How to make a GapCover claim

You can submit GapCover claims through ECLIPSE with the following information: 

Claim Type: SC (Scheme) 

Fund payee ID: Medicare generated Provider number 

Fund Brand ID: MPL 

If you don’t have access to ECLIPSE, you can submit a manual claim. Download the GapCover Batch header, and fill out and post as per the instructions on the form.

To help us process your claim quickly and correctly, please make sure your claim includes the following:

• Correct Medicare number. If the Medicare number is incorrect or not provided, the account will be rejected. Please put the UPI (Unique Patient Identifier) at the end of the Medicare number. If the UPI is at the start of the Medicare number, the account may be rejected.
• Referring Provider Number. Although our requirement is only for referring provider details, including the referring provider number ensures that the account is processed correctly and removes any confusion that may arise from providers with multiple locations.

We pay via EFT. 

For help with claiming issues, please call us on 1300 130 460 (Medical Provider access code 540 300) or contact us via web messaging