Fund Notes
Doctors' Health Fund
Doctors' Health Fund cover is usually paid at AHSA rates, with top cover paid at up to ASA/AMA rates. The patient's level of cover can be determined with the Check Eligibility button on the invoice screen. Top Cover Gold pays ASA/AMA rates. Prime ...
HCF No Gap Clinical Program
Participating anaesthetists and orthopaedic surgeons can charge a loading for hip and knee joint replacements without the patient incurring an out of pocket expense. The anaesthetic loading applies when the items are: Primary Knee - 21402 Bilateral ...
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 ...
Registering/Updating details with AHSA
Due to recent security breaches of provider banking details at AHSA they have changed their procedures for registering and updating your details. AHSA requires a copy of the Provider Details in a screenshot from your PRODA account: 1. Login to your ...
Refunding DVA claims
It is possible to refund DVA claims which have been sent in error or for other reasons. Go to: Services Australia Forms https://www.servicesaustralia.gov.au/mo057 Complete Form: Voluntary Acknowledgement of incorrect payments. Complete a separate ...
Notes about AMA Fees List
The AMA Fees List is the intellectual property of the AMA and provided free to AMA members. Non-members need to obtain a licence from AMA to access the Fees List. Your use of the AMA Fees List is subject to their Terms and Conditions. In particular, ...
New MBS Anaesthetic Items from 1 March 2024
There are several new items available to Anaesthetists from 1st March 2024 22052 Transfusion of blood by an anaesthetist, for intra-operative normovolaemic haemodilution, 6 Units (anaesthetic equivalent of 13703) 22053 Insertion of lumbar ...
iCare Workers Compensation Claims
ICare have advised that they no longer accept claims via email. The claim needs to be sent to the relevant insurance authority handling that case - hence the warning that you will have seen in CESoft. iCare is an umbrella organisation that allocates ...
BUPA schedules
BUPA has three schedule types which affect the rebate: BUPA Known Gap, which allows a gap of up to $500 BUPA No Gap, which pays a higher rebate but doesn't allow any gap MBS only, used for facilities where gap scheme rebates do not apply. Providers ...
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 ...
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 ...
RT Health joins HCF
From 1 November 2021 RT health became a wholly owned subsidiary of HCF. Unlike HCF, RT Health has only two scales 100% of MBS Medicover which is the HCF Known Gap rate. See this PDF from RT Health and the HCF website Although HCF has a No Gap ...
Health Fund Contact Details
Please see the attached link for a list of contact details for a large number of health funds. https://privatehealthcareaustralia.org.au/resources/provider-resources/contacts-for-providers/
March 2020 MBS Update
From 1 March 2020 the Medicare Benefits Schedule (MBS) will be updated with the following changes: 2019-20 Budget measure to amend intensive care and emergency medicine MBS items Six new items for extracorporeal life support have been introduced and ...
Cessnock District Health Fund
Cessnock District Health Fund has had a name change and is now known as Hunter District Health. See the link below regarding the fees and how they are calculated. https://www.hunterhi.com.au/providers/
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 ...
What are the 1 November 2019 changes to MBS items
From 1 November 2019 the Medical Benefits Schedule will revise many of the items for anaesthesia. Both Cutting Edge and Access Anaesthesia have been updated to apply these changes on invoices with a date of service from 1 Nov. There are 28 amended ...
Which funds are in AHSA?
AHSA maintains a list of member funds on their website that is updated whenever the situation changes. Cutting Edge will automatically update the list and schedules in the software, you don't need to do this yourself. ...
Additional fund updates
Here are some funds that we're often asked about. AHM - uses the Medibank Private fee schedule. AIA - See MYO APIA - is an NIB fund Budget Direct - a GMHBA fund, pays 120% of Medicare for its gapcover product. (GMHBA is otherwise and AHSA fund.) CUA ...
HBF Schedules
HBF has several different schedules. For all states except WA On 13 February 2017, HBF joined the AHSA Gap Cover system for all states except WA. Cutting Edge will load the appropriate state AHSA schedule. Copayments rules are in the the AHSA ...
ADF claims through the BUPA Defence Contract
From July 2019, BUPA has assumed management of healthcare services for Australian Defence Force personnel. Previously this was managed by Medibank Health Solutions as Garrison Health. In Cutting Edge select the ADF fee schedules. The fund and ...
Finding the correct Health Fund code
From time to time you may need to search for a fund code. From the Databases > Funds page, click on search and enter the name or code you're looking for. This will give you a list of possible matches. Some funds have updated their names or codes. AHB ...