Frequently asked questions.

ECLIPSE (Electronic Claim Lodgement and Information Processing Service Environment) is the Medicare channel specialists use to lodge in-hospital and specialist claims (Medicare, DVA and private health fund claims, including no-gap and known-gap) electronically, and be paid directly to their bank. FreshClaim lodges every claim through ECLIPSE the same day it’s captured and tracks it to payment.

A specialist captures the service, applies the correct MBS item numbers and fee schedule, and lodges the claim (through ECLIPSE for in-hospital work) to Medicare and any relevant health fund, then follows it to payment. With FreshClaim, you scan the patient sticker and add the items; we check, price and lodge the claim the same day, resolve any rejections and reconcile the payment, for 2.85% plus GST of what you collect.

Book a 10-minute call, or register in the app. You’ll need your provider numbers, ABN, AHPRA registration number and banking details. We prepare the Medicare and health fund paperwork and submit it for you.

Yes. Book a call on the Get Started page and we will go through it with you.

Your part takes about 15 minutes. We prepare the Medicare and health fund paperwork and submit it for you. Most funds complete their side within one to two weeks, and one or two can take up to three, but you do not wait for them. Capture and send claims from day one, and each is lodged as the relevant registration completes.

Yes. Send claims from day one. Each is lodged as soon as the relevant registration completes.

Yes. We send you a Medicare HW027 form for each provider number you want to use. Complete and sign each one and email us a scan; we check the details and submit it to Medicare.

Each health fund network has its own forms. Once you complete registration in the app, we prepare and submit them for you.

The onboarding guide covers each step. Or contact us and we will go through it with you.

The app shows the status of each claim and payment, taken directly from ECLIPSE.

It varies by health fund. The median is 64 hours from submission, and the vast majority of claims are paid within a week.

In the app, or in the web dashboard, which also has detailed analytics and history.

2.85% plus GST where the payment comes through ECLIPSE (Medicare, DVA and health fund benefits). 5% plus GST where it comes from the patient, TAC, WorkCover or a hospital, because each of those accounts is invoiced, followed up and reconciled on its own.

On a known-gap claim both apply: 2.85% on the fund’s benefit and 5% on the patient’s balance. You are charged on what you are actually paid, not on what was billed, and nothing is charged on a claim that does not pay. There are no subscription, setup or follow-up fees.

Most charge a percentage of what they collect. It is worth checking what the rate leaves out: setup fees, extra charges for rejection follow-up, and claims or staff time it does not cover. FreshClaim is 2.85% plus GST of collected revenue, with no setup fee or lock-in, and the fee covers the whole billing process.

No. FreshClaim has no lock-in contracts, no setup fees, and no add-ons for claim follow-up. You can stop at any time.

Both rates cover the same claiming work: the claim is checked against the admitting fund’s schedule, lodged the same day, followed up to payment, and re-lodged by us if it is rejected.

The 5% covers what an ECLIPSE claim does not require. A payment from a patient, TAC, WorkCover or a hospital has to be invoiced, the invoice has to be followed up if it is not paid, and the payment has to be reconciled against the claim on its own rather than arriving in a fund remittance. Where a patient is paying, the money is also collected and held in trust so that refunds are handled before the money reaches your practice.

Monthly in arrears, on the claims paid to you that month: 2.85% plus GST of ECLIPSE payments and 5% plus GST of invoiced payments. Most customers pay by credit card. There is no subscription.

How soon the claim is lodged, whether it is right first time, and how the fund pays. FreshClaim prices each claim against the admitting fund’s schedule and lodges it the same day it is captured; no-gap claims are paid electronically from lodgement to deposit, which keeps most payments inside a week.

ECLIPSE pays into your nominated bank account directly, and so do TAC, WorkCover and hospitals against invoices we raise. FreshClaim is not in the path of that money and cannot hold it up. Our fee is invoiced at the end of the month rather than deducted.

A patient invoice is the exception, because the money has to be collected first. The patient pays FreshClaim into a designated trust account, and it transfers to your practice account when you confirm the service was completed, usually the same day and otherwise the next business day. You receive the full amount collected; the 5% plus GST is invoiced with the month’s fees.

Our transaction record automatically matches claims to payments, so reconciliation is already done by the time you see it. Every payment is linked to the claim it belongs to, and you can open any deposit to see exactly which claims it covers.

At the end of each month you receive a summary of claims made against claims paid, in a form your accountant can use.

You scan the patient sticker, add the items and send. We check each claim against Medicare and health fund rules before lodging it, so most are accepted first time.

Yes. All your billing history is visible and searchable (by location, by patient, or for a specified time period) in self-serve reporting.

Yes. The web dashboard has your billing and reporting, including downloadable transaction and practice reports.

FreshClaim stores all patient data in Australia and encrypts it with AES-256, on ISO 27001-compliant, PCI DSS Level 1 infrastructure. All FreshClaim staff are Australian citizens or permanent residents.

Billing software is a tool you operate: you and your staff enter claims, fix rejections and reconcile payments. A billing service does some of that work for you, usually on similar software, for a percentage fee. FreshClaim does the billing for you, on software we built and run, for 2.85% plus GST of what you collect.

