Medical providers

Information for medical providers on all things HBF and AHSA.

On 1 July 2024, the Australian Health Service Alliance’s Access Gap Cover schedules are changing.

Learn more

HBF and the Australian Health Service Alliance (AHSA)

In 2017, HBF partnered with the Australian Health Service Alliance (AHSA) to give providers access to Access Gap Cover (AGC) for medical services outside of Western Australia.

AGC is used amongst many health funds to help assist in an inclusive agreement rather than having individual contracts with doctors. This type of scheme facilitates payment of medical gaps above the schedule fee, benefiting both patients and medical providers.

If you are a doctor located outside of Western Australia treating an HBF member and would like to partake in the AGC scheme, please contact AHSA directly to register. If you are already registered with the AHSA then HBF will have your information ready to process your claim.

All your registration and scheduling needs are managed through the AHSA. They can also assist you with adding additional locations to your agreement, updating your direct credit and contact details, and accessing the latest billing information relevant to your state.

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.

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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.

Common Medical FAQs

Who is AHSA?

The AHSA is a service company representing several small to medium size private health insurance funds.

The company was formed in 1994 to provide management services to these funds throughout Australia. By pooling their resources and creating AHSA, participating funds can respond more effectively to the numerous changes occurring in the private health industry.

What services does AHSA provide?

AHSA provides a range of management services including:

  • Access Gap Cover billing scheme
  • Educational services and training
  • Integrated Health Management Services
  • Negotiation of contracts
  • Prostheses and claims support
  • Provider relationships
  • The collection, dissemination, and analysis of data.

How do I register with AHSA?

Please visit the AHSA website or contact the AHSA directly to register.

I’m already registered with the AHSA, do I need to register with HBF as well?

No you don’t need to register separately with HBF. Once your information is registered with the AHSA, HBF will receive your information as well.

How do I update my contact or billing information, with HBF or the AHSA?

You will need to update your details with the AHSA which will automatically update your details with HBF. 

How do I add a new provider number/hospital location?

You will need to contact AHSA and complete their “Additional Location” form which, once added with them, will automatically update your details with HBF. 

When should I provide an Informed Financial Consent form?

When there is a patient gap or when a member requests one.

It is crucial to the success of the scheme that your patients are correctly informed of their out-of-pocket expenses. This can also be a helpful tool to allow your patient to understand the fees for the procedure and can assist HBF to provide our member with quotes or further information if they call.

You can find the Estimate of Medical Fees form on the AHSA website for your use.

Where can I find the AHSA medical schedules?

All schedules are completed by AHSA so please refer to their website.

Please note: Every state has an individual schedule.

How can I make a claim for a HBF member under AGC?

If you have ECLIPSE software installed and are registered with the AHSA, you can use ECLIPSE straight away or you can manually lodge a claim using the Access Gap Cover Account Summary Form as a batch header and submitting the invoice directly to HBF at GPO Box 1440, Perth 6845.

I have submitted a claim and it was rejected as I am not a registered provider, what do I do now?

If you are not already registered with the AHSA and you wish to take part in the Access Gap Cover, you will need to register with the AHSA directly. Once this is processed you will automatically be registered with HBF.

If you have contacted the AHSA and they have confirmed you are a registered but still having issues, we recommend contacting our Medical Relations team on 08 9265 6378 or at medicalgap@hbf.com.au between 8am - 4pm WST Monday to Friday excluding public holidays.

Who do I contact to discuss a claims query?

For all general claims queries like:

  • How to submit claims
  • Batch header queries
  • Updates on payment of claims
  • Remittance advices

Please contact the HBF claims department on 08 9625 3644.

If you have queries on how to bill using AHSA AGC, changing of contact and billing information or agreement types, please contact the AHSA directly. 

If you would like to confirm you are a registered provider and listed with HBF please feel free to contact our Medical Relations team on 08 9265 6378 or at medicalgap@hbf.com.au between 8am - 4pm AWST Monday to Friday, excluding public holidays.

I’m having some trouble understanding the agreements, who can I contact for help?

We recommend you contact the AHSA so you can get the latest information and details from them directly.

Contact details

All management of provider records, such as registration and updating of details are completed through the AHSA. Please contact them to assist.

AHSA

1800 664 277
access@ahsa.com.au

*Monday – Friday – Closed public holidays

HBF AHSA provider relations

1300 810 475 7am-3pm AWST*
ahsaproviderrelations@hbf.com.au

*Monday – Friday – Closed public holidays

General Support

1300 810 475
8am-4pm AWST*

*Monday – Friday – Closed public holidays