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Provider FAQ

Answers to frequently asked questions

 

Why should I join the Bupa Australia Medical Gap Scheme?

The Bupa Australia Medical Gap Scheme will save you time and money. You will receive payments quicker, and receiving them as one payment will reduce the paper work for you, your practice and your patients.

 

When can a payment be expected and how can the claim it relates to be determined?

For manual claims payment can be expected after 20 working days processing period. EFT payments are paid into accounts every Wednesday. For electronic claims payment can be expected within 14 days.

To identify the claim and the payment it relates to check your Medical Payment Detail Report (PDF 13.3kB)

(For ECLIPSE payments refer to your Medical Payment Summary Report.)

This report will list:

  • Provider batch reference number (your reference number)
  • Bupa Australia batch reference
  • The amount charged and benefit paid
  • A list of patients and the benefits relating to each patient

A slip will be attached to the report indicating any rejections, which will be followed through.
 

 

Why are some items paid and others not?

All claims submitted via the Bupa Australia Medical Gap Scheme are subject to the normal Medicare Australia rulings. If there are restrictions for the medical items, some benefits are not payable.

 

Why is it important to supply the Medicare number and fund membership number?

The Medicare number is required to identify the patient once the claim details have reached the Health Insurance Commission (MEDICARE AUSTRALIA) for processing.

The fund membership number is required to confirm policy details and eligibility. The patient is required to supply you with their current Medicare number and fund membership details at the time of consultation.

 

Why do some items attract a benefit equal to 100% of the MBS fee?

When the Bupa Australia Medical Gap Scheme system was introduced 10 years ago it was designed to cover or reduce gaps in the most affordable way. Business decisions were made to pay some items at 100% of the MBS fee while providing doctors with the convenience and cost savings of direct billing.

 

How can I recognise if a Bupa Australia Medical Gap Scheme benefit has not been paid for a patient and where do I find an explanation for the non-payment?

If there is a rejection by Medicare Australia for any reason, this will show on the Medical Payment Detail Report (PDF 13.3kB with an error code and explanation. For ECLIPSE rejections please refer to Medicare Australia Online Manual. Payment amounts are listed in detail on a payment report, which is sent each time a claim has been finalized.

 

I cannot find the item I require on the schedule of benefits?

Not all items in the Medicare Benefits Schedule appear in the Bupa Medical Gap Scheme Schedule. Only services provided as inpatient services are eligible for the Medical Gap Scheme benefits.

Pathology and Radiology item numbers are contained in separate Bupa Medical Gap Scheme Schedules. As we have contracts for most Radiology and Pathology item numbers, these items are not on the internet. If you require a copy, please send an email to sprovops@bupa.com.au and an attached file will be returned to you via email. Please ensure that you include your unique Bupa Practice Identification (ID) number in all correspondence submitted to Bupa.

 

What will happen in July each year when the main changes to the Medicare Benefits Schedule occur?

Indexation of the Bupa Medical Gap Scheme fees and benefits are revised in line with the Medicare Australia MBS reviews in July each year. This process occurs automatically on 1 July each year unless otherwise advised and shall be determined by taking into account the following things:

  • The movement in labour price applicable in the specified State and as published by the Australian Bureau of Statistics;
  • The index of movements in Consumer Prices (all groups) applicable in the specified Capital City and as published by the ABS;

 

Who should we contact for further explanation of rejection or error description?

For further clarification of a Bupa Australia Medical Gap Scheme rejection, please call Bupa Australia Medical claims on 134 135.

 

Can the practice account forms be used?

Yes. It is important to note, however, that a Batch Header Form must be attached and your practice ID number must be written on the batch header.

If you are unsure of the practice ID, please contact Provider Operations on 1800 060 239.

 

What is ECLIPSE?

ECLIPSE is a secure information processing system that uses the internet to link Medicare Australia, health funds and doctors.

Medicare Australia developed ECLIPSE to enable doctors to lodge, within six months of providing the service, their Bupa Australia Medical Gap Scheme electronically directly to Medicare Australia which then relays their assessment speedily to us for our further assessment and payment. This will help eliminate errors in transmissions between the Medicare Australia and us, thus saving doctors’ time and money. Your software vendor will help you make immediate use of this exciting new development in the Bupa Australia Medical Gap Scheme.

Your software supplier will give you all the information you need but Medicare Australia can also advise you. Either telephone Medicare Australia on 1800 700 199 or access their website on www.medicareaustralia.gov.au.

 

Why should I use ECLIPSE?

ECLIPSE will save you time and money. Here's how:

  • There's no limit to the amount of claims or batches you can submit
  • Improved financial management through faster resolution of claims and quicker payment times
  • Online patient verification of Medicare enrolment and health fund membership
  • Online viewing of payments
  • One single point of contact and one system for all health funds
  • Lower incidence of error and shortened review times - giving you faster resolutions and immediate knowledge of any rejections
  • No hub transaction fees
  • View rejection codes and explanations online
 

How do I become an ECLIPSE user?

If you are not yet registered to use ECLIPSE or want to know more about electronic claiming go to the Medicare Australia website or call the ebusiness centre on 1800 700 199.

 

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