Gentu directly integrates with ECLIPSE, meaning that you can easily submit electronic health fund claims. Before you get started with claiming, there are a few configuration steps necessary to get Gentu set up.
If you have not yet activated ECLIPSE as part of your Gentu subscription, please contact our Sales team on firstname.lastname@example.org or 1300 889 362.
Looking for instructions on billing ECLIPSE claims? Please see the Invoicing a Private Health Fund (ECLIPSE) article.
Practitioners who provide billable services need to have their provider number recorded in their user preferences. You can record multiple provider numbers for one practitioner, each one linked to a particular site of service.
- Navigate to Settings > Manage Users
- Select the relevant practitioner from the list
- Select the 'Practitioner Details' tab
- Click the [+] next to 'Sites of Service' and enter the relevant details, then click 'Save'.
You will need to create a site of service for each location the provider practices at.
Hospital Details & Facility ID
Hospitals where surgery is performed must be entered into the Address Book in Gentu, with their Facility ID recorded. A Facility ID is required for online claiming - similar to a practitioner provider number, the Facility ID uniquely identifies the location where service was provided.
Facility IDs are issued by the Department of Health and the list of hospitals is updated regularly. If you're unsure of the Facility ID for a hospital please confirm it with the hospital administration directly, or check the list of hospitals on the Department of Health's website.
To record a hospital in Gentu:
- Navigate to the Address Book module.
- Click 'Add' > Hospital.
- Enter the Hospital details, including the Facility ID.
- Tick the 'Procedures will be performed at this Hospital' checkbox.
- Click 'Save Contact'.
Before claiming from a fund for the first time, you will need to enter the details of the doctor's fund agreement(s) into Gentu.
To enter the details of a doctors' agreement with a health fund:
- Navigate to Settings > Health Funds.
- Select the relevant fund from the list.
- Under 'Practitioner Details' select the Doctor making the claim.
- Enter the doctor's details as per their agreement with the fund, particularly including Fee Schedule (where applicable), Billing Type (Known Gap/No Gap), Max Known Gap (if applicable), Claim Type and Payee ID.
- Click 'Save'.
Some notes on setting up Health Funds:
- BUPA Funds (ANZ, BUPA, HBA, Health Cover Direct, MBF, MBF Alliances, Mutual Community) all use the same Payee ID, so you can easily set these up in once go.
- Medibank Private and AHM funds should always be set to Scheme claim type.
- HBF and HCF use a different schedule of fees in WA. If your practice is located in WA, confirm your fee schedule is set to the correct schedule for your agreement, rather than the default AHSA schedule.
Some Health Funds are AHSA members, which means their schedule of fees are based on those set by the Australian Medical Association (AMA). As the AMA fee schedule is not available to the public it may be necessary to upload the AMA fee schedule into Gentu, so you can ensure that the fees claimed match what you are entitled to claim under your agreement.
To do this, first log-in and download the AMA schedule of fees from the AMA website. The file must be in .CSV (Comma Separated Variable) format, which can be opened in Microsoft Excel or a similar spreadsheet program. Please do not attempt to upload the .PDF file as it is unable to be read by Gentu.
Then upload the AMA Schedule file by:
- Navigate to Settings > Fee Schedules
- Click 'Upload AMA'.
- Locate and select the AMA Fee Schedule CSV file on your computer.
- Wait for the upload to complete. This may take some time, but you'll be notified with a pop up message when it's done.
> What is the Fund Payee ID?
The Fund Payee ID is a reference unique to each practitioner which identifies them to the health fund. Certain funds (such as BUPA and Medibank Private) require the fund payee ID in order to process your claims. If you are not sure of your fund payee ID, you can check the registration documentation supplied to you by the fund, or contact the fund directly.
> What is a health fund agreement?
A 'health fund agreement' is an arrangement between a practitioner and a private health fund. Under a health fund agreement, a doctor can use the private health fund's fee schedule to set the item charge, and the health fund pays the gazetted rebate amount. (This is true for both No-Gap and Known Gap claims.)
If your doctor doesn't have a health fund agreement, they can still send claims to the health fund. However, the health fund will treat the claim as a private-type bill, and you will receive a reduced rebate amount from the fund in payment.