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The full cover arrangement is a ‘no gap’ arrangement.
As a full cover provider, you are agreeing to charge all eligible HBF members fees which do not exceed the fee specified in the HBF Full Cover Schedule. HBF will pay you an additional benefit above the MBS, fully covering the difference between your fee and the Medicare Benefits Schedule fee resulting in a no gap experience for the member.
When providing services under the fully covered options, the total fee for the service(s) includes all fees associated with or otherwise relevant to the service(s) such as administration or booking fees.
The specialist anaesthetist arrangement is a ‘no gap’ arrangement.
As a specialist anaesthetist provider, you are agreeing to charge all eligible HBF members fees which do not exceed the fee specified in the HBF Specialist Anaesthetist Schedule. HBF will pay you an additional benefit above the MBS, fully covering the difference between your fee and the Medicare Benefits Schedule fee resulting in a no gap experience for the member.
To be eligible to register on the specialist anaesthetist arrangement you must hold an 051 anaesthesia specialty code with Medicare.
The known gap opt in/opt out cover arrangement allows you flexibility to adjust the fee you charge for each individual patient.
As a known gap provider, you can elect to bill in one of three ways on an episodic basis:
You elect to charge fees that do not exceed the fee specified in the Known Gap Schedule, the account will be paid in full and the member will have no out of pocket expense.
You elect to charge fees that do not exceed the fee specified in the Full Cover Schedule, the account will be paid up to the fee specified in the Known Gap Schedule. The difference between the Known Gap Schedule fee and the Full Cover Schedule fee is the out of pocket expense the member pays.
You elect to charge a fee that exceeds the fee specified in the Full Cover Schedule, the account will be paid up to the MBS fee. The member is required to pay the difference between the MBS fee and your fee.
For more member focused information on medical out of pockets and other hospital stay costs, visit: Understand your hospital cover
Item numbers on the HBF Limited Surgical Items List are excluded from all Medical Gap
Arrangements and will only ever attract benefits up to the MBS scheduled fee.
anaesthetic services associated with item numbers on the HBF Limited Surgical Items List are
also excluded from the Medical Gap cover Arrangement.
To participate in HBFs Medical Gap Arrangements you will be required to adhere to terms and
conditions, which are subject to change from time to time.
To view the latest terms and conditions that apply to you when you participate in HBFs Medical
Gap Arrangements click here:
We understand that obtaining prompt payment for the services you provide is important. HBF’s express pay is designed to make this process easier for you. Using express pay will provide you with a number of advantages, including:
As an HBF Medical Gap provider, you will be registered as a direct billing provider under HBF’s simplified billing system (express pay). Alternatively, you may submit claims electronically through Eclipse.
Express pay is easy to use, all you need to do is forward all fully unpaid accounts for private hospital services provided to eligible HBF members directly to HBF.
HBF will process the account and forward it to Medicare. We will arrange for the combined HBF and Medicare benefits to be paid directly to you by Electronic Funds Transfer within approximately 21 business days of receiving the claim.
HBF will forward a detailed statement to you for your records.
If you have Eclipse software installed and are registered with HBF, you can use Eclipse straight away. To claim through Eclipse simply send your claims to HBF using Fund ID ‘HBF’ and claim type ‘AG’.
For claims submitted electronically via Eclipse, the Eclipse remittance advice (ERA) will match your Eclipse claim to the deposits made into your bank account allowing for automated reconciliation.
To register for our medical gap arrangements, we require you to complete a medical gap – practitioner application form.
Please read through the application carefully and complete all necessary elements including the arrangement you wish to register for.
Once completed, please return your signed form via email to email@example.com
When your application is finalised, you will receive a confirmation letter outlining the details of your registration.
Please note you can only register for one arrangement type.
If you are already registered for an agreement with HBF and need to update the information we hold for you, such as bank account details, contact numbers, email address, and postal addresses, you will need to complete a change of details form.
This form should also be used to cease provider numbers/locations you are no longer using.
When your form is processed, you will receive a confirmation letter outlining any changes
We understand that things can change within the medical industry and this may mean you need to change the way you bill HBF members.
To update your arrangement type with HBF, we require you to complete a change of arrangement form.
When your change of arrangement has been finalised, you will receive a confirmation letter outlining the new details of your arrangement.
Please note when changing arrangements, you will be required to adhere to a 90-day termination period. During this time, you will need to adhere to the terms and conditions of your previous arrangement, this is to ensure all HBF members have the correct billing information for upcoming procedures.
HBF schedules may be amended from time to time to accommodate changes as a result of MBS updates and to ensure our arrangements are delivering the best value for both members and providers.
HBF participates with AHSA in all states except WA. If you are a registered doctor practicing outside of WA, you can find the relevant AHSA Access Gap Cover Schedule here.
Download Medical Benefits Schedule (PDF)
Download Medical Benefits Schedule (Excel)
Download Specialist Anaesthetists Schedule (PDF)
Download Specialist Anaesthetists Schedule (Excel)
*For any earlier schedules please contact firstname.lastname@example.org
You can access the arrangements for any HBF member with HBF Hospital cover (including Overseas Visitors cover) provided:
Yes, our full cover arrangement does not allow for you to opt in/out on a patient by patient basis. You will be required to adhere to the arrangement for all eligible members.
Eligible member means any HBF member with HBF hospital cover (including overseas visitor cover) who:
You can add a new provider number by completing the provider registration form and sending it to email@example.com
Remember to select the same agreement type as what you already have with your other provider numbers.
If you need to cease any old provider numbers/locations, you will need to complete a change of details form, which has a section for ceasing numbers/locations.
Please make sure all forms are filled out in full and have been signed and dated by the provider.
HBF registers you for our medical gap arrangements (including additional provider locations) from the date we receive your application form. However, in extenuating circumstances, we may authorise a backdate to a maximum of 30 days.
To request a backdate, please email firstname.lastname@example.org outlining your reason for requesting a backdate including the date you wish your registration to start from.
Once reviewed you will be advised of the outcome.
Yes, you can. You can change your arrangement type by completing a change of agreement form listed above and emailing to email@example.com
You will be required to serve a 90 day termination period before the new arrangement comes into effect.
Changing arrangements requires 90 days’ notice to ensure your patients and our members are informed financially about any out of pocket expenses they may have and can plan accordingly.
To be listed on the HBF website you will firstly need to be on our full cover or specialist anaesthetist arrangement.
Once registered as a full cover or specialist anaesthetist provider you will be automatically advertised on our medical provider search.
If you are a full cover or specialist anaesthetist and no longer wish to be listed on our website please email firstname.lastname@example.org and request to be removed.
You will receive confirmation once your request is actioned.
Please note: to be added or removed from the HBF website can take up to 24 hours.
Our medical relations team are a dedicated provider support team who are available to assist you with understanding how to bill a patient or how to choose the correct arrangement for you and your patients.
You can reach the medical relations team by emailing your query to email@example.com or contacting us on 08 9265 6378 between 8am - 4pm WST, excluding public holidays.
Our medical relations team is here to help, we are a dedicated team specifically here to assist you with your HBF medical gap queries.
(08) 9265 6378 8am-4pm AWST*
GP referral search
HBF health services
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