ECLIPSE Medical Billing for Australian Specialists

A practical guide to ECLIPSE, Simplified Billing and electronic inpatient medical claiming.

ECLIPSE — the Electronic Claim Lodgement and Information Processing Service Environment — is an important part of Australian inpatient medical billing.

It enables eligible inpatient medical claims and related information to move electronically between health professionals, Medicare, private health insurers, hospitals and billing agents.

DEVZ Solutions specialises in managing inpatient billing workflows, including ECLIPSE claiming where applicable.

Talk to DEVZ Solutions About ECLIPSE Billing See Our 3.5% Pricing

ECLIPSE Codes & Health Fund IDs →

What Is ECLIPSE?

ECLIPSE is an electronic claiming and information-processing environment operated by Services Australia.

It provides a secure connection and direct communication between participants including:

• health professionals;
• public and private hospitals;
• billing agents;
• private health insurers;
• Services Australia; and
• the Department of Veterans' Affairs.

For medical specialists, one of its most important functions is electronic inpatient medical claiming.

ECLIPSE can be used for paid and unpaid inpatient medical claims and for eligible services provided in public and private hospitals or day facilities.

Why ECLIPSE Matters for Inpatient Specialists

Specialist inpatient billing can involve both Medicare and private health insurance.

That creates an administrative process involving patient information, practitioner information, medical services, Medicare benefits, private health insurer benefits and applicable billing arrangements.

ECLIPSE provides an electronic claiming pathway designed specifically to support this environment.

Services Australia's current digital claiming guidance identifies ECLIPSE as a claiming channel for In-patient Medical Claims.

For specialists undertaking significant private hospital work, understanding ECLIPSE is therefore an important part of understanding their billing workflow. DEVZ Solutions also provides a broader guide to inpatient claim lodgement.

What Is an In-patient Medical Claim?

An In-patient Medical Claim, commonly referred to as an IMC within ECLIPSE documentation, relates to medical services provided in an inpatient setting and processed through the applicable ECLIPSE claiming pathway.

Services Australia's digital claiming guidance identifies ECLIPSE as supporting In-patient Medical Claims.

ECLIPSE allows applicable claims to involve both Medicare and participating private health insurers within the electronic claiming environment.

The exact claim pathway depends on the patient, provider, insurer, service and applicable billing arrangement.

ECLIPSE and Simplified Billing

Simplified Billing is particularly important for privately insured inpatient services.

Services Australia explains that ECLIPSE can be used to submit Simplified Billing claims.

Under Simplified Billing, hospitals or billing agents can submit applicable claims on behalf of a provider involving Medicare and the private health insurer.

The purpose is to streamline the claiming process and reduce the number of separate accounts a privately insured patient receives following hospital treatment.

DEVZ Solutions can manage applicable Simplified Billing administration as part of a specialist inpatient billing workflow.

How an ECLIPSE Inpatient Billing Workflow Can Work

1. Step 1 — Inpatient Service Provided

   The specialist provides the relevant medical service to the admitted patient.

2. Step 2 — Billing Information Received

   Relevant patient, provider, service and billing information is supplied or authorised for administrative processing.

3. Step 3 — Patient and Insurance Information Checked

   Where appropriate, available ECLIPSE verification and eligibility functions can assist in checking Medicare and private health insurer information.

4. Step 4 — Assignment of Benefit Position Established

   For applicable Simplified Billing claims from 1 July 2026, the relevant Assignment of Medicare Benefits pathway must be supported before the Medicare claim is made.

   This may involve implied or requested assignment depending on the circumstances.

5. Step 5 — Claim Prepared

   The applicable inpatient medical claim is prepared using the relevant provider, patient and billing information.

6. Step 6 — ECLIPSE Claim Submitted

   The claim is transmitted through the appropriate ECLIPSE claiming pathway.

7. Step 7 — Claim Response Monitored

   Claim responses and reports are monitored rather than assuming submission automatically means successful processing.

8. Step 8 — Issues Followed Up

   Rejected, returned, delayed or unresolved billing items can be identified and appropriately investigated.

9. Step 9 — Payment Reconciled

   Payment information can be reconciled against processed billing to identify items requiring further attention.

ECLIPSE Patient Verification

Patient verification can help identify incorrect patient information before claiming.

Services Australia provides several verification functions through ECLIPSE.

Online Patient Verification can be used to verify patient information involving Medicare and private health insurer records.

Depending on the verification type, information can be checked with Medicare, the private health insurer or both.

Services Australia recommends using Online Patient Verification before an appointment where the relevant information and ECLIPSE participation are available.

Identifying discrepancies earlier can help reduce avoidable rejected claims.

OPV — Online Patient Verification

Online Patient Verification, commonly referred to as OPV, helps verify patient details.

Services Australia describes different verification functions involving:

• Medicare information;
• private health insurer information; or
• both Medicare and private health insurer information.

