About Health Funds
- Mar 12, 2023
- 2 min read
Updated: Mar 8
There are over 80 Health Funds in Australia the majority of which are members of the Fund Group Australian Health Service Alliance (AHSA).
Each Group has various billing rules that need to be followed if the Practitioner has entered into an Agreement with them and some Funds have setup their own Fee Structures and have their own Group.
If you need to contact a Fund or to Register with a Fund, you can find a list of them here http://www.privatehealthcareaustralia.org.au/for-providers/contacts-for-providers/
Other Groups are:
BUPA
Medibank Private
GMHBA
HCF
NIB
St. Lukes
HBF
ARHG
The Australian Regional Health Group (ARHG) have a number of Regional Funds as members. This group does not have a Fee Schedule for Medical Billing. They do, however, enter into Contract fees for Hospital Billing.
The majority of Funds also participate in Direct Billing. This is known as ECLIPSE for Medical Billing and In Hospital Claiming (IHC) for Hospital Stays.
Stay Up-To-Date
Take time to update the Contact Management – Insurers/Companies table. Health Funds are being taken over and merging and it is hard to keep up. On your first installation of Direct CONTROL™ the Insurers/Companies table contains Health Fund detail for you to maintain and ensure the detail is relevant to you. Direct CONTROL™ software updates do not change this table. Go to http://www.medicareaustralia.gov.au/provider/business/online/eclipse/files/health-fund-functionality-and-contact-details.pdf
You also need to know that GU Corporate (ex Grand United) only looks after corporate health funds and they do not ECLIPSE. There are over 300 of these funds and include Boeing Australia, Cadbury Schweppes, Caltex, Caterpillar, FAI, Kraft, Motorola and Rockwell to name a few). Grand United non-corporate funds are now Australian Unity.
Better Health no longer exists. Use AHM
Not all Health Funds have Agreements with Hospitals. You will find Hospital Agreement details here:
Participants IDs
Also known as Fund Brand IDs and on the link above they reference ATO IDs that may differ from the Participant ID. All very confusing and sometimes there is a typo in the documentation provided! Some funds actually have one ID for ECLIPSE and another Statutory Reporting ... just to keep us on our toes. So Direct CONTROL allows for three Fields to store these IDs being:
HCP for Hosptial Casemix Reporting
IHC for Hospital Medical Billing
IMC for Doctors Medical Billing