Bulk bill
The patient assigns their Medicare benefit to you, and pays nothing. You lodge the claim, and Medicare pays the benefit into your account. One claim holds up to 80 patient visits.
- General
- Specialist
- Pathology
Claiming
Claims,
Claims,
lodged right.
Right the first time.
Lodge bulk bill, patient, DVA and in-patient (ECLIPSE) claims through one connection, then follow each claim to its payment.
- Patient
- Rose Riviera
- Item
- MBS 23 Level B consult
- Schedule fee
- $45.05
Lodged
Accepted by Medicare for processing
F3848@
A sample bulk bill claim, lodged and accepted.
Services Australia Certified
Used by GP, specialist and diagnostic practices across Australia
Every way you claim
Four claim types, one connection.
Each claim type moves the benefit differently between Medicare, DVA, the health fund, the practice and the patient. All four lodge through one connection, for general, specialist and pathology services.
Patient claims
The patient has paid the account, in full or in part. You lodge the claim and Medicare assesses it in real time. The benefit goes to the claimant, or by a cheque made out to you when the account is not paid in full.
- General
- Specialist
- Pathology
DVA
You treat a veteran or their dependant, and claim the Department of Veterans’ Affairs on the same connection as Medicare. DVA pays you, and the veteran pays nothing. DVA claims are for holders of the Veteran Card for All Conditions (Gold) or Specific Conditions (White).
- General
- Specialist
- Pathology
In-patient claims (ECLIPSE)
For a patient admitted to hospital, one claim goes to Medicare and the patient’s health fund. Under an agreement or scheme, the fund pays you both benefits at once.
- General
- Specialist
- Pathology
In-patient claims (ECLIPSE)
One claim, to Medicare and the health fund.
For the medical services a patient receives while admitted to hospital, one claim goes to Medicare and on to the patient’s health fund. It travels through ECLIPSE, the Services Australia service that connects Medicare and the private health funds. You follow the claim to each assessment, then to the payment.
| Claim type | When it is used | Who is paid |
|---|---|---|
| Agreement | The provider has an agreement with the patient’s fund. | The fund pays the provider both benefits in one payment. |
| Scheme | The provider treats the patient under a scheme with their fund. | The fund pays the provider both benefits in one payment. |
| Billing Agent | A billing agent claims from Medicare and the fund. | Medicare and the fund each pay the billing agent. |
| Medicare Only | A billing agent claims from Medicare, and no fund takes part. | Medicare pays the billing agent. |
| Patient Claim | The patient claims, as a member of the fund. | Account paid. Medicare pays the claimant, and the fund pays the patient.Not paid in full. Medicare and the fund each pay by a cheque made out to the provider. |
-
When you lodge
Acknowledged
Medicare accepts the claim for processing.
Item 30026
-
Once assessed
Reported
- Medicare
- $46.95
- Health fund
- $15.63
-
Once paid
Paid
$62.58
One payment from the health fund, itemised on its remittance advice.
What comes back
Paid, pending, or a reason why.
Every claim resolves to a clear outcome. A declined claim comes back with its reason in plain English, ready to show the person who lodged it.
Paid
The claim was assessed and the benefit paid. For a claim paid to you, the payment report or the remittance advice records the deposit.
Pending
A Services Australia officer assesses the claim by hand. You get the claim reference immediately, and the outcome follows.
Rejected
Medicare, DVA or the fund declined the claim. The reason comes back in plain English, so you can correct the claim and lodge it again.
Reconciliation
Tracked to the cent, down to the bank deposit.
A claim is complete when the benefit is paid. Every claim that pays you has a record of the payment, so you can match what was assessed, what was paid and the deposit in your account.
- Bulk bill and DVA
- A processing report, then a payment report
- In-patient
- A claim report, then a remittance advice for each payment
Each is ready to retrieve for 6 months from lodgement. Patient claims have neither: Medicare pays the claimant, or sends a cheque the patient passes on to you.
$4,218.60
- F3848@
- $45.05
- G2207@
- $80.10
- H4419@
- $124.05
and 41 more claims in this payment run
Remittance advice
In-patient
$62.58
- Agreement claim, item 30026
- $62.58
More than lodging
Everything around the claim.
The work a claim needs before it is lodged and after it is paid, on the same connection.
Verify the patient first
Patient verification confirms the patient’s Medicare details, a veteran’s DVA card or the patient’s health fund membership, before you treat and claim.
Ask the fund first
Before an admission, the health fund eligibility check asks the patient’s fund to estimate what it pays. The estimate prints for the patient, so they can give informed financial consent.
Check before you lodge
The eligibility check tests the patient and each item against 300+ Medicare rules before you lodge.
Forms from the claim’s details
The Assignment of Benefit agreement, the DVA service voucher, the patient claim statements and the in-patient claim declaration print as PDFs, from the claim’s own details.
Withdrawn the same day
A patient claim lodged in error can be deleted on the day it was lodged, with the reason for the deletion.
No double lodgements
Every claim carries its own reference, so it can be resent safely after a dropped connection. Medicare refuses a resend with the same reference, so the claim is not lodged twice.
