Information for specialists and providers about the nib MediGap network. Register for MediGap, check the current Schedule of Benefits or update your details.
nib MediGap helps eliminate or reduce the 'gap' for nib members' inpatient medical and surgical fees. The MediGap benefit is often higher than the Medicare Benefits Schedule (MBS) rate, as detailed in the MediGap Schedule of Benefits.
As a registered MediGap provider, you can choose to participate in MediGap on a case-by-case basis. You have the option to charge no out of pocket costs (No Gap) or a Known Gap of up to $500. This approach provides greater cost certainty for members while supporting your practice management. Additionally, you'll be listed in our MediGap specialist search directory (Find a Provider tool, opens in a new tab).
To claim MediGap benefits, you must first be registered for MediGap. You, the patient, and the claim must also meet the eligibility criteria set out in the Medigap Terms and Conditions, opens in a new tab.
Please note: Honeysuckle Health now manages nib's Hospital, MediGap and First Choice Network agreements. Learn more. Learn more, opens in a new tab.
Digital tools
nib members can search for a specialist who is registered to participate in MediGap in the following ways:
Using the Going to Hospital tool in their Member Account
We welcome many practitioners to participate in MediGap including anaesthetists, GPs, surgeons, psychiatrists, cardiologists and many more. To ensure compliance, please note that specific requirements must be met as outlined in the MediGap Terms and Conditions., opens in a new tab
Practitioners employed by public hospitals or pathologists are not eligible for MediGap participation. These practitioners can still register with nib to claim the 25% portion of the Medicare Schedule of Benefits fee, unless a separate Medical Purchaser Provider Agreement (MPPA) exists.
From 1 October 2024, all providers who are currently registered with or registering for MediGap will have the ability to charge a discretionary Known Gap of up to $500. Each medical provider involved in the admitted episode of care, including the surgeon, assistant surgeon, and anaesthetist, can choose to charge their patient a Known Gap.
Information for assistant surgeons: If the primary surgeon submits a single claim that includes both their services and the assistant surgeon's services, the combined Known Gap for the member cannot exceed $500, provided the claim is under MediGap.
From 1 October 2024, MediGap registered medical specialists will have the flexibility to charge a discretionary Known Gap of up to $500 per episode.
If you have already registered for MediGap, you do not need to register or re-register individually as either a No Gap or a Known Gap provider – both billing options will be available to you.
Once you've registered for MediGap, participation is discretionary and you may elect whether to charge for your services through MediGap. This option remains available for all medical specialists registered with MediGap after 1 October 2024 when the network terms and conditions are updated.
We are committed to the ongoing review and improvement of our provider networks to better serve you. While we are dedicated to continuous improvement, please note that the MediGap Schedule of Benefits will remain unchanged at this time.
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).
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.
Have questions about claiming?
Check out the FAQs to get answers to the most commonly asked questions.
Claiming FAQs
Eclipse, opens in a new tab 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.
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).
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:
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.
Eligibility and troubleshooting FAQs
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.
Specialists can check a patient's eligibility electronically via ECLIPSE. If you need further support, please contact nib on 1300 853 530. 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.
If you need to update your details (such as banking information, address or email) and are a registered provider in one of our networks, the process depends on which network you're a part of:
If you’re registered for direct billing with us, you’ll need to complete the direct billing form, opens in a new tab. Only providers outside our networks can be registered for direct billing.
If you would like to join one of our provider networks (such as MediGap, GapSure Anaesthetics), you can complete our online form, opens in a new tab to become registered.
For MediGap claims enquiries, please contact nib: Mon – Fri: 9:00 AM – 5:00 PM AEST/AEDT Closed: Saturday, Sunday and NSW public holidays, opens in a new tab
For MediGap claims enquiries, please contact nib: Mon – Fri: 9:00 AM – 5:00 PM AEST/AEDT Closed: Saturday, Sunday and NSW public holidays, opens in a new tab
