Medical providers

Information for medical providers on all things HBF Medical Gap.

Medical Gap Arrangement

HBF’s Medical Gap Arrangement is designed to make life easier for you and your patients. It applies to services provided in a licenced private hospital or day hospital facility (Private Hospital) only.

Our Fully Covered arrangement allows your HBF patients to have no gap for your eligible Private Hospital services.

Access Gap Cover

Access Gap Cover is the AHSA’s gap cover scheme that aims to minimise or eliminate out-of-pocket costs for members in-hospital specialist treatment.

As a provider, Access Gap Cover allows you the flexibility to opt-in or opt-out of the agreement on an episode by episode basis and charge a co-payment if you wish to do so.

If you choose to opt-in to the AGC agreement these are your billing options:

No gap

Where you elect to charge the patient an amount equal to the AGC fee, the patient will have no gap or out of pocket to pay.

Find the latest schedule billing information here: AGC fee schedules.

Known Gap

Where you elect to charge a co-payment, under AGC you can charge a maximum of $500, or $800 for MBS items that relate to ‘Management of Labour and Delivery’ as defined in the MBS above the AGC scheduled fee per hospital episode. This is irrespective of how many MBS item numbers are included in the treatment.

Find the latest schedule billing information here: AGC fee schedules.

If you elect to charge above the allowable AGC co-payment, the account will be paid up to the MBS fee only. For more information on AGC please refer to the billing guide and terms and conditions please visit the AHSA website or contact the AHSA directly.

For more member focused information on medical out of pockets and other hospital stay costs, visit: Understand your hospital cover

AHSA Access Gap Cover schedules

For the latest Access Gap Cover billing schedules please visit the AHSA website.

Please note that the schedules are worked out on a state by state basis so please ensure you select the correct state where the procedure will be taking place within.

What’s in it for you?

Better patient experience

Access to WA’s largest member base

Claiming is made easy with payment within 21 days

Help reduce bad debts

Claim electronically via Eclipse to reduce paperwork

Email your invoices for easy billing

HBF Limited Surgical Items List

Item numbers on the HBF Limited Surgical Items List are excluded from the Medical Gap Arrangement and will only ever attract benefits up to the MBS scheduled fee.

Benefits for anaesthetic services associated with item numbers on the HBF Limited Surgical Items List are also excluded from the Medical Gap cover Arrangement.

HBF Limited Surgical Items List

Terms and conditions

To participate in HBFs Medical Gap Arrangement you will be required to adhere to terms and conditions, which are subject to change from time to time.

To view the current terms and conditions that apply when you participate in HBFs Medical Gap Arrangement click here:

Terms and conditions
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You can now email your accounts

Simply email your account to medicalinvoices@hbf.com.au in one of the following formats: PDF, JPG, TIF, PNG, DOC, XLS, or CSV. Make sure the account is not password or print-protected. If the account is received in a different format or protected we will be unable to process it for you.

Eclipse

You can use Eclipse right away if you have Eclipse software installed and are registered with HBF. Simply send your claims to HBF using fund id ‘HBF’ and claim type ‘AG’ to make a claim.

The Eclipse remittance advice (ERA) will match your Eclipse claim to the deposits made into your bank account, allowing for automated reconciliation of claims submitted this way.

Express pay

Express pay is easy to use, simply send all fully unpaid accounts for private hospital services provided to eligible members directly to HBF.

The account will be processed by us and forwarded to Medicare. Within approximately 21 days of receiving the claim, we will arrange for the combined HBF and Medicare benefits to be paid directly to you via Electronic Funds Transfer.

Once completed, HBF will send you a remittance statement to your registered postal address.

How to:

HBF Medical Gap Schedules

HBF schedules may be amended from time to time to accommodate changes brought about by MBS updates and to ensure our arrangement provides the best value for both members and providers.

HBF participate 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.

Common medical FAQs

Who is eligible for HBF medical gap cover?

You can access the arrangement for any HBF member with HBF Hospital cover (including Overseas Visitors cover) provided:

  • They are up to date with their premiums at the time of service/treatment.
  • They have served any necessary waiting periods.
  • The service/treatment received is covered under their policy.
  • They are admitted to and the service/ treatment is provided at a licensed private hospital or day hospital facility.

If I register for the full cover arrangement, do I need to adhere to the arrangement with all HBF patients?

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:

  • is up to date with their premiums at the time a service is provided;
  • has served all required waiting periods;
  • receives a service that is covered under their policy; and
  • is admitted.

What arrangement can I register on if I am practising outside of Western Australia (WA)?

HBF currently participates in the AHSA (Australian Health Service Alliance) Access Gap Cover (AGC) for all other states outside of WA. For more information please visit the AHSA website to read more about the AGC Agreement.

I already have an arrangement with HBF. How do I register a new provider number?

You can add a new provider number by completing the provider registration form and sending it to medicalgap@hbf.com.au

I am no longer practising at a location, how can I cease my provider number?

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.

How can I update my bank account or contact details?

You can change your banking or contact details by completing a change of agreement form listed above and then emailing to medicalgap@hbf.com.au

Can I be listed as a provider on the HBF website?

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.

I don’t want my details to be advertised on the HBF website, how can I have them removed?

If you are a full cover or specialist anaesthetist and no longer wish to be listed on our website please email medicalgap@hbf.com.au 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.

What are the benefits of being listed on the website?

Being listed on the website helps our members or their referring GPs to find your contact information easier. This ensures they can make an informed decision to choose a provider who won’t charge any out of pocket costs and is at a location that is easy for them to access.

I am having some trouble understanding the arrangement who can I contact for help?

Our medical relations team are a dedicated provider support team who are available to assist you with understanding how to bill a patient and how our arrangement works for you and your patients.

You can reach the medical relations team by emailing your query to medicalgap@hbf.com.au or contacting us on 1300 810 475 between 8am - 4pm WST, excluding public holidays.

Contact details

Our medical relations team is here to help, we are a dedicated team specifically here to assist you with your HBF medical gap queries.

Medical relations

1300 810 475 8am-4pm AWST*
medicalgap@hbf.com.au

*Monday – Friday – Closed public holidays

General Support

1300 810 475
8am-4pm AWST*

*Monday – Friday – Closed public holidays