Medical
Find out more about how to claim, and Access Gap Cover.
GMHBA/Frank Health Insurance contributes to the cost of in-patient medical services for eligible members.
Eligibility for benefits is dependent on the product the member holds with the fund, waiting periods, and the financial status of the policy.
Access Gap Cover
GMHBA Health Insurance/Frank Health Insurance participates in the Access Gap Cover Scheme maintained by the Australian Health Services Alliance (AHSA)
Please contact the AHSA directly to update any contact or payment information, to enrol or learn more about the scheme.
Fund Own Agreements
GMHBA Health Insurance/Frank Health Insurance has ‘no gap’ agreements in place with Clinical Labs, Melbourne Pathology, and Epworth Pathology.
If you wish to speak with the fund directly regarding a Fund Own Medical Agreement, please contact registration@gmhba.com.au
Clinical Labs, Melbourne Pathology and Epworth Pathