Privately Insured In Hospital Claim (IHC)

Requirements

Hospital/Entity is registered with Health Funds
Hospital Contracts are setup
Hospital/Entity has Insured Rate selected in Location rates for each Active Location in Utilities - Entities - Locations (Active)
Patient/Client has a current and verified Private Insurance Membership
Patient/Client has a current the Referrer/Surgeon in Referrals
Date of Service (DOS) is within that agreed by the Health Fund
DCM will not process an IHC if any of the above is not correct
On transmitting the Claim, the Health Fund membership is verified again based on the Date of Service (DOS)

Unlike Patient Claiming, Bulk Billing, DVA Billing or ECLIPSE for the Medical Service, you cannot transmit the IHC from the invoice
The IHC is transmitted from the Admission form
This IHC option is ONLY available when the Health Fund Contract is met
This allows for improved cash flow prior to finalising Clinical Coding for HCP and PHDB reporting

The timing of the receipting for an In Hospital Claim (IHC) varies per Fund
This process can be automated
Otherwise, go to Regular Tasks - Online Claiming and select the Get ECLIPSE button on the sidebar

On getting the ECLIPSE Payment details, and the Invoice is paid in full, the Invoice will be receipted, and the status of the Claim Status will change to Completed without staff involvement
Should there be a difference in what was paid to what was claimed, the Claim Status will be Reports Available.
Right-click on the Claim and select Get Report for detail. Options are:
- Accept what has been paid resulting in what was invoiced updating to what was paid
- Right-click and go to Invoice and Resolve the Issues
- Resubmit Later resulting in the Claim being moved to the Claims to Resubmit section
- Resubmit Now resulting in the Claim being Resubmitted with a new Claim ID