Verification does not itself guarantee that a subsequent claim will be accepted.

It is an administrative check that can help identify problems with patient information before claiming.

OEC — Online Eligibility Checking

ECLIPSE also provides Online Eligibility Checking.

Services Australia states that an Online Eligibility Check can check a patient's eligibility for treatment associated with a presenting illness or condition on the admission date.

Depending on the check, information can include matters associated with:

• Medicare eligibility;
• private health insurance;
• applicable hospital cover;
• exclusions;
• excesses;
• co-payments; and
• medical services covered by Medicare and the private health insurer.

Services Australia recommends an OEC before an anticipated admission date.

Eligibility information can also assist with the financial information provided to patients before treatment.

OPV and OEC Are Not the Same Thing

ECLIPSE and Private Health Insurers

ECLIPSE provides electronic interaction with participating private health insurers.

However, private health insurers do not necessarily support every ECLIPSE function in exactly the same way.

Services Australia maintains information identifying the ECLIPSE functions available through participating private health insurers.

These functions can include, depending on the insurer:

• patient verification;
• eligibility checking;
• In-patient Medical Claims;
• agreements;
• schemes;
• patient claims; and
• other ECLIPSE functionality.

The appropriate workflow therefore depends on the insurer and the functionality available for the relevant claiming arrangement. Provider setup may also involve health fund registration.

ECLIPSE Agreements and Schemes

Private health insurers may make particular agreement or scheme functionality available through ECLIPSE.

These arrangements can be relevant to specialist inpatient billing, including applicable gap arrangements.

However, insurer participation, practitioner agreements and scheme requirements vary.

DEVZ Solutions does not assume that every specialist or every service qualifies for the same insurer arrangement.

Billing is processed according to the applicable provider, insurer, service and billing information.

ECLIPSE and Gap Cover Billing

Many specialists participate in private health insurer No Gap or Known Gap arrangements.

ECLIPSE can form part of the electronic claiming workflow for applicable privately insured inpatient services.

The actual gap arrangement depends on the practitioner's relationship with the insurer, the applicable scheme or agreement and the circumstances of the service.

ECLIPSE does not automatically make every service No Gap or Known Gap, and private health insurers do not necessarily have identical gap arrangements.

ECLIPSE and the 1 July 2026 Assignment of Benefit Changes

From 1 July 2026, updated Assignment of Medicare Benefits requirements apply to Simplified Billing.

The new framework includes:

• implied assignment; and
• requested assignment.

An Assignment of Benefit must exist before the relevant Medicare claim is made.

Where the statutory requirements for implied assignment are satisfied, assignment can occur automatically by operation of law.

Where implied assignment does not apply, requested assignment may be required.

This is now an important part of the ECLIPSE Simplified Billing workflow.

ECLIPSE Claim Responses

Submitting an ECLIPSE claim is not necessarily the final administrative step.

Claims can generate responses requiring review.

Depending on the circumstances, an item may be:

• processed;
• returned;
• rejected;
• delayed;
• require additional information; or
• otherwise require administrative attention.

A structured billing workflow monitors claim responses rather than assuming every transmitted claim has completed successfully.

Rejected ECLIPSE Claims

Rejected or unresolved ECLIPSE claims need to be investigated according to the available response information.

The appropriate action depends on the reason for the response.

Some issues may involve administrative information.

Others may require additional information or practitioner review.

DEVZ Solutions can assist with the administrative investigation and follow-up of rejected or unresolved billing items, but not every rejected claim can necessarily be corrected or paid.

Rejected Claim Recovery →

Adjusting an ECLIPSE Claim

Sometimes a previously processed claim needs to be amended because information has changed or requires correction.

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

The appropriate adjustment process depends on the circumstances of the claim.

DEVZ Solutions can assist with applicable billing administration where an adjustment is required based on information supplied or authorised by the practitioner.

ECLIPSE Claim Monitoring

One of the most important parts of medical billing is what happens after submission.

Claim monitoring can help identify:

• claims that have processed;
• rejected billing;
• outstanding responses;
• items requiring further information;
• unresolved billing;
• payments requiring reconciliation.

DEVZ Solutions incorporates monitoring into the billing workflow rather than treating electronic submission as the end of the process. Where historic items have accumulated, dedicated medical billing backlog cleanup may also be appropriate.

ECLIPSE Payment Reconciliation

Payment reconciliation compares processed billing with resulting payment information.

This can help identify claims or billing items that remain unresolved.

Relevant medical payments are directed according to the applicable provider, payer and nominated payment arrangements.

DEVZ Solutions manages the billing administration and does not need to receive the specialist's medical income before transferring it to the practitioner.

ECLIPSE and Locum Billing

Locum billing can involve an additional provider relationship.

