Claim requirements

Latrobe Health Services provides “Known Gap” cover under an Medical Practitioner Provider Agreement (MPPA). It is a legislative requirement for all Simplified Billing Claims to include evidence of Informed Financial Consent (IFC), even if you are not charging ‘gap’ to our member. If your claims come to us without this information, or without a declaration, we may return the claim to you for further clarification and/or completion.

All practitioners submitting claims via Simplified Billing must be registered with Latrobe Health Services. (See registration process below)

Please refer to the below forms:

• Batch Header Form
• Simplified Billing Claim Form

Eclipse - Medical online claiming

Latrobe participates in the Eclipse online medical claiming system. We accept Agreement (AG) and Scheme (SC) claim types via this system. Please note that Simplified Billing Eclipse claims cannot be accepted without registration. Please ensure you have registered with our Known Gap Scheme prior to submitting your first Simplified Billing claim to ensure correct benefits are paid, and to avoid claims being rejected (refer to Simplified Billing Provider Registration).

Simplified Billing Provider Registration for Latrobe

Latrobe Health Services has become a member of the Australian Health Services Alliance (AHSA) effective 01/05/2023.

Latrobe will not be taking up the AHSA Medical Gap Scheme at this time. Any changes to Latrobe’s current gap arrangements will be communicated in the future.

Australian Regional Health Group (ARHG) will continue to process all provider applications on behalf of Latrobe Health Services (excluding pathology and radiology).

Latrobe does not accept provider registrations directly from medical providers. Simply log onto ARHG's form and complete registration online.

If you have a question regarding Latrobe Health Services current Known Gap Scheme, please contact our Simplified Billing team by emailing sbenquiry@lhs.com.au or call 1300362144.

If you have any enquries in relation to the change to provider registrations, please contact ARHG by emailing medicalproviders@arhg.com.au or visit www.arhg.com.au

Pathology and Radiology Medical Provider Purchasing Agreement (MPPA)

Effective 1 August 2024, Latrobe Health will be participating in the AHSA no-gap radiology and pathology medical agreements. All pathology and radiology provider registrations are managed through the AHSA agreement process. Any queries please direct to AHSA doctors.ahsa.com.au.

Payment of claims

All payments will be made by direct credit to your nominated account, as per your registration. Non-Eclipse remittance advices will be forwarded to the email address also nominated on your Simplified Billing Provider Registration Form. If you require a change in banking details please complete a new online registration via the Simplified Billing Provider Registration. *Note: Please direct all Pathology and Radiology MPPA changes to AHSA.

Please allow 24 hours to enable the changes to take effect.

For further information or assistance, please contact us.

Amount of benefit you will receive

When the claims are submitted directly to Latrobe Health through Simplified Billing our payments are a percentage in addition to the Medicare Scheduled Fee. This is based on the specialty of the practitioner.

• Specialist - 25%
• General Practitioner - 16%

Because we provide a percentage-based benefit we do not produce our own schedule of fees. To calculate the amount you will receive from Latrobe Health Services, simply use the current Medicare Benefits Schedule and add the applicable percentage to the Scheduled Fee. 

Privacy

At Latrobe Health Services, our commitment is to handle personal information in a way that is consistent with our Privacy Statement and our obligations under the Australian Privacy Principles. If you would like more information concerning our information handling practices, please contact our Privacy Officer.