Medical providers
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:
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.
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
What is the Australian Health Service Alliance (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 the Australian Health Service Alliance (AHSA) provide?
The 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 the Australian Health Service Alliance (AHSA)?
Please visit the Australian Health Service Alliance website or contact the AHSA directly to register.
I'm already registered with the Australian Health Service Alliance (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 and the Australian Health Service Alliance (AHSA)?
When you update your details with the AHSA, your details will be automatically updated with HBF.
How do I add a new provider number or hospital location?
You will need to contact the Australian Health Service Alliance and complete their Additional Practice Location form which, once added with them, will automatically update your details with HBF.
When should I provide an Informed Financial Consent form?
You should provide an Informed Financial Consent form to a patient when there will be a patient gap or at any time that a patient requests one.
It is crucial to the success of the Access Gap Cover 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 us to provide our member with quotes or further information if requested.
You can download the Estimate of Fees form from the Australian Health Service Alliance's website.
Where can I find the Australian Health Service Alliance (AHSA) medical schedules?
All schedules can be found on the AHSA's website
Please note: Every state has an individual schedule.
How can I make a claim for an HBF member under the Access Gap Cover scheme?
If you are registered with the Australian Health Service Alliance and have ECLIPSE software installed, you can use ECLIPSE to make a claim. Alternatively, you can manually lodge a claim using the Access Gap Cover Account Summary form as a batch header and submit the invoice directly to HBF at GPO Box 1440, Perth 6845 or email to medicalinvoices@hbf.com.au.
Please note: Accounts received via email will need to be in one of the following formats: PDF, JPG, TIF, PNG, DOC, XLS, or CSV. If the account is received in a different format or password protected we will be unable to process it for you.
Who do I contact to discuss a claims query?
For all claims related queries, such as:
- How to submit claims
- Batch header queries
- Payment updates
- Remittance advices
Or, if you would like to confirm that you are a registered provider and listed with HBF, please call our provider line on 1300 810 475.
Please contact the Australian Health Service Alliance (AHSA) directly if you have any questions about:
- How to bill using the AHSA's Access Gap Cover scheme
- Changing contact and billing details
- Changing your agreement
I'm having some trouble understanding the Australian Health Service Alliance's (AHSA) agreements, who can I contact for help?
We recommend you contact the AHSA directly to get the latest information and details on agreements
Helpful resources
Here is some helpful AHSA documents and links to find the latest AHSA updates and information:
Contact us
AHSA provider relations
1300 810 475
7am-3pm AWST*
ahsaproviderrelations@hbf.com.au
*Monday – Friday – Closed public holidays