For applicable ECLIPSE locum accounts, the servicing provider and payee provider information needs to be represented according to the relevant claiming arrangement.

DEVZ Solutions has dedicated information about this workflow.

Locum Medical Billing Australia →

ECLIPSE for Surgeons

Surgeons undertaking private hospital work may generate inpatient medical claims involving Medicare and private health insurers.

ECLIPSE can form part of the electronic claiming workflow for applicable services.

DEVZ Solutions can manage the administrative process surrounding claim preparation, submission, monitoring and reconciliation.

Surgeon Medical Billing →

ECLIPSE for Anaesthetists

Anaesthetists can generate significant inpatient billing across different theatre lists, hospitals, surgeons and patients.

A centralised ECLIPSE billing workflow can help organise applicable claims and monitor their progress through the billing cycle.

Anaesthetist Medical Billing →

ECLIPSE for Gastroenterologists

Gastroenterologists providing inpatient services may use ECLIPSE for applicable privately insured medical claims.

DEVZ Solutions can support the administrative workflow around applicable Medicare and private health fund billing.

Gastroenterologist Medical Billing →

ECLIPSE for Physicians

Physicians may provide inpatient services across multiple admissions, hospitals and episodes of care.

ECLIPSE can form part of the billing workflow for applicable inpatient medical claims involving Medicare and participating private health insurers.

Physician Medical Billing →

Do Specialists Need to Register for ECLIPSE?

Services Australia states that registration is required before submitting ECLIPSE claims.

The setup process involves applicable claiming software and Services Australia registration requirements.

Current Services Australia guidance includes steps involving:

• compatible practice management software;
• online claiming registration;
• PRODA;
• applicable provider agreements; and
• linking the relevant PRODA organisation to Medicare Online/ECLIPSE/DVA/AIR.

Requirements should always be checked against current Services Australia guidance.

ECLIPSE and PRODA

PRODA — Provider Digital Access — forms part of the digital access environment used by healthcare providers and organisations interacting with Services Australia systems.

Services Australia's ECLIPSE registration guidance includes establishing applicable PRODA access and linking the relevant organisation with Medicare Online/ECLIPSE/DVA/AIR.

PRODA for Medical Billing →

What Information Is Needed for ECLIPSE Billing?

The exact information depends on the claim.

Relevant information may include:

• patient details;
• Medicare information;
• private health insurer information;
• practitioner details;
• provider numbers;
• service location;
• date of service;
• authorised billing information;
• applicable MBS item information supplied or authorised for billing;
• insurer or scheme information where relevant;
• Assignment of Benefit information;
• locum servicing/payee information where applicable.

The treating practitioner remains responsible for the accuracy of clinical information and billing instructions supplied.

See the DEVZ guide to MBS medical billing for more information about Schedule items and practitioner responsibility.

Common ECLIPSE Billing Problems

ECLIPSE reduces manual administration but does not eliminate billing problems.

Examples of issues that may require attention include:

• incorrect patient information;
• Medicare information discrepancies;
• private health insurer information discrepancies;
• provider information issues;
• eligibility issues;
• insurer participation or scheme issues;
• incomplete billing information;
• rejected claim responses;
• unresolved claims;
• Assignment of Benefit issues;
• reconciliation differences.

The correct response depends on the actual claim and the information returned through the claiming process.

Why Outsource ECLIPSE Billing?

For specialists undertaking regular inpatient work, ECLIPSE administration can become a significant part of practice administration.

A dedicated billing workflow can provide:

• consistent claim processing;
• patient verification where applicable;
• eligibility checking where applicable;
• Simplified Billing administration;
• ECLIPSE claim submission;
• claim monitoring;
• rejected claim follow-up;
• payment reconciliation;
• locum billing administration;
• Assignment of Benefit workflow support;
• centralised billing across multiple hospitals.

The practitioner remains responsible for clinical information and billing instructions while DEVZ Solutions manages the administrative billing workflow.

DEVZ Solutions ECLIPSE Medical Billing

DEVZ Solutions specialises in Australian inpatient medical billing.

Our service can include:

• Medicare inpatient billing;
• private health fund billing;
• ECLIPSE claiming;
• Simplified Billing;
• Assignment of Benefit workflow support;
• locum billing;
• patient/provider administrative verification;
• claim monitoring;
• rejected claim follow-up;
• payment reconciliation;
• billing backlog management.

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

Relevant medical payments remain directed according to the applicable provider and nominated payment arrangements.

Talk to DEVZ Solutions About Your ECLIPSE Billing

ECLIPSE Medical Billing Across Australia

ECLIPSE is an electronic claiming environment.

This allows specialist inpatient billing administration to be managed across different private hospitals and locations, subject to applicable provider, payer, software and claiming requirements.

DEVZ Solutions provides specialist medical billing support to Australian medical practitioners using a centralised administrative workflow.