NIB Medigap versus GapSure

NIB Medigap versus GapSure

NIB has MediGap and GapSure billing arrangements, for more information see https://www.nib.com.au/providers/medical

MediGap

If you’re a medical specialist, you can register to become a MediGap provider, which means you agree not to charge NIB members any out of pocket costs for their inpatient service. Provided there's no gap amount you can submit these claims through ECLIPSE and get paid electronically into your nominated account.

If you charge an out of pocket amount, the rebate is reduced to 100% of MBS and the claim can only be sent as a Patient Claim, with rebates going to/via the patient. For this reason we recommend to only use this for fully paid NIB patient accounts

See https://www.nib.com.au/providers/medigap for more information

GapSure Anaesthetics schedule


NIB GapSure Anaesthetics billing is an opt-in arrangement for a higher value per unit on all MBS Item numbers ($41/unit until 31/7/2023, $43/unit from 1/8/2023). 
A discretionary $500 known gap is permitted on GapSure claims but only where the base procedure is 5 or more RVG units.
The NIB GapSure Anaesthetics schedule is not discretionary. Once registered, it's applicable to all your NIB billing until you opt out.

You'll need to indicate which NIB schedule to use in your Provider Settings > Online page (CESOFT Version 8 and above).

See https://www.honeysucklehealth.com.au/for-providers/anaesthetics-network/ for more information


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