St.LukesHealth is changing the terms and conditions of St.LukesHealth Medical Gap.
From January 1, 2022, St.LukesHealth has adjusted some rates and introduced a maximum out-of-pocket cost per provider per episode of $500.
The Schedule of Fees for March 1, 2022 is available for medical providers to assist in providing informed financial consent (using current MBS) to patients.
The Terms and Conditions effective January 1, 2022 provide more information on the maximum allowable out-of-pocket cost.
St.LukesHealth Medical Gap Terms and Conditions effective January 1, 2022 can be found here.
There are no required actions from providers.
Information for medical providers
St.LukesHealth Medical Gap 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 advantages - medical practitioners
- Your patient will receive a higher benefit for the services provided by you;
- The St.LukesHealth Medical Gap 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 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.
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 here.
Fund ID: SLM Location ID: HSL00799
St.LukesHealth Medical Gap
From Thursday 01 August 2019, the Australian Regional Health Group (ARHG) will handle all provider applications on behalf of St.LukesHealth. This means that from this date, ARHG member funds will not accept provider registrations directly from medical providers.
If you have any questions regarding the St.LukesHealth Medical Gap Scheme please contact our Customer Care Centre by emailing firstname.lastname@example.org or call 1300 651 988.
If you have any enquiries in relation to the change to provider registrations, please contact ARHG on email@example.com or visit www.arhg.com.au
Online Provider Registration
To update provider information, please complete the provider registration form above.
Other registration and claiming forms
Customer Service Listing
As a condition of provider registration for St.LukesHealth Medical Gap, providers are requested to participate in the Fund’s customer service listing.
It is important to understand that this information assists our members in identifying participants of St.LukesHealth Medical Gap, 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.
If a provider does not wish to partcipate in our provider listing, a seperate opt out form is available above. If a provider registers and then opts out later, changes may take up to 90 days to action.
Benefit schedules and supplements
IMPORTANT - Prior to downloading new schedule, please read Important Information at the top of this page.
St.LukesHealth Medical Gap