Medical FAQs

Information about Medicare rejection codes and what they mean is available here:
https://www.medibank.com.au/providers/claims/medical-claims/rejection-reasons/

Please contact Provider Services to assist with registration or updates:
https://www.medibank.com.au/providers/contact/

You can view current and historical GapCover rates here:
https://www.medibank.com.au/providers/medical/gapcover/current-rates/

No, medical claims cannot be submitted via email.
Claims must be submitted:

• Electronically via Eclipse, or
• By post using the GapCover batch header

Please find the batch header here: https://medibank.com.au/providerforms

If you are unable to submit a claim via Eclipse, please:

• Complete the GapCover batch header
• Attach the invoice
• Send via post (address provided on the form)

Please find the batch header here: https://medibank.com.au/providerforms

If a claim for a deceased member cannot be submitted through Eclipse, please:

• Complete the GapCover batch header
• Attach the invoice
• Send via post (address provided on the form)

Please find the batch header here: https://medibank.com.au/providerforms

Medical claims are first processed by Medicare before being sent to health funds, and Medicare cannot stop a submitted claim.
Please allow a few days for the claim to be received by Medibank, after which we can assist with adjustments if required.

You can:

• Apply the $5 reduction to the second item, or
• Submit surgical and diagnostic imaging items as separate claims

If your claim appears underpaid, please contact Provider Services:
https://www.medibank.com.au/providers/contact/

Please contact Provider Services to lodge your request:
https://www.medibank.com.au/providers/contact/

For late lodgements, you will also need to complete a Medicare form: https://www.servicesaustralia.gov.au/hw026

• Do not use the GapCover batch header
• Use the Medibank claim form instead
• Attach the invoice and complete all required sections

Download forms here: https://medibank.com.au/providerforms

• Add item 30001 directly below each abandoned MBS item
• Charge 50% against the surgical item
• Charge $1 against item 30001

• GapCover / Resident claims:
   Medibank Private GapCover
   GPO Box 1288K
   Melbourne VIC 3001
  
  
• Overseas Workers or Visitors Cover:
  Medibank Non Resident
  Reply Paid 2984
  Melbourne VIC 8060
  
  
• Overseas Student Health Cover (OSHC):
  Medibank OSHC
  Reply Paid 2984
  Melbourne VIC 8060

You must first register your bank details with Provider Services:
https://www.medibank.com.au/providers/contact/

Once registered, you can submit your claim via Eclipse or manually.
As long as:

• Your Medicare provider number was valid on the date of service, and
• Medicare approves the claim; the claim will be payable.

The incorrect claim type was selected. "Agreement" was selected on Eclipse. Please resubmit and select "Scheme" on Eclipse which is for Gapcover claims.

• Submit each claim with time as service condition text
• If one claim has already been paid without times, you can still submit the second claim with service condition text “RVG@0900hr PD, @1200hr UNPD”

To access and claim eligible Midwife MBS items, a midwife must hold a valid Medicare provider number, be registered with the Australian Health Practitioner Regulation Agency (AHPRA), and be practising privately (not employed by a public or private hospital).

To participate in Medibank Gap Cover, the midwife must complete a Gap Cover Application Form and submit it to GapCoverForms@medibank.com.au. 
Please find more information Medibank GapCover scheme | Medibank.