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| | | | | | Document last updated on: 26/11/2020 |
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Software as a Service Cloud Practice Management |
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| | | | | | | | ECLIPSE Reporting and Receipting
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Sections in the ECLIPSE Reporting and Receipting User Guide.
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1 - The Medicare ECLIPSE Menu |
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The Medicare ECLIPSE Menu is where you access Medicare Processing Reports (IMC Reports) and ECLIPSE Remittance Advice Reports (ERA Reports - amounts paid to your account by the Health Funds).
1. IMC Reports (In-Patient Processing Reports) - present a list of IMC (In-Patient Medical Claims) and the current status of each claim.
2. ERA Reports (ECLIPSE Remittance Advice Reports) - present a list and the details of amounts paid.
When ERA's are retieved - each Remittance Advice then has to be reconciled with the originating IMC. The amount deposited to your bank account is Receipted and the Invoice Status is set the PAID.
Note that the entire process of lodgeing an In-Patient Claim - to receiving the Remittance Advice can take some time and depends on the Health Fund and their billing cycle.
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2 - IMC Reports and Processing |
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Understanding ECLIPSE ReportsA status report provides the status for submitted transactions. It lets you know if the transaction has been validated and assessed, and whether a report is available. The response depends on the state and type of transmission.
You should request a status report before attempting to retrieve a report.
If you try to retrieve a report that isn’t ready you’ll get an empty report.
You can request the report or it can be provided in response to a submitted transaction. The Status of a report may be:
IMC Claim Processing Report
You can retrieve these reports at any time. You can request them more than once within 6 months of the claim.
The presentation and structure of the report depends on the type of software your practice uses.
The status response will indicate a report is available. The response will look different depending on the transmission type.
For billing agent claims, you can only retrieve the report after the private health insurer pays their benefit.
An ECLIPSE remittance advice (ERA) report includes payment information for unpaid IMCs that were submitted under these claim types: - AG - agreements
- SC - approved gap cover schemes
- MB - Billing Agent submitting claims to private health insurers and Medicare
- MO - Billing Agent submitting claims only to Medicare
ERAs aren’t available for IMC patient claims (IMC PC) because the patient or claimant is responsible for the account.
The private health insurer will create an ERA when they deposit the EFT funds into your bank account.
If you have more than 1 payee submitting per location, you’ll get a remittance advice for each payee.
You can retrieve an ERA report at any time. You can request them more than once within six-months of the original request. ERAs are only available if the private health insurer supports the ERA function. |
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Processing Reports screen
The table will display all of the current or recent IMCs and the current status.
From here you can retrieve the Status and retrieve the Report if it is available.
Status Request by Date Range or Status Request of Selected Claim
You can Retrieve Processing Reports by
Retrieve Reports of All Selected Claims or Retrieve Report of Selected Claim
You can then Display the Report of a Selected Claim
You can also view the claim details with Display Claim in Progress |
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| In this Processing Report example - the 1st item has been accepted - and the 2nd Item has been rejected (Medicare Explanation Code = 160 Maximum number of services for this item has already bben paid.
You will need to refer to the Handling Exceptions section. |
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In this example - a claim with 3 items has been ACCEPTED - and the Total Benefit will be paid by the Health Fund. |
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3 - ERA - Eclipse Remittance Advice |
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Before the ERA report can be retrieved from the Medicare Hub - the ERA Statutus must be retrieved.
You can retrieve the ERA Status by Date Range or by selecteing a range of claims.
You can retrieve the ERA Reports only after successfully retrieving the ERA Report Status/ |
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4 - Remittance Advice List and Receipting |
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The ECLIPSE Remittance Advice List provices a list of Remiitance Advice reports received from the Health Funds.
These reports advise your practice on how much has bee deposited for each claim.
From this list - you can review the individal claim details, review the remittance advice received - and Receipt the amount deposited.
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Details of the Remittance Advice received from the Health Fund are displayed on the left.
Details of the Invoice and Invoice Items (Vouchers and Services) - are displayed on the right.
If everything matches - i.e. the Deposit Amount equals the Balance Due - then kust click Receipt All to complete the receipting and reconcilliation. |
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To receipt a remittance advice - select (highlight) the remittance advice on the list - then click Receipting |
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Receipt and Payment details are automatically created, and all status and balances are update.
The ERA record is set to PAID The Invoice is set to PAID
The Claim, Invoicing, and Receipting process is complete. |
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