaimed grid, rather than claimed directly from the invoice

For a broader comparison of when to use a Standard Invoice versus an In-Patient Invoice, see Invoice Types: When to Use Each, and from Where.

Prerequisites & Configuration

Before ECLIPSE Billing can be used, meaning before an In-Patient Invoice or Quote can be created and submitted, the following must be in place:

• The user or provider must have a Specialist Subscription (Integrated, Practice, or Clinical)
• The practice must have a Medicare Certificate
• The practice must have a valid PRODA organisation account configured
• The patient must have a Health Fund recorded under Details > Settings
• The provider's ECLIPSE User Preferences must have an Assigned Schedule, Claim Type, and Fund Payee ID set
• Rooms must be added to the practice, with a Facility ID, for ECLIPSE billing

These are practice-level settings, so they're usually configured once by an administrator rather than by each specialist. Full setup steps for all of the above are covered in ECLIPSE & Inpatient Medical Claims (IMC): Configuration.

Creating an In-Patient Invoice or Quote

The In-Patient Invoice and In-Patient Quote screens are the ECLIPSE-enabled invoice types covered in this guide. They're the only screens that support ECLIPSE claim submission.

Entry Points

Once the prerequisites above are met, New In-Patient Invoice and New In-Patient Quote become available from:

• The Accounts tab of a patient's record
• The Sales screen
• Patient Dashboard > Invoice icon
• Appointment pop-up > More > New In-Patient Invoice
• The At Billing tile in the Waiting Room

If these options aren't visible, check the prerequisites in the section above, particularly the Specialist Subscription and patient Health Fund requirements.

Key Fields

The Inpatient Invoice and Inpatient Quote screens include the following fields and behaviours in addition to those on a standard Invoice:

The Claiming Workflow

Creating an In-Patient Invoice and claiming it are part of the same workflow, rather than two separate stages. The steps below take you from opening a new invoice through to reconciliation. An In-Patient Quote follows the same steps and doesn't need to be recreated as an Invoice; it's submitted and claimed the same way.

1. Confirm the patient's Medicare Number and Health Fund details are recorded
2. Select the Provider, Bill To (Health Fund or Patient), and Claim Type
3. Complete all existing fields marked with an asterisk (*), along with any others required for the specific invoice you are claiming
4. If required, add services such as Diagnostic Imaging or Anaesthetic Services

5. Add invoice items, including the Referral where required

   

   
    

6. Select Save to send the invoice to the Unclaimed grid
7. From the Claiming > Unclaimed grid, select and submit the claim
8. Request a processing report to check the claim has been received. This does not generate payment, and the invoice status remains unchanged
9. Once processed, request a payment report to reconcile the claim and apply any payment

Note: If an overpayment is identified after reconciliation, the invoice amount and Medicare or Health Fund Rebate fields can be adjusted, and a journal generated to reflect the correction.

For invoices using Assignment of Benefit, including the Print AoB and SMS AoB pathways, see Assignment of Benefit: Workflow.

Further Reading

• ECLIPSE & Inpatient Medical Claims (IMC): Configuration
• Invoice Types: When to Use Each, and from Where
• Manual Invoicing - Medicare, DVA & ECLIPSE: Quick Guide
• Assignment of Benefit: Workflow
• Medicare & ECLIPSE: Claiming Errors & How to Fix Them