Benefit statements online
Use Bupa's secure provider website for quick and easy access to your weekly hospital statements.
To register for access, complete the online hospital benefit statement access form (168kb PDF)
For further information, contact Bupa on 1800 060 239.
ECLIPSE hospital patient eligibility checking
Confirming patient hospital eligibility for benefits prior to admission is done via ECLIPSE. You are able to check online 24 hours a day, 7 days a week.
To register access to ECLIPSE, complete the register for ECLIPSE online patient eligibility checking form (239kb PDF)
Find out more information on online patient eligibility checking.
Hospital claiming
To submit a hospital claim, complete the National Private Patient Claim form (55kb PDF)
Partial and other hospital claims
There are factors to be aware of where a member is admitted to hospital for multiple treatments. If at least one of those treatments is covered by the member's policy but one or more of those treatments is not covered, Bupa will generally only pay a benefit towards the covered treatment, as long as the member has served the applicable waiting periods and meets eligibility requirements.
For domestic members, Bupa will also cover treatment as required under the legislation related to paying benefits. This includes paying benefits towards Associated Treatments for Complications, Associated Unplanned Treatments, Common Treatments, and Support Treatments.
Outside of these situations, if a member receives hospital treatment during an admission to hospital that is both included and excluded, we will pay for all the included treatment and may pay any element of treatment that cannot be appropriately allocated to the excluded treatment on an ex-gratia basis. Otherwise, the member will be responsible for all expenses related to the treatment which is excluded on their policy.
Guidance on submitting a partial coverage hospital claim in ECLIPSE.
- If you submit a partial coverage hospital claim in ECLIPSE, you may receive a message indicating that benefits are not payable, including the following message '2006 Benefit not payable for services claimed or requested.'
This may be an error if the member is covered for at least one treatment submitted as part of the partial coverage claim. If you receive this message indicating that benefits are not payable for a partial coverage claim, please contact us, so that we can urgently reassess the covered treatments of the claim.
- If you submit a partial coverage hospital claim on ECLIPSE, and receive the message 'Additional Information Required – See correspondence' we need more information to assess the claim.
Please refer to our correspondence sent through the Bupa Partner Portal. It will detail the additional information we need to correctly assess the benefit entitlement. If you have not received our correspondence, please contact us so that we can assist.
Email: hospitalclaims@bupa.com.au
Call: 1300 663 590
Availability: 9.00am – 4.30pm AEST/AEDT Monday to Friday.
Update - Changes for hospital claims
From 1 October 2016, any hospital claims received by Bupa (including claims with a service date prior to October) that do not have the Care Type accurately populated (as per the "HCP Data Specification (hospital to insurer) 2016-2017, element 20") on either the Eclipse Episodic Data Segment (EPS), element number 060005), or on the National Private Patient Hospital Claim Form or any other hospital claim form, will not be assessed and will be returned to the hospital provider for re-submission.
Submission of Manual Claims
A number of data items that are transmitted in the HCP file must also be submitted on the hospital claim form. Therefore claims for all hospital separations on or after 1 November 2012 should include the Condition Onset Flag (COF flag) as the leading character for all diagnosis codes. And as a reminder, hospitals can submit up to 50 diagnosis codes and 50 procedure codes with the claim.
- COF flag values are:
- 1 = condition with onset during episode of admitted patient care
- 2 = condition not noted as arising during episode of admitted patient care
- 9 = not reported
Also to minimise delays in processing your claim, please ensure the following details are provided:
- Correct spelling of the patient's name
- Patient's address
- Eight digit Bupa membership number
- Date of birth (DDMMCCYY)
- Address of primary cardholder
- Surname of primary cardholder
- Fully completed National Private Patient Hospital Claim form including Section 3 Accommodation Details.
When submitting a hospital claim, if any of the forms listed below are required, please ensure they are completed fully and submitted with the claim. Where:
- the patient's admission relates to an accident - Bupa Accident / Injury Report (198kb PDF).
- the hospitalisation relates to a member who has held their current level of hospital cover for less than 12 months – Request for Information form (67kb PDF)
- The member was an inpatient for more than 35 continuous days – Acute Care Certificate (28kb PDF)
Please ensure that you have:
- provided the member with Informed Financial Consent in relation to additional Hospital charges which will not be covered by Bupa.
- arranged payment from the member for any excess and/or co-payment relating to their product.
If you have any queries regarding hospital claims, please do not hesitate to contact 1300 663 590 or email hospitalclaims@bupa.com.au for hospital claims queries.
Hospital Casemix Protocol (HCP) Data Collection
All private hospitals (including day surgeries) are required to send Bupa Australia the Hospital Casemix Protocol (HCP) data, which contains the financial, clinical and demographic information about Bupa Australia's customers who are admitted to their hospitals, within six weeks of separation. To submit HCP data or to send any HCP related queries, please contact hcp@bupa.com.au. More information regarding the HCP data specification can be found at the Department of Health and Ageing website.
Prescribed List
For the most up-to-date Prescribed List of Medical Device and Human Tissue Products (Prescribed List), please refer to the Australian Government Department of Health and Ageing website (external link).
Arrangements for removed fibrin sealant items from 1 Nov 2024
Following PHI Circular 72/24 concerning the removal of 26 billing codes for medicines and accessories to medicines from Part D of the Prescribed List, Bupa will fund these items for all hospitals (including non-contracted and public hospitals) according to the Bupa Fibrin Sealant Schedule (PDF), using existing billing codes and benefits on and from 1 November 2024. Existing HCP data provision, record keeping, and audit requirements will continue to apply.
Useful forms and quick links
Useful forms
- Clinical documentation form (86KB, PDF)
- Bupa Accident / Injury Report (141KB, PDF)
- Direct credit form (603KB, PDF)
- Acute Care Certificate (27KB, PDF)
- National Private Patient Hospital claim form (55KB, PDF)