NIB Medigap and GapSure (Anaesthetists Only) Claims
NIB has MediGap for Medical Specialists and GapSure for Anaesthetists billing arrangements, for more information see https://www.nib.com.au/providers/medical
MediGap - for Medical Specialists
MediGap can be used as a No Gap or Known Gap scheme. Once registered for MediGap you do not need to register individually as either a No Gap or a Known Gap Provider. You may charge at the MediGap schedule (No Gap) or with a gap of up to $500 per episode, on a case by case basis. The rebate to the patient will be the same in either case. You must show the gap on the claim.
Should you exceed a gap of $500 the rebate is reduced to 100% of MBS.
NIB MediGap network Terms and Conditions also apply to members of these partner brands:
- AAMI Health Insurance
- Apia Health Insurance
- Suncorp Health Insurance
- Qantas Health Insurance
- ING Health Insurance
- Priceline Health Insurance
- Real Health Insurance
- Seniors Health Insurance
- United Healthcare Global for Medicare eligible residents in Australia.
Note for Assistant Surgeons
Where the surgeon submits a single Claim to the Fund including both the assistant surgeon’s fees together with the surgeon’s fees the maximum total Known Gap for that Claim cannot exceed $500. For this reason we advise that Assistant Surgeons submit their own claim separately.
See these links for further information
GapSure - Anaesthetist opt-in
NIB GapSure Anaesthetics billing is an opt-in arrangement for a higher value per unit on all MBS Item numbers ($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 > Default Fee Basis
See https://www.honeysucklehealth.com.au/for-providers/anaesthetics-network/ for more information
See https://www.honeysucklehealth.com.au/for-providers/anaesthetics-network/ for more information
Related Articles
NIB Claims - Overseas & Manual Claims
As of June 2023 - NIB will no longer accept manual claims. All claims need to be submited via Eclipse. If you have any issue with a verification - contact NIB 1300 853 530 For deceased patients, Cutting Edge will do a verification based on the date ...NIB Clinical Partner Agreements
Administered by Honeysuckle Health, the NIB Clinical Partners program allows participating orthopaedic surgeons and anaesthetists to charge a loading for hip and knee joint replacements without the patient incurring an out of pocket expense. The ...Manual Claims - Health Fund Notes
AHM Manual claims can be emailed to AHM (deceased patients etc.) email is info@ahm.com.au - enter GAP COVER CLAIM in subject of email and include a batch header. https://static.ahm.com.au/files/forms/gapcover-batch-header.pdf NIB Manual claims can ...DVA Claims
In Cutting Edge you can submit DVA claims electronically, much like any other claim. Simply create a new invoice, enter the patient name and DOB then select DVA as the fund. In most cases CE will look up the Veteran's File Number for you, but if not ...Types of Online Claims
The Health Fund you've selected on an invoice will dictate which claim type (Medicare, DVA or Private Health) is used. This also sets the Fee Calculation to the correct value. Bulk Bill Claims Electronic Bulk Bill claims allow you to claim the MBS ...