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, so you get ECLIPSE billing without running the software yourself.

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. FreshClaim does all of it: scan a patient sticker, add the items, and we check, price, lodge same-day, resolve any rejections, and reconcile the payment for 2.85% plus GST of what you collect.

There are two steps:

1. Let us know which provider numbers you want to link with FreshClaim

2. Complete FreshClaim registration: FreshClaim then manages the required health fund registrations

There is a simple onboarding guide, or get in touch and we will step you through it.

Fill out your details on our “Get Started” page, and we’ll be happy to help.

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 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, you can capture and queue all of your claims ready for submission prior to provider registration being completed. We will submit them for you as soon as your registration is complete.

Yes. FreshClaim will send you copies of the Medicare-required HW027 form for each provider number you wish to use. You simply print out the form, fill in the blanks, sign it, then scan and email it back to us. FreshClaim does a final proofread, checks that all details are correct, and then submits it to Medicare for you.

There are a number of forms that need to be completed and sent through to the different private health fund networks. Once you have downloaded the app and filled in the registration form, we will compile and submit the forms on your behalf.

FreshClaim has created a simple onboarding guide, which you can find in our “Resources” section. Or just get in touch, and we’ll be happy to walk you through it.

FreshClaim integrates directly with ECLIPSE and reflects the real-time status of all your claims and payments.

This varies by health fund. With FreshClaim, half of all claims are paid within 64 hours of submission (that is the median), and the vast majority within a week.

You can check your claims easily in either the mobile app at the touch of a button, or access more detailed analytics and history in your FreshClaim web dashboard.

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, and a low headline rate often hides extras: setup fees, add-ons for chasing rejections, and the claims and staff hours the fee never covers. FreshClaim is 2.85% plus GST of collected revenue, with no setup fees and no lock-in. The fee is the whole cost of billing.

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.

FreshClaim’s transaction fees are billed monthly in arrears, calculated on the claims paid to you that month. Most customers pay by credit card.

Your claim is priced against the admitting fund’s own schedule and lodged the same day it is captured, so nothing waits in a batch. No-gap claims travel fully electronic payment channels from lodgement to deposit, which is what 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.

Yes, payment is deposited straight into your nominated bank account, directly from ECLIPSE.

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.

Customers generally find it easiest to pay by credit card. FreshClaim’s transaction fees are billed monthly in arrears, on the claims paid to you that month. There is no subscription.

Transaction fees are calculated by applying the FreshClaim invoice fee to all the claims that have been settled and paid to you in that month.

Every claim is validated against ECLIPSE before submission, so the vast majority are accepted on the first attempt. An error is surfaced and corrected before lodgement rather than after a rejection, which is what keeps the time from your phone to fund payment short.

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 is designed to help you manage your billing and reporting, and provides easy-to-download transaction reports as well as a range of other reports to help you manage your practice.

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

Medical billing software is a tool you operate yourself: you and your staff still enter claims, fix rejections, and reconcile payments; the software just makes those steps possible. A billing service is people who do some of that work for you, usually on the same kind of software, for a percentage fee. FreshClaim is a third option: your billing done for you, on software we built and run ourselves, 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 software is rarely the hard part. The cost is the hours it takes each week and the claims that slip through: missed entries, unfixed rejections, and payments never reconciled add up to roughly 3–8% of revenue, on top of any software licence. Doing it yourself keeps control, but it keeps the labour too.

It is not a straight either/or. Software alone gives you control but hands you the operation. A traditional service takes some work but leaves the rest, and still charges a fee. The question worth asking is not “software or service” but “who runs the software?” FreshClaim answers it by being both: the software and the team that operates it, at a price built to compete with doing it yourself.

It’s both, and that is the point. FreshClaim is billing software built specifically for specialist claims, run end to end by our own team: capture, coding, lodgement, rejection follow-up, and reconciliation. You get the control and visibility of monitoring claim progress without needing the staff time of running it, for 2.85% plus GST of collected revenue. In plain terms, it is a billing department you do not have to hire.

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.

Yes. Under Australian Medicare rules, a valid referral is required for all specialist and consultant physician services billed to Medicare. Public hospital inpatients, pathology, and diagnostic imaging are treated differently.

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, an Australian specialist may provide services without a referral, but this exception covers only the first 30 minutes. After that, a referral must be obtained.

No. Backdating a referral constitutes a false statement under the Health Insurance Act 1973. If a referral was not in place at the time of service, do not create one afterwards with an earlier date.

Anaesthetic fees are derived, not fixed. The base unit values of the billed MBS items and the anaesthetic time units are summed, then multiplied by a multiplier specific to the patient’s health fund and state.

Time units convert elapsed anaesthetic time (start to finish) into billable units under a two-tier block system. They are added to the procedure base units before the fund multiplier is applied.

Because each private health fund applies its own multiplier to the MBS base value, and the multiplier also varies by state, typically between about 1.65 and 1.86 times the base value.

When an anaesthetic is provided after-hours in an emergency, an additional loading of 50% of the base anaesthetic subtotal applies, billed via item 25020, 25025, 25030 or 25050 depending on the circumstances.

Item 21990 covers an abandoned anaesthetic: anaesthesia administered but the surgery abandoned before it began. It carries a fixed fee of $69.30 and must be claimed alongside the appropriate time item.

A surgical assistant’s MBS schedule fee is 20% of the surgeon’s Multiple Operation Rule (MOR) total. Item 51300 applies a fixed fee of $100.65 when the MOR total is at or below the $651.30 threshold; item 51303 pays 20% of the entire MOR total once it exceeds that threshold.

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, so verify assistant eligibility at the item level before invoicing.

Email support@freshclaim.com.au or call us directly: you reach the person handling your claims, not a ticket queue.