How it fits
Claim from the software you already use.
RebateRight connects to your practice management or billing software, so claims go out from the system your team already works in. There is nothing new to open, and nothing to enter twice.
No new system to learn
The patient and item details your team enters become the claim, so the front desk and the billing team keep working as they do now.
Connected once
Your software provider connects to RebateRight one time, against a test environment first. The claiming guide in the docs has every request, response and rule.
Each clinic registers for claiming once. We issue its Minor ID, the identifier that tells Medicare which clinic a claim comes from. The clinic then sends Services Australia the HW027 form, which registers its bank details and links its first provider number. We guide you through each step.
“A claim had been rejected across all five items. Using RebateRight we were able to claim back $500 we would have lost.”
Who claims with RebateRight
From the solo practice to the national network.
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GP clinics
A full day of bulk billed consults in a single claim, with each payment matched to its deposit.
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Specialist clinics
Referred consults and procedures, in rooms and in hospital, with the referral sent on each claim.
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Pathology labs
Bulk bill and DVA pathology at volume, with the request on each claim and duplicate protection built in.
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Radiology practices
Diagnostic imaging claims, each with its request, matched to the payment run.
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Allied health
Care-plan and chronic-disease items, claimed and reconciled in one place.
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Medical billing services
Every clinic in your portfolio on a single key, including in-patient claims as the billing agent.
Pricing
Claiming is in every plan.
You pick the volume you need. Every plan gets every feature.
Claiming questions
Answered, in full.
What kinds of Medicare claims can I lodge?
Bulk bill, patient, DVA and in-patient (ECLIPSE) claims, each for general, specialist and pathology services. RebateRight lodges 5 types of in-patient claim: Agreement, Scheme, Billing Agent, Medicare Only and Patient Claim. The Assignment of Benefit agreement, the DVA service voucher and the patient claim statements print as PDFs.
What is the difference between bulk billing and a patient claim?
With bulk billing, the patient assigns their Medicare benefit to you and pays nothing. You claim Medicare, and Medicare pays you by EFT. With a patient claim, the patient has paid the account, in full or in part. You lodge the claim for them and Medicare assesses it in real time. Medicare pays the benefit to the claimant, or by a cheque made out to you when the account is not paid in full.
What is an in-patient (ECLIPSE) claim?
An in-patient claim is for the medical services a patient receives while admitted to hospital. Services Australia carries it through ECLIPSE, which connects providers, Medicare and the private health funds. Medicare assesses the claim, then the patient’s health fund where the claim type has one. The claim report gives each assessment, and the remittance advice records each payment to the provider or billing agent.
Does an in-patient claim cover the hospital’s own claim for the stay?
No. An in-patient claim is for the medical services a practitioner gives an admitted patient. The hospital claims for the admission itself through a separate Services Australia service, which RebateRight does not lodge.
Which health funds take part?
The private health funds that take part in ECLIPSE. Get Participants returns each fund with its code and the claims and checks it accepts, so your software offers only what the patient’s fund supports. The fund codes guide in the docs explains the list.
Do you support DVA claiming?
Yes. You claim for veterans and their dependants across general, specialist and pathology services, on the same connection as Medicare. You can verify a veteran’s entitlement first, including which Veteran Card they hold, for All Conditions (Gold), Specific Conditions (White) or Pharmaceuticals Only (Orange), and print the DVA D1216S service voucher.
How do I know a claim was paid?
Each bulk bill and DVA claim has a processing report and a payment report. The processing report shows what Medicare assessed, and the payment report shows the deposit paid into your account, with every claim in that payment run. Each in-patient claim has a claim report, and each in-patient payment a remittance advice, which gives the deposit and the benefit paid for each claim. Each is ready to retrieve for 6 months from lodgement.
Can I cancel a claim after I lodge it?
Yes, for a patient claim lodged earlier the same day. Same-day delete withdraws it, with a reason code, so you can correct a wrong patient, item or payment type.
What do I need before I can claim?
Each clinic that claims needs a Minor ID, the identifier we issue for each clinic location, and a HW027 form, which registers the clinic’s bank details with Services Australia and links the Minor ID. Each practitioner’s provider number is then linked to the Minor ID. We guide you through each step. Eligibility checks and patient verification need none of this.
What happens when a claim is rejected?
It comes back as a result, never a silent failure. You get the reason in plain English, so you can correct the claim and lodge it again.
How is claiming counted against my plan?
Each MBS item on a claim counts as one request, so a claim with 3 items counts as 3. Every other submission counts as one request, including a request for a report or a remittance advice. Section 3 of our Pricing Agreement has the full definition.
What happens to patient data?
Zero Data Persistence. The claim is lodged and the request is discarded once the response returns, so patient details are never stored. The service is hosted in Australia, in Microsoft Azure’s Australia East region, which is assessed to IRAP PROTECTED. The only thing we keep is billing metadata, such as the endpoint name and the outcome, never patient details.
Lodge your first claim today.
For 14 days you have unlimited requests at no charge, with no credit card. Connect your software, test each claim type, then go live.