Information on Medical Purchaser Provider Agreements (MPPA)
Notice Board
I wish to set up a new MPPA agreement with Medibank
I have an existing MPPA agreement with Medibank
Forms and Batch Headers
List of current MPPA Providers
FAQ
Glossary of Terms
Contact us
Medibank now has the capability to accept MPPA claims via ECLIPSE. If you are interested in submitting medical claims via ECLIPSE, please contact the Medical Services Manager for further information.
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.
An MPPA (Medical Purchaser Provider Agreement) is a no gap contract negotiated between Medibank and a diagnostic services provider for in hospital pathology and radiology services. Once an MPPA is in place, benefits payable by Medibank to the diagnostic services provider are at or above the Medicare Benefits Schedule for pathology and/or radiology services as specified in the MPPA.
An MPPA is designed to eliminate medical gaps for our members and provide certainty to providers as to funding.
As a diagnostic services provider with a Medibank MPPA, you can:
• Potentially increase patient volume as Medibank has approximately 30% total market share
• Receive Medicare and Medibank payments in one simple transaction
• Potentially experience a reduction in administration costs as billing patients directly is no longer required
• Provide your eligible patients a no-gap experience and reduce enquiries relating to medical bills
• Potentially reduce your aged and bad debts as payments are made directly to you via EFT.
• Diagnostic services providers - pathology and radiology services
• Hospitals, both private and public
• Medical Billing Agents who represent providers of pathology and radiology services.
If eligible and approved, obtaining an MPPA is simple:
1. Contact the Medical Services Manager in the first instance to discuss your eligibility. If approved, you will be asked to complete an application form.
2. Complete the “New Medical Purchaser Provider Agreement Application” and send to Medibank
3. Medibank will request the Provider Numbers of the relevant pathology, radiology or medical providers that you wish to cover under the proposed MPPA. You will need only to complete one form to register your EFT Details and submit to Medibank
4. Medibank will review your application for approval
5. If the application is approved by Medibank, a standard MPPA will be sent to you, for your review
6. Once agreed, two copies of the standard MPPA will be issued for signature
7. Once the signed MPPA has been returned to Medibank, you will be provided with your unique Billing Entity Number, your Medibank Batch Headers, and our MPPA Procedures and Information brochure to help you commence claiming immediately.
The steps to claiming are outlined below. Medibank will provide you with everything you need to make a claim under your MPPA.
1. You will be provided with a unique Billing Entity Number to identify your organisation when claiming, to allow your accounts to be easily sorted and processed.
2. All you need to do is include this Billing Entity Number on a Batch Header when submitting accounts to enable Medibank to easily identify them as MPPA accounts. Batch Headers are supplied to you at the same time as your Billing Entity Number. Complete your Batch Header and attach to the accounts.
3. Once the accounts are received, Medibank captures them and the information is sent to Medicare each night.
4. Medicare then assess the accounts and send it back to Medibank.
5. If a benefit is payable, you will receive Medicare and Medibank's payments in a single EFT transaction and an itemised Statement of Benefits.
6. If a benefit is not payable, your 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.
Online Claiming with Medibank via Eclipse
Medibank now has the capability to accept MPPA claims via ECLIPSE. If you are interested in submitting medical claims via ECLIPSE, please contact the Medical Services Manager for further information.
Online Claiming with Medibank via Eclipse
Medibank Private now has the capability to accept MPPA claims via ECLIPSE. If you are interested in submitting medical claims via ECLIPSE, please contact the Medical Services Manager for further information.
An MPPA (Medical Purchaser Provider Agreement) is a no gap contract negotiated between Medibank and a diagnostic services provider for in hospital pathology and/or radiology services. Once an MPPA is in place, benefits payable by Medibank to the diagnostic services provider are at or above the Medical Benefits Schedule Fee for pathology and/or radiology services as specified in the MPPA.
An MPPA is designed to eliminate medical gaps for our members, and as part of the MPPA a provider must obtain our member’s informed financial consent in relation the cost of treatment.
It is your responsibility to confirm the patient's eligibility before a service is performed.
You will need to confirm the following:
• Is the patient eligible for the specific item(s) to be performed under their health cover
• Is the service eligible for a Medicare benefit
• Is the patient seeking compensation or damages from another source.
MPPA accounts are not claimable in relation to:
• Patients with Visitors Covers (unless your MPPA specifically includes them as Eligible Members)
• Patients with Overseas Student Health Cover (unless your MPPA specifically includes these as Eligible Members)
• Patients without Hospital cover
• Patients with an unfinancial membership (arrears for unpaid premiums) or who have suspended their insurance cover
• Patients who have not served their waiting periods
• Patients who are not eligible to receive a Medicare benefit for the relevant treatment
Eligibility can be confirmed by phoning 1300 130 460. You will need the patient's Medibank membership number and their date of birth.
1. Medibank will issue you a unique Billing Entity Number to use when submitting claims. This number allows your accounts to be easily sorted and processed
2. Include your Billing Entity Number on a Batch Header when submitting accounts to enable Medibank to easily identify them as MPPA accounts. Batch Headers are supplied to you at the same time as your Billing Entity Number
3. Send your completed accounts to:
Medical Billing
Medibank
GPO Box 9999
MELBOURNE VIC 3001
4. Once the accounts are received, Medibank will capture them and the information is sent to Medicare each night
5. Medicare then assess the MPPA account and send it back to Medibank
6. If a benefit is payable, you will receive Medicare and Medibank's payment in a single EFT transaction and an itemised Statement of Benefits
7. If a benefit is not payable, your 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.
It is also important that all required information is included on the account itself to allow Medibank to assess it. You will need to provide:
• Patient's full name, address and date of birth
• Patient's account reference (if any)
• Patient's Medicare card number and reference number
• Patient's Medibank membership number
• Full service details; date of service, MBS item number, special exemptions
• Whether the account was compensable or accident related
• Referral details
• Any other information relevant to the assessment of the service
Online Claiming with Medibank via Eclipse
Medibank now has the capability to accept MPPA claims via ECLIPSE.
