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Welcome to DCM Help Centre

Schemes and Agreements

  • Updated
Providers need to register with the Health Funds in order to be able to ECLIPSE claims.
Register for ECLIPSE - Health professionals - Services Australia
Insurers/Companies – Direct CONTROL Medical (DCM)

In hospital Medical Claims (IMC) can be classified as a Scheme (SC), an Agreement (AG) or a Patient Claim (PC). These can be transmitted directly from the invoice by selecting the IMC button on the sidebar. Should be button show IMC (PC), this will only show for two reasons:

  1. The Health Fund selected is not added to this Entity's Schemes and Agreements, or
  2. The Out-Of-Pocket (OOP) being charged is greater than the fund allows.

On transmitting an IMC (PC), this will result in:

  • Medicare paying 75% of their fee
  • The Fund topping up 25%, and
  • If an OOP, the client/patient has to pay
On first installing DC, there is the entity Dr Firstname Lastname and a list of Health Funds participating in ECLIPSE are listed in the Schemes and Agreements section.
  • If in a Group Practice, Dr Firstname Lastname is changed to ...Please select
  • Health Funds and other third-party payers can be copied from or to other Entities
 

  • It is important to ensure that Entities are added in DC with their Provider Number before Copying. The Payee ID will populate with that Entity's Provider Number against each fund. Should you not do this, enter the Provider Number at the top of the form and copy again.
  • All Health Funds reference the Provider Number Stem (first six numbers) except for BUPA
  • BUPA require a unique Practice/Payee ID
  • When a doctor/health professional register with BUPA, they are issued a Practice ID number that is associated with their Provider Number. If that health professional has multiple Provider numbers with different bank details attached to each or some provider numbers, a different Practice ID is given as they are also attached to the bank account
  • If the Entity has multiple BUPA Practice IDs, the ID entered in Schemes and Agreements above can be overridden per Location
  • Go to Utilities - Entities - Locations (Active) - Other and enter it in the BUPA Practice ID Override box

Should a Fund not be listed in Schemes and Agreements, it needs to be added in Contact Mangement - Insurers/Companies before Adding here.

If there is more than one Entity, add the new fund in ... Please select and then right click on it and select Copy Selected Fund Details to all Entities

 

 

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