An online eligibility check lets you check the eligibility of a patient with the Department of Human Services or private health insurers, and to estimate out of pocket expenses for in-hospital care. The patient can then provide informed financial consent.
Before carrying out a patient eligibility check, you must obtain consent from the patient or their legally authorised representative. The way the patient consent is obtained will depend on legislative requirements and your software product.
There are 3 types of online eligibility checks available in ECLIPSE:
- Hospital only checks(ECF) determines whether the patient is eligible for a selected presenting illness or condition on the admission date. It provides the out of pocket expenses for excess, exclusions and co-payments associated with the patient’s hospital product. This check is used by hospitals and day surgeries
- Medicare only checks (ECM) determines whether the patient is covered by Medicare, and what benefits are payable for in-patient medical services. This check is used by hospitals, day surgeries and health professionals
- Hospital and medical checks at both Medicare and the private health insurers(OEC) determines whether the patient is eligible for a presenting illness or condition on the admission date. It provides the out of pocket expenses for excess, exclusions and co-payments associated with the patient’s hospital product, and the Medicare and the private health insurer benefits payable for the medical services. This check is used by hospitals, day surgeries and health professionals
Source: Medicare Australia