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Health Funds

  • Updated

In this article:

Gentu comes pre-loaded with all major, ECLIPSE-enabled Australian health funds.

If you need to add another fund for manual billing purposes, it is possible to do so.

This article also contains information on the fund-specific settings that should be configured for each fund.

Create a new health fund

If you need to add a custom health fund that doesn't already exist in Gentu:

  1. Navigate to Settings
  2. Select Health Funds
  3. Click the Create New button.
  4. Enter the name of the Health Fund
  5. Click Create.

Gentu will create the fund.

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To delete a custom fund, click the gentu_health_fund_delete.png button within the Edit Health Fund window as shown above.

Please note that custom funds cannot be made ECLIPSE capable.

 

Health fund details

If you wish to record additional details for the new fund, such as its address and a contact person, click the address book icon to the far right of the new fund's name to open its Address Book record.

Underneath the fund you will also find the Practitioner Details list, where each billing provider at your practice will be listed.

Click on a provider's name to open a new window, where you can set the practitioner's specific details for this fund, such as the fee schedule and maximum known gap amount.

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Once you have confirmed these details, click Save.

Repeat this process for each practitioner who has an agreement with the fund.

Please note: Custom-added health funds are not ECLIPSE capable. If you wish to bill this fund you would need to send any invoices through manually.

  

Fund-specific details

HCF fee schedule

HCF has two gazetted fee schedules: one for No Gap and one for Known Gap. (Most funds only have one fee schedule which they use for both.)

Depending on your agreement with the fund, you should select the relevant fee schedule to ensure that you are not being underpaid.

  1. Navigate to Settings > Health Funds
  2. Select HCF
  3. Scroll down to Practitioner Details
  4. Click on the doctor's name
  5. Set the Fee Schedule to HCF No Gap or HCF Known Gap as needed.

If you regularly bill HCF using one method (e.g. Known Gap) and need to bill one particular invoice using the other method (e.g. No Gap), you would need to change the HCF fee schedule as described above, create and print/claim the invoice, and then change the schedule back as needed.

BUPA Payee ID

BUPA and all its subsidiary funds require that the Payee ID be sent along with any claims.

If you are sending a BUPA claim electronically via ECLIPSE, you can ensure the Fund Payee ID is included with the claim by recording it as follows:

  1. Navigate to Settings > Health Funds
  2. Select BUPA
  3. Scroll down to Practitioner Details
  4. Click on the doctor's name
  5. Enter the Fund Payee ID in the Payee ID field
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  6. Press Save.

Our understanding is that the BUPA Payee ID needs to be entered against all of the BUPA funds, which are:

  • ANZ
  • HBA
  • Health Cover Direct
  • MBF
  • MBF Alliances
  • Mutual Community

If you are sending a manual claim to BUPA and would like the Payee ID listed on the invoice, we recommend typing it into the Invoice Note. Text typed as an Invoice Note will then display on the printed invoice.

Medibank Private scheme claims

All Medibank Private claims, if send via ECLIPSE, need to be sent as Scheme - regardless of whether they are No Gap or Known Gap.

You can set Scheme as the default claim type for Medibank Private as follows:

  1. Navigate to Settings > Health Funds
  2. Select Medibank Private
  3. Scroll down to Practitioner Details
  4. Click on the doctor's name
  5. Click into the Claim Type drop down menu
  6. Select Scheme
  7. Press Save.