Yes. Many specialists lodge their own claims through practice management software or an ECLIPSE tool. The cost is the weekly hours and the claims that slip through: missed entries, unfixed rejections and unreconciled payments add up to roughly 3–8% of revenue, plus any software licence.

It depends who you want doing the work. With software, you or your staff lodge claims, fix rejections and reconcile payments. A billing service takes on some of that for a percentage fee. FreshClaim is both: the software and the team that runs it.

For inpatient billing, it removes the need to run claims through it. FreshClaim is an end-to-end closed system: claims are captured in the app and tracked to payment, with a monthly claims-made against claims-paid statement. Our transaction record automatically matches claims to payments, so nothing has to be re-entered into practice management software to reconcile.

For attendance items, yes. A valid referral is needed for specialist and consultant physician attendances to attract Medicare benefits at the referred rate. Procedural items and pre-anaesthesia consultations (17610 to 17625) do not need one.

A GP referral to a specialist is valid for 12 months. A specialist-to-specialist referral is valid for 3 months.

An in-hospital referral override is a Medicare pathway where an admitted patient is referred to a specialist by a colleague within the hospital, documented in the hospital record instead of a standard written GP referral. It is valid only for the duration of the admission and expires on discharge.

In a genuine emergency, where the service has to be rendered as quickly as possible, an Australian specialist may provide it without a referral. Services after the emergency need a referral.

No. Backdating a referral constitutes a false statement under the Health Insurance Act 1973.

In units. The base item for the surgery sets the base units, anaesthesia time sets the time units, and the patient’s ASA status, age and an emergency add modifying units. The total is multiplied by the RVG unit value, $23.70 at 1 July 2026, to give the schedule fee.

The schedule fee is $23.70 a unit at 1 July 2026. Medicare pays 75% of that, $17.80, for an in-hospital service. Under a no-gap or known-gap arrangement, the fund’s rate is about $38 to $45 a unit in total. Medicare pays its $17.80 of that and the fund pays the rest. Indicative at the time of writing.

From when the anaesthetist begins exclusive and continuous care of the patient until the patient is safely handed to other staff. The first two hours count one unit per 15 minutes or part; beyond two hours, one unit per 10 minutes or part. The total selects one time item from 23010 to 24136, claimed with the base item.

8 pm to 8 am on a weekday, or any time on a Saturday, Sunday or public holiday. The after-hours emergency loading (25025) applies when more than half of the anaesthesia time falls after hours and the case needed immediate treatment; it adds 50% of the fee for the base item, time item, modifiers and any 22002 to 22051 service.

No. Items 17610 to 17625 do not require a referral. A referral is required for other anaesthetist consultations (17640 to 17655) to be paid at the specialist rate.

Under no-gap and known-gap schemes, most fund rates are about $38 to $40 a unit, and nib Gapsure about $45, against the $23.70 schedule fee. That is the total paid: Medicare pays $17.80 a unit and the fund pays the rest, about $20 to $27. TAC pays about $58 a unit itself. These are approximate at the time of writing; fees and schedules change.

Not the base item. The assistant claims 25200 (an emergency with imminent danger of death) or 25205 (complex elective cases, or a service over 6 hours), worth 5 units, plus the time item, the modifiers and any 22002 to 22051 service.

An abandoned anaesthetic: anaesthesia given but the surgery not started. It carries 3 units ($71.10 at 1 July 2026) and is claimed with the time item, with a note that the procedure was abandoned before it began.

A surgical assistant’s MBS schedule fee is derived from the surgeon’s Multiple Operation Rule (MOR) total, run over the “(Assist.)” items only. Item 51300 applies a fixed fee of $103.25 when that total is at or below the $668.25 threshold; item 51303 pays one fifth of the total once it exceeds that threshold. Figures at 1 July 2026.

The surgical assistant item for an operation, or a combination of operations, marked “(Assist.)” whose fee or abated total exceeds $668.25. It pays one fifth of the established fee. Below that threshold the assistant claims item 51300 at a fixed $103.25 (1 July 2026). See the item reference for 51300 and 51303.

Not always. Medicare runs the multiple operation ladder a second time over only the “(Assist.)” items the assistant was present for, so the assistant’s total can be lower than the surgeon’s. When the surgeon’s list clears the $668.25 threshold but the assistant’s does not, item 51300 applies at the fixed fee. See surgical assistants and the multiple operation rule.

The Multiple Operation Rule is the Medicare rule for multiple procedures performed in one operation: the highest-fee item is paid at 100% of the schedule fee, the second at 50%, and every subsequent item at 25%.

Under a known-gap arrangement, the maximum patient out-of-pocket is $500 per procedure (not per item). Charge more than $500 above the fund schedule and the fund reverts to paying only the Medicare schedule fee.

Under no-gap, the doctor charges at or below the health fund’s no-gap schedule fee and the patient pays nothing. Under known-gap, the patient pays an agreed out-of-pocket amount of up to $500 per procedure, consented to before treatment.

No. Only items Medicare flags as assistant-eligible can be claimed. Billing against an ineligible item results in claim rejection with no Medicare benefit and no fund contribution.

Email support@freshclaim.com.au or call us directly. You reach the person handling your claims.