Information for Simplified Billing Agents

How Do I Register as a Simplified Billing Agent?

To register as a Medibank Simplified Billing Agent, you need first to be registered with Medicare as a Simplified Billing Agent and have a Medicare registration number (Note: this is different to a Provider Number). To find out more about becoming a registered Simplified Billing Agent with Medicare, please visit their website.

Terms and Conditions for Simplified Billing Agents

In conjunction with the new EFT payment methods for Simplified Billing Agents, Medibank has introduced Terms and Conditions. These Terms and Conditions apply from 5 September 2010.

How to register with Medibank Private

If you wish to submit 25% Fund Gap accounts to Medibank as a Simplified Billing Agent, you need to register with Medibank. When you register with Medibank, you agree to accept the Terms and Conditions that apply when submitting claims as a Simplified Billing Agent for 25% Fund Gap Claims. 

To register, complete a Simplified Billing Agent Registration & Change of Details Form and mail to:

Medical Services Manager
Provider Relations
Medibank
GPO Box 9999
MELBOURNE VIC 3001

You will then receive confirmation of your registration, together with relevant details to help you claim as a Simplified Billing Agent for 25% Fund Gap.

How to claim 25% Fund Gap as a Simplified Billing Agent

1. As a Simplified Billing Agent, you submit the account to Medicare to receive the 75% Medicare benefit.
2. Once you have received your benefit from Medicare, forward the Medicare Simplified Billing Statement of Benefits and account, together with your completed Batch Header to Medibank.
3. Send your completed accounts to:

   Medical Billing
   Medibank
   GPO Box 2984
   MELBOURNE VIC 3001

4. Once the accounts are received, Medibank will process and assess the claim for payment.
5. If a benefit is payable, payment will be made via EFT (if you are registered with Medibank)
6. If a benefit is not payable, the Statement of Benefits will contain a code explaining the reason.

It is important that the correct information is provided on the Batch Header to ensure timely and accurate processing of accounts.

Claim Batch Headers

When submitting 25% Fund Gap Claims, you are required to include a completed Medibank Batch Header for all claims, including resubmissions, and ensure that they are grouped separately.

Required information on claims

When submitting claims, please ensure all mandatory and accurate information is included. Mandatory Fields include:

• Patient Membership Number
• Patient First and Last Name
• Date of Birth
• Date of Service
• Service Provider Name and Service Provider Number
• Charge Amount
• Medicare Benefits Schedule Item
• Medicare Schedule Fee
• Medicare Benefit
• If the claim is accident or compensation related

If a claim is an accident or compensation related, it is a mandatory requirement that Medibank is informed. Please ensure that this is clearly marked on the front of the relevant claim/s if this is the case.

Online Claiming with Medibank via Eclipse

Medibank now has the capability to accept 25% Fund Gap Medical claims via ECLIPSE for Simplified Billing Agents under claim type ‘MB’.

• ECLIPSE is an extension to Medicare Australia's online claiming solutions
• offers a secure connection between practices, public and private hospitals, billing agents, Medicare and Department of Veterans' Affairs and health funds. 
• incorporates direct communication for providers with Medicare and health funds, all in the one transaction.

What are the benefits of ECLIPSE?

• Faster resolution of claims and faster payment times 
• Less manual intervention - fewer errors, speedier resolutions 
• Clearer error messages with a single point of contact for problem resolution 
• Online patient verification of Medicare enrolment and health fund membership 
• No more claims batching 
• One system for all health funds 
• No transaction costs for medical claiming 
• A one stop shop for claiming

You can obtain further information on ECLIPSE from Medicare Australia

If you are interested in submitting medical claims via ECLIPSE, please contact the Medical Services Manager for further information.

What happens if an account is rejected?

A 25% Fund Gap account can be rejected by Medibank for a number of reasons.

If you believe that a claim has been rejected in error, underpaid or overpaid, please return the claim to Medibank for re-assessment by attaching a Resubmission Batch Header.

Resubmission Batch Header

It is important that Resubmission Batch Headers are included with resubmissions and completed accurately to allow for timely and accurate re-assessment.

Where do I send resubmitted accounts?

Completed batches of resubmissions can be sent to:

Medical Billing
Medibank
GPO Box 2984
MELBOURNE VIC 3001

Contact Us

Accounts & Patient Eligibility Queries
Phone: Hospital and Provider Advocacy Team (HPAT) - 1300 130 460
Post:  

Medical Billing
Medibank
GPO Box 9999
MELBOURNE VIC 3001

Registration enquires for Simplified Billing Agents    

Fax:   03 8456 6250
Email:  Medical_AncillaryProviders@medibank.com.au 
Post:  

PMDM Team
Medibank
GPO Box 9999
MELBOURNE VIC 3001