Medical specialists

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.

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.

nib claims must be submitted electronically through ECLIPSE. This secure system ensures efficient processing for inpatient medical services, automatically handling claims through both Medicare and nib.

Medical specialist claiming: If you’re not billing under the MediGap agreement, you can submit the claim via ECLIPSE using claim type PC (Patient Claims). Benefits will be paid up to 100% of the Medicare Benefit Schedule (MBS) Fee.

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.

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 on the nib App.

If a claim is rejected, the ECLIPSE report will list it with a return code explaining the reason for rejection. For further assistance, call nib on 1300 853 530, opens in a new tab.