Information for medical providers
St.LukesHealth Medical Gap Cover is designed to provide medical practitioners with the option to eliminate or reduce the medical gap for eligible St.LukesHealth members requiring hospital inpatient services. This is done through the payment of an additional benefit over and above the Medicare Benefits Schedule (MBS) fee for those members who receive in-hospital treatment from a participating practitioner.
St.LukesHealth Medical Gap Cover advantages - medical practitioners
- Your patient will receive a higher benefit for the services provided by you;
- The St.LukesHealth Medical Gap Cover Schedule of Fees is reviewed from time to time;
- The claiming process is streamlined, therefore improving your accounts administration and cash flow while providing greater convenience for patients;
- Online claiming of Medicare and Fund benefit is available through Electronic Claim Lodgement and Information Processing Environment (ECLIPSE)
- Quicker processing time means faster payment of accounts;
- The incidence of bad debts and the expense involved in collecting those debts can be reduced;
- Visibility for members of your participation through our customer service listing.
St.LukesHealth Medical Gap Cover advantages - St.LukesHealth members
- Financial certainty of ‘no’ or ‘known’ medical gap for inpatient services;
- Patients continue to have their choice of medical practitioner;
- Simplified billing process - no need for patients to claim through several sources;
- Improved value perception of private healthcare, further supporting the private system.
Forms can be emailed to St.LukesHealth via firstname.lastname@example.org
, or mailed to PO Box 915, Launceston TAS 7250.
St.LukesHealth uses ECLIPSE billing as the primary process for submission of medical gap claims. Using this form of billing has some significant benefits, particularly ensuring claims are processed in a timely manner, clear provision of information and once a claim is paid, electronic statement issuing. Most practice billing software has the ability to submit accounts via ECLIPSE. Further information on ECLIPSE billing can be found at https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/simplified-billing-and-eclipse
Fund ID: SLM Location ID: HSL00799
St.LukesHealth Medical Gap Cover
Electronic Provider Registration - Our fastest and easiest method of registration
Other registration and claiming forms
November 1, 2018, Changes
St.LukesHealth will update its Terms and Conditions document from November 1, 2018. These changes relate to our provider registration forms and billing requirements (for the ease of our providers), with a change to the Fund’s customer service listing processes.
The key changes are as follows:
**Please note, after February 1, 2019, the use of old forms will result in the application being rejected and a new form will need to be completed**
- Changes to the electronic St.LukesHealth Medical Gap Cover registration form, the Fund’s preferred method of registering for the program;
- Changes to the St.LukesHealth Medical Gap Cover PDF registration form to allow for the addition of EFT information and inclusion of acceptance of the Fund’s Terms and Conditions;
- Removal of the EFT form – replaced by our Provider Update Details Form;
- Changes to the requirement to submit a Batch Summary – now listed in the St.LukesHealth Medical Gap Cover Terms and Conditions; and
- Changes to the Fund’s customer service listing (information below).
Customer Service Listing effective November 1, 2018, for implementation February 1, 2019
St.LukesHealth has changed the way it manages its customer service listing. As a condition of provider registration for the St.LukesHealth Medical Gap Cover program, providers are requested to participate in the Fund’s customer service listing. We have amended the registration for the customer service listing to an OPT-OUT process, requiring providers to complete a separate opt-out form as a part of the registration process or when they no longer wish to participate in our customer service listing.
It is important to understand that this information assists our members in identifying participants of the St.LukesHealth Medical Gap Cover program, which provides more transparency to our members around out-of-pocket costs. The information collected and used includes provider name, practice address, contact details, specialities and other information (including) program participation and is managed by a third party to publish this in a manner that empowers our members.
Do I need to do anything?
If you are happy to be listed on St.LukesHealth’s Medical Gap Cover customer service listing, you do not need to do anything further. After February 1, 2019, your details will be updated on our customer service listing as you register for the St.LukesHealth Medical Gap Cover program or submitted a claim for payment.
If you wish to opt-out of this process, you have until February 1, 2019, to complete a Provider Opt-Out form and return it to St.LukesHealth. At any stage after February 1, 2019 you wish to opt-out, please submit a Provider Opt Out form, however, please understand this may take up 30 days to action.
Benefit schedules and supplements