About Medical Claiming

GapCover

Medibank’s GapCover scheme is a flexible arrangement that eligible medical practitioners can participate in to help Medibank members reduce or avoid out out-of pocket expenses for in-hospital medical services. Under our GapCover arrangements, eligible medical practitioners can set their fees above the Medicare Benefits Schedule (MBS), so long as the requirements of the scheme are met.

To find more information on GapCover, please click here.

MPPA Billing Channel (for pathology and diagnostic imaging providers, and public hospitals)

The Medical Purchaser Provider Agreement (MPPA) Billing Channel is a claiming option offered by Medibank to private providers of in-hospital pathology and diagnostic imaging services, and to public entities for diagnostics and all other services provided to private patients in public hospitals.

If you are an MPPA Provider, please click here.

If you would like to become an MPPA Provider, please click here for more information.

Fund Gap 25% (Medibank Registered Provider)

If you’re a Recognised Provider of Medibank, you’re eligible to claim the 25% fund gap for in-hospital medical services provided to Medibank members who are covered for those services.

If you are a Recognised Provider, please click here for more information on Fund Gap.

Fund Gap 25% (Simplified Billing Agent)

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.

If you are registered as a Simplified Billing Agent through Medicare, please click here for more information on Fund Gap for Simplified Billing Agents.

Rejection code management tool

Practice Managers have reported that one of their most pressing pain points is claims management, in particular the claims rejection process.

Medibank has prepared, in close consultation with Australian Association of Practice Management (AAPM) Members, a Rejection Code Management Tool as a helpful resource to address these issues. The tool lists the most common rejection codes and provides you with strategies to resolve the rejections.

Medibank is committed to improving Practice Managers’ experience in their day-to-day interactions with the business.

Please click here for more information on Medibank Rejection Codes.