System upgrade FAQs for providers

We're upgrading our systems from 6.00pm WST, Thursday 22 August to 8.00am WST, Monday 26 August 2024.

Over this period, many services will not be available.

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What do I need to know?

We are switching to a new website and updated claims systems. During the systems upgrade, claims cannot be submitted or processed, and online eligibility checks (OEC) cannot be conducted.

For more information about what the systems upgrade means for providers, please review our Frequently Asked Questions below.

Learn more about what’s changing for HBF members.

Ancillary

An HBF member plans to use my services during the system upgrade period. What do I need to inform them?

HBF members will be unable to claim on the spot during the system upgrade period. Members will need to pay for your services upfront, then submit the claim directly to HBF after the system upgrade is complete.

Alternatively, you may wish to advise the member to return after the system upgrade is complete to settle their account (within 7 days of the date of service). 

What happens if I try to use HICAPS/HealthPoint terminal during the system upgrade period for HBF members?

An error message will be displayed if you try to swipe an HBF member’s card or if they tap their digital card. The member will need to pay for your services upfront, then submit a claim after the system upgrade is complete. 

Alternatively, you may wish to advise the member to return after the system upgrade is complete to settle their account (within 7 days of the date of service). 

How can HBF members get a benefit quote during the system upgrade?

Benefit quotes will be unavailable during the system upgrade period. HBF members will be able to obtain a benefit quote until 6pm WST Thursday 22 August 2024, or after the system upgrade from Monday 26 August 2024.

How can HBF members submit claims after the system upgrade?

Once the upgrade is complete, HBF members will be able to submit claims as they normally would via the HBF App, myHBF Member Portal or by visiting an HBF branch after the system upgrade.

Alternatively, if the member returns to settle their account (within 7 days of the date of service) you can submit their claim via the HICAPS / HealthPoint terminal.

Hospital & Medical

Why hasn’t my manual medical claim been processed?

To help facilitate a smooth transition to our upgraded systems, HBF has put a temporary hold on accepting new manual medical claims. Manual medical claims received after Thursday 25 July 2024 will be processed after the system upgrade is complete from Monday 26 August 2024. Hospital claims are not affected at this time.

You may continue to submit medical and hospital claims via ECLIPSE until 6.00pm AWST, Thursday 22 August 2024.

An HBF member has a planned hospital admission during the system upgrade. What do I need to do?

Please ensure you have conducted an eligibility check prior to the system upgrade. Eligibility checks will not be available during the system upgrade.

An HBF member unexpectedly needs to be admitted to your hospital during the system upgrade period. What do I need to inform them?

Please advise the member that hospitals are unable to conduct eligibility checks during HBF’s system upgrade. Hospitals can contact HBF on 133 423 for support or ask members to provide a copy of their recent hospital quote (if they have one).

An HBF member calls an ambulance and is taken to hospital. What do I tell the member if they are concerned about the cost?

All HBF members who hold any level of Hospital and/or Extras cover are generally covered for urgent ambulance transport by road by an HBF approved ambulance provider. If the situation is not an emergency or the member is not up to date with their payments, the cost of an ambulance may not be covered by HBF. Ambulance coverage differs between Australian states and territories. For more information, visit the Australian Government’s Private Health website.

When will I be able to submit online eligibility checks (OEC) and claims if systems are down during the system upgrade period?

Online eligibility checks and claims can be submitted after the system upgrade is complete.

Is there a dedicated phone number or contact person I can speak with if I need help or advice – before and after the system upgrade?

If you’d like to speak to HBF about the system upgrade, you can contact the team on 1300 810 475 during business hours (WST). Please note, the team will not be taking calls during the system upgrade. Hospital providers should contact their internal contract manager for support.

Will I still be able to submit manual claims up to and during the system upgrade period?

Only hospital claims can be submitted for manual processing during this time. Please note, extended processing delays may occur.

Will claiming via ECLIPSE change?

Slight amendments will be made when submitting claims via ECLIPSE.

Specialists on HBF’s Full Cover or Specialist Anaesthetists agreements, can continue to submit to HBF using fund id ‘HBF’ and claim type ‘AG’. 

Specialists on HBF’s Provider Choice or Access Gap Cover agreements, from Monday 26 August 2024 will need to submit to HBF using fund id ‘HBF’ and claim type ‘SC’. 

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.