ECLIPSE Codes, Health Fund IDs and Return Codes

A practical reference for Australian specialist inpatient medical billing.

ECLIPSE billing involves more than an MBS item number.

Claims and eligibility transactions can also use:

• health fund identifiers;
• location IDs;
• claiming channels;
• ECLIPSE functions;
• Medicare return codes;
• private health insurer responses; and
• servicing and payee provider details.

Understanding these identifiers can help determine why a claim processed, rejected or requires further administrative attention.

DEVZ Solutions specialises in Australian specialist inpatient medical billing and ECLIPSE administration.

Talk to DEVZ Solutions About ECLIPSE Billing

What Are ECLIPSE Return Codes?

Services Australia returns 4-digit codes when an error occurs or additional claim information needs to be communicated.

A return code can help identify:

• why a claim was rejected;
• how a claim was assessed;
• a transmission problem;
• missing or invalid data;
• information requiring review; or
• whether correction or resubmission may be appropriate.

Return codes do not all mean the same thing. A code must be interpreted according to its actual description and the claim circumstances.

Main ECLIPSE Return Code Categories

Reference: Services Australia — About Medicare Online and ECLIPSE return codes.

Searchable ECLIPSE Return Code Reference

This operational reference contains commonly encountered ECLIPSE and inpatient medical billing codes. It is not represented as a permanent or complete copy of the Services Australia lookup.

Search All Current Services Australia Return Codes →

Common ECLIPSE Codes Seen in Inpatient Billing

The searchable table above includes common fund, membership, provider, channel and MBS-service messages used in inpatient billing administration. The wording is taken from the Services Australia lookup reviewed in August 2026.

A code's presence does not establish that a claim can or should simply be resubmitted. Read the message with the transaction, payer response and verified billing information.

What Does an ECLIPSE Code Actually Tell You?

A return code is a diagnostic or assessment message. It does not automatically tell the biller to:

• change an MBS item;
• alter clinical information;
• resubmit repeatedly;
• change a provider number; or
• change patient details without verification.

The correct response depends on the code and actual billing circumstances. Possible actions may include:

• checking patient details;
• checking health fund membership;
• checking provider registration;
• checking applicable ECLIPSE functionality;
• checking supplied billing information;
• obtaining clarification from the practitioner;
• contacting the health fund;
• contacting Services Australia;
• correcting authorised administrative information; or
• resubmitting where appropriate.

ECLIPSE Health Fund Brand IDs

Services Australia publishes a Fund Brand ID for private health insurers listed in its ECLIPSE directory. These short identifiers help identify the relevant private health insurer within ECLIPSE administration.

The searchable directory below reproduces the insurer, Fund Brand ID and Location ID information published by Services Australia and reviewed on 9 August 2026. Insurer support for individual functions varies and must be checked in the live official function table.

Source: Services Australia — Private health insurers' functions and contact details for ECLIPSE, page last updated 22 July 2026.

Examples of Current Health Fund Brand IDs

Examples in the current directory include ACA Health Benefits Fund — ACA; AHM Health Insurance — AHM; AIA Health Insurance — MYO; Australian Unity Health — AUH; Bupa Australia — BUP; CBHS Health Fund — CBH; Defence Health — DHF; Doctors' Health Fund — AMA; GMHBA — GMH; HBF Health — HBF; HCF — HCF; and Health Insurance Fund of Australia — HIF.

Use the full table and the current Services Australia directory rather than relying on examples alone.

What Is the ECLIPSE Location ID?

The Fund Brand ID and Location ID are different identifiers. The Services Australia ECLIPSE insurer directory includes both.

This is one current Bupa example. Do not assume every insurer follows the same formatting convention.

ECLIPSE Function Codes and Abbreviations

Services Australia's insurer-function table uses abbreviations to identify ECLIPSE functions and service variants.

Not Every Health Fund Supports Every ECLIPSE Function

Participation in ECLIPSE does not mean every insurer supports every function.

Services Australia's current insurer-function table identifies which insurers support functions including:

• OPV;
• OEC;
• IMC;
• Agreements;
• Schemes;
• Patient Claims;
• Medicare/private health insurer billing-agent transactions;
• Two-Way claiming;
• In-Hospital Claiming;
• Overseas claiming; and
• ECLIPSE Remittance Advice.

A biller should not assume one workflow works identically across every insurer.

View Current ECLIPSE Insurer Functions →

Why Old Health Fund Names Still Appear in Medical Billing

Australian private health insurance has undergone acquisitions, mergers, brand changes and consolidation over many years.

