Information for Simplified Billing Agents
Notice Board
Product Changes effective 1 January 2011
How Do I Register as a Simplified Billing Agent?
Terms and Conditions for Simplified Billing Agents
How to register with Medibank Private
How to claim 25% Fund Gap as a Simplified Billing Agent
Online Claiming with Medibank Private via Eclipse
What happens if an account is rejected?
Where do I send resubmitted accounts?
Contact us
From 1 January 2011, some changes to our hospital products have been introduced, including
- two new products, Ultra Health Cover and Young Hospital
- changes to our hospital covers excess levels and co-payment requirements
- name changes to our products
Contact 1300 130 460 to check if a patient has an eligible cover before a service is performed.
To register as a Medibank Simplified Billing Agent, you need first to be registered with Medicare as a Simplified Billing Agent and have a Medicare registration number (Note: this is different to a Provider Number). To find out more about becoming a registered Simplified Billing Agent with Medicare, please visit their website.
In conjunction with the new EFT payment methods for Simplified Billing Agents, Medibank has introduced Terms and Conditions. These Terms and Conditions apply from 5 September 2010.
If you wish to submit 25% Fund Gap accounts to Medibank Private as a Simplified Billing Agent, you need to register with Medibank Private. When you register with Medibank Private, you agree to accept the Terms and Conditions that apply when submitting claims as a Simplified Billing Agent for 25% Fund Gap Claims.
To register, complete a Simplified Billing Agent Registration & Change of Details Form and mail to:
Medical Services Manager
Provider Relations
Medibank Private
GPO Box 9999
MELBOURNE VIC 3001
You will then receive confirmation of your registration, together with relevant details to help you claim as a Simplified Billing Agent for 25% Fund Gap.
1. As a Simplified Billing Agent, you submit the account to Medicare to receive the 75% Medicare benefit.
2. Once you have received your benefit from Medicare, forward the Medicare Simplified Billing Statement of Benefits and account, together with your completed Batch Header to Medibank Private.
3. Send your completed accounts to:
Medical Billing
Medibank Private
GPO Box 9999
MELBOURNE VIC 3001
4. Once the accounts are received, Medibank Private will process and assess the claim for payment.
5. If a benefit is payable, you will receive Medibank Private's payment by cheque addressed to you. From September 2010, payment will by made via EFT (if you are registered with Medibank Private)
6. If a benefit is not payable, the Statement of Benefits will contain a code explaining the reason.
It is important that the correct information is provided on the Batch Header to ensure timely and accurate processing of accounts.
When submitting 25% Fund Gap Claims, you are required to include a completed Medibank Private 'Batch Header'. A 'Resubmission Batch Header' has been introduced for claims requiring review following the initial assessment.
Please ensure the correct Batch Header is attached when submitting new claims or claims requiring resubmission and that they are grouped separately. Copies of the Batch Headers are below.
Batch Header (limit of 40 claims)
Resubmission Batch Header (limit of 10 claims)
View a completed Batch Header or Resubmission Batch Header
When submitting claims, please ensure all mandatory and accurate information is included. Mandatory Fields include:
- Patient Membership Number - Charge Amount
- Patient First and Last Name - Medicare Benefits Schedule Item
- Date of Birth - Medicare Schedule Fee
- Date of Service - Medicare Benefit
- Service Provider Name and Service Provider Number - If the claim is accident or compensation related
If a claim is an accident or compensation related, it is a mandatory requirement that Medibank Private is informed. Please ensure that this is clearly marked on the front of the relevant claim/s if this is the case.
Medibank Private now has the capability to accept 25% Fund Gap Medical claims via ECLIPSE for Simplified Billing Agents under claim type ‘MB’.
ECLIPSE is an extension to Medicare Australia's online claiming solutions and
• offers a secure connection between practices, public and private hospitals, billing agents, Medicare and Department of Veterans' Affairs and health funds.
• incorporates direct communication for providers with Medicare and health funds, all in the one transaction.
What are the benefits of ECLIPSE?
• Faster resolution of claims and faster payment times
• Less manual intervention - fewer errors, speedier resolutions
• Clearer error messages with a single point of contact for problem resolution
• Online patient verification of Medicare enrolment and health fund membership
• No more claims batching
• One system for all health funds
• No transaction costs for medical claiming
• A one stop shop for claiming
You can obtain further information on ECLIPSE from Medicare Australia
If you are interested in submitting medical claims via ECLIPSE, please contact the Medical Services Manager for further information.
A 25% Fund Gap account can be rejected by Medibank Private for a number of reasons.
If you believe that a claim has been rejected in error, underpaid or overpaid, please return the claim to Medibank Private for re-assessment by attaching a Resubmission Batch Header.
Resubmission Batch Header
It is important that Resubmission Batch Headers are included with resubmissions and completed accurately to allow for timely and accurate re-assessment.
Completed batches of resubmissions can be sent to:
Medical Billing
Medibank Private
GPO Box 9999
MELBOURNE VIC 3001
Accounts & Patient Eligibility Queries
Phone: Medical Enquiry Line - 1300 130 460
Email: Medical_Provider@medibank.com.au
Post: Medical Billing
Medibank Private
GPO Box 9999
MELBOURNE VIC 3001
Registration enquires for Simplified Billing Agents
Phone: Medical Services Manager - 03 8622 5947
Fax: 03 8622 5691
Email: Medical_Contract_Administration@medibank.com.au
Post: Medical Services Manager
Provider Relations
Medibank Private
GPO Box 9999
MELBOURNE VIC 3001