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.
Completed batches of accounts can be posted to:
Medical Billing
Medibank
GPO Box 9999
MELBOURNE VIC 3001
An MPPA account can be rejected by either Medibank or Medicare for a number of reasons. Click here for a detailed explanation of the most common rejection codes and what you can do should you receive one on your Benefit Statement.
If you believe that an account has been rejected in error, underpaid or overpaid it can be returned to Medibank 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
GPO Box 9999
MELBOURNE VIC 3001
• New Medical Purchaser Provider Agreement Application
The “New Medical Purchaser Provider Agreement Application” is completed when you would like to enter into a new MPPA with Medibank.
• MPPA EFT Registration and Change of Details
The “MPPA EFT Registration and Change of Details” is used to register or change your bank account information to ensure payments are processed accurately. It is also used to advise Medibank of address or staffing changes. It is important that Medibank has accurate information to enable us to provide you with the best possible service.
• Batch Header
The “Batch Header” is used for submitting accounts. They can be submitted in batches of up to 40 accounts per Header. It is important that the information on the Batch Header is correct, to allow for timely and accurate assessment of your accounts.
An example of a completed Batch Header can be found here
• Resubmission Batch Header
The “Resubmission Batch Header” is used for resubmitting accounts that have been rejected, part paid or overpaid. It is important that the information on the Resubmission Batch Header is correct, to allow for timely and accurate re-assessment of your accounts.
An example of a completed Resubmission Batch Header can be found click here
What forms do I need to set up a new MPPA?
To apply for an MPPA you will need to complete a New Medical Purchaser Provider Agreement Application form. The forms needed to help you operate under your MPPA are all provided to you once the MPPA is finalised. To view these forms, click here.
25% Fund Gap is the alternative claiming method to MPPA for the payment of benefits for pathology and radiology services. The account is given to the patient, who makes two separate claims; one through Medicare and one through Medibank. Once the accounts have been assessed, the patient will receive two cheques; one from Medicare and one from Medibank which they then need to pass on to their medical provider.
MPPAs remove much of this complication, as the account is sent straight to Medibank Private, and the billing entity receives the Medicare and Medibank payment in one simple EFT transaction.
How do I change our details relating to our MPPA?
Simply complete the Change of Details Form located on the forms page and send to Medibank.
How long does it take to change our contact or EFT details?
Change of details requests are completed within two business days of receipt.
Who can I contact for MPPA contract queries?
The Medical Services Manager is able to assist with queries relating specifically to the MPPA contract itself.
How does claiming work for MPPA?
The claiming process is very simple. Accounts are sent to Medibank with an MPPA Batch Header and assessed accordingly. Click here for more information.
Who can I contact for accounts queries?
The Medical Enquiry Line staff are able to assist with all queries related to MPPA accounts.
MPPA Claiming
How would I know if a patient has eligible cover?
Simply contact Medibank to confirm a patient’s level of cover and their eligibility. Click here for more information.
Why have my accounts been sent back to me?
Accounts are normally posted back if the Batch Header or Resubmission Batch Header has not been completed, or if it has been completed incorrectly. Please check the details on the Batch Header to ensure they are correct, and resubmit the accounts. If you have any queries, please contact Medibank.
I haven't received payment for my accounts, what should I do?
Please contact Medibank.
I haven't received a Statement of Benefit for my payments, what should I do?
Please contact Medibank.
Why has my account been rejected?
Accounts can be rejected for several reasons. Simply contact Medibank for assistance. Click here for more information.
Why has my account been part paid?
Accounts can be part paid for several reasons. Simply contact Medibank for assistance. Click here for more information.
What systems does Medibank use?
We use two systems for MPPA accounts. iMed is used for accounts assessment and the Claims and Re-Assessment System (CARS) is used for re-assessment of accounts. Please contact Medibank if you have any questions about these systems.
Billing Entity: A diagnostic service provider who enters into an MPPA with Medibank
Billing Entity Number: The identification number of the Billing Entity which determines who will be paid the benefit
Date of Service: The date the service was performed
IFC: Informed Financial Consent
Inpatient: Patient who is admitted to a private or public hospital as a private patient
Item Number: Valid MBS item number (up to 5 digits long)
MBS: Medicare Benefits Schedule
MPPA: Medical Purchaser Provider Agreement
Provider Number: The identifying number issued by Medicare to a medical provider and for a specific location
Schedule Fee: The fee published for a particular item number in the MBS
Accounts & Patient Eligibility Queries
Phone: Medical Enquiry Line - 1300 130 460
Email: Medical_Provider@medibank.com.au
Post: Medical Billing
Medibank
GPO Box 9999
MELBOURNE VIC 3001
MPPA Contract Queries
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
GPO Box 9999
MELBOURNE VIC 3001
Website Feedback / Corrections
Email: Medical_Contract_Administration@medibank.com.au