As a result, medical practices may encounter:

• an old health fund name in historical records;
• a current brand operating under a larger insurer;
• changed provider registration arrangements;
• changed ECLIPSE identifiers;
• historical membership information; or
• legacy billing records.

This can become especially relevant when clearing old billing backlogs, investigating rejected historical claims, reconciling old remittances or working with long-standing patient records.

Health Fund Acquisitions and Mergers — Practical History

Brand Name vs Underwriting Insurer

A consumer-facing health insurance brand is not always a separate registered health insurer. Brands can operate within larger insurer groups.

Billing staff should therefore use current insurer identification and ECLIPSE information rather than assuming the consumer brand name alone identifies the ECLIPSE payer.

Why Fund Mergers Matter for Old Claims

For historical or backlog billing, an old fund name can create confusion. If a practice sees an insurer name that no longer appears in the current ECLIPSE list, do not invent a replacement code.

1. Identify the historical insurer.
2. Determine whether it was acquired, merged, renamed or transferred.
3. Check the current Services Australia ECLIPSE insurer list.
4. Check the current insurer/provider information.
5. Confirm membership or claim arrangements where necessary.

This is particularly relevant to backlog cleanup, rejected claim recovery, historical reconciliation and old patient records.

Rejected Claim Recovery →
Medical Billing Backlog Cleanup →

ECLIPSE Codes and Patient Eligibility

OPV means Online Patient Verification. OEC means Online Eligibility Check.

Return codes arising during these processes can identify issues such as patient details not matching, membership issues, fund contact being required, Medicare validation issues or insurer eligibility information.

Verification and eligibility checks do not guarantee eventual claim payment.

Complete ECLIPSE Medical Billing Guide →

ECLIPSE Codes and Health Fund Registration

Some ECLIPSE errors can relate to insurer/provider registration information. Current Services Australia return codes include messages concerning provider contact with the fund, incomplete fund registration, health fund transmission availability and outdated fund information.

DEVZ Solutions can assist with the administrative workflow, but practitioner/provider recognition and participation remain subject to the applicable fund and Services Australia requirements.

Health Fund Registration →

ECLIPSE Codes and Locum Billing

Locum claims can add another level of provider information. The correct servicing provider, payee provider, principal provider, applicable provider number, health fund and claiming pathway must be represented according to the claim circumstances.

For applicable ECLIPSE locum accounts, Services Australia guidance allows relevant servicing-provider/payee-provider structures.

Locum Medical Billing Australia →

ECLIPSE Codes and Assignment of Benefit

Return codes and Assignment of Benefit are separate concepts.

For Simplified Billing from 1 July 2026, the updated Assignment of Medicare Benefits requirements also need to be satisfied. Do not interpret an ECLIPSE return code as automatically establishing whether a valid assignment exists.

1 July 2026 Assignment of Benefit Changes →

ECLIPSE Claim Adjustment

Services Australia provides a Simplified Billing or ECLIPSE adjustment process for previously processed claims that require amendment with new or altered information.

A claim should not simply be altered without understanding why the adjustment is required, what information is changing, whether practitioner authorisation is required and the applicable payer requirements.

Services Australia — Simplified Billing or ECLIPSE adjustment claim form →

How DEVZ Uses ECLIPSE Codes

DEVZ Solutions uses available return information as part of the administrative billing workflow. This can include:

1. identifying the claim or transaction;
2. reviewing the returned code;
3. checking the official meaning;
4. reviewing supplied billing data;
5. determining whether administrative correction is possible;
6. obtaining practitioner clarification where required;
7. contacting the applicable fund where appropriate;
8. resubmitting where authorised and appropriate;
9. monitoring the resulting claim; and
10. reconciling the outcome.

DEVZ does not alter clinical information simply to make a claim pass.

DEVZ Solutions — ECLIPSE Billing Expertise

DEVZ Solutions specialises in Australian specialist inpatient medical billing.

Our billing administration can include:

• ECLIPSE inpatient medical claiming;
• Simplified Billing;
• Medicare claiming;
• private health insurer claiming;
• health fund administration;
• return-code investigation;
• rejected claim follow-up;
• locum billing;
• Assignment of Benefit workflows;
• payment reconciliation; and
• billing backlog cleanup.

Our specialist medical billing service is available from a simple 3.5% flat fee.

Talk to DEVZ Solutions About ECLIPSE Billing