ECLIPSE (Fund) invoicing

Create an invoice for an in-patient covered by a health fund and make a claim.  

ECLIPSE is only used to submit health fund claims. 

For ECLIPSE billing, The Payer or a Health Fund can be the payer. We recommend setting the Health Fund as the Payer in the patient's record. This means the Health Fund will show as the payer on reports rather than the patient. 

• Set Health Fund as Payer
• Set Patient as Payer.

Branch selection

From Zedmed v37, you can change the branch when billing from a patient's record. The invoice will use the treating doctor's provider number and letterhead for that branch. You do not need to log into another branch. You cannot change the branch if you bill from the Appointment Grid or Waiting Room. Zedmed checks for an appointment matching the branch and doctor. If it does not find one, it creates a new attendance without a booking.

To create and send an ECLIPSE  invoice:

1. Go to Zedmed's Reception tab.
2. Select Patients or Waiting Room then locate the patient and open their record.
3. Check the Payer is correct. We recommend the Health Fund as the payer.
4. Check that there is a current referral entered in the Referrals section.
5. Select Patient Verification. 
   The Patient Verification dialog will open.  
6. Select OK and a check will run and advise if the patient is eligible for claims.
   To learn more, see our Easyclaim eligibility article

   

7. Bill the patient to open the New invoice screen.
   Billing is usually initiated from the Waiting Room by right-clicking the patient and selecting Bill.
   If you are billing from the Patient Record, Open the Patient Record and select Bill from the top menu
   The New Invoice screen (shown below) will open.
8. Check that the:
   • Payer is correct..
   • Doctor is correct.
   • Request/Referral Dr fields contain the correct information.
   • Fund Details fields contain the correct information.
9. Add service items to the invoice.
   For invoices raised from the Waiting Room, use the items entered by the practitioner in the Doctor Assigned Billing Codes box. Select Add All to add these codes to the invoice. Items can also be added, deleted and changed.
   
   To add items:
   
   
   1. In the Item# field, enter the service's item code.
   2. Press Tab to populate the other fields.
   3. Update the Fee field so it matches the Fund Fee Type in the Fund Details section.
      The next step is to update the Properties while the service is in the entry field and before you select Add in Step 11.  It's important to set the first item's properties because they're applied to all other items.
      
10. Update the Properties as follows:
    
    
    1. Select Properties to open the screen shown below.
    2. The only mandatory selection is the Hospital/Site field. Select the hospital the patient attended.
    3. Select any relevant Indication flags. E.g. if a patient returned later that day, you would select Not Duplicate Service.
    4. Enter the number of Patients seen.
    5. If the item is radiology or pathology, the LSPN and Specimen Collection Point fields are automatically populated.
       To learn more, see the Location Specific Practice Number (LSPN) article.
       
    6. Select OK to return to the New Invoice screen.
11. Select Add, and the item will move to the display area.
    
    
    • To add another service to the bill, select Add and repeat the steps.
    • To modify a service, select it and select Change. This will place the service into the editable fields.
    • To delete a service, select it and select Change, then select Delete.
    • To print the invoice, select Print.
12. Determine if the patient is paying a GAP fee.
    Select ECLIPSE if the patient is not paying a Gap Fee.
    Select Quick Pay if the patient is paying a Gap Fee, complete the Quick Pay screen, then select ECLIPSE  to claim the remaining balance.
    The Quick Pay process is shown in the screenshot below.
    Select Gap, then a payment method and then select Add.
    
13. After you select ECLIPSE, select Yes to the pop-up advising the invoice will be saved.
    The Eclipse screen will open for review.
14. Select an Admission date and a Financial Consent option before sending the claim:
     
    1. The Hospital Admission/Discharge dates. The Admission date is required.
    2. Under Other, make a selection for Financial Consent. A selection is required.
    3. Check that the Claim Type is either IMC Agreements or IMC Schemes.
       The Claim Type will default to the setting in the Doctor Fund Schemes table, as shown in the Setup Eclipse article's Treating doctor section. If this is incorrect or was not entered for that fund, it will default to IMC Patient Claims.
       If it is transmitted as a patient claim, the practitioner's cheque will go to the patient to bring in. You can override the setting by choosing IMC Agreements or IMC Schemes. Remember to change it in the doctor’s details as well.
    4. Review the options under Other: if the practitioner has Disclosed Financial Interest or if the claim is the subject of a Compensation claim (this will default depending on whether it’s an Agreement or Scheme).
       
15. Select Ok to submit the claim.
    You will get a response from InPatient Medical Claim Assessment advising if the claim was successfully queued for sending.
    Each claim is sent individually. There is no batching required, but they may be paid in a batch.
    If there is an error, you can go to Acc Enquiry in the Patient Record to make any changes to the invoice and complete the workflow.
    To learn more, see the Review Claims and Reconcile Payments articles.
    
16. Select Print or Continue.
    •  Print will print out the claim details, including any remittance advice for the patient.
    •  Continue will close the prompt.
    That is all you need to do. ECLIPSE will send the invoice to Medicare, where it needs to be approved before going to the health fund because this is for hospital billing. Once the health fund approves the claim, it comes back to Zedmed via ECLIPSE.
    If a claim is not sent successfully, an error code will be displayed. To learn more, see the Medicare error codes article.
    You can retry by selecting the invoice > selecting the ECLIPSE button and repeating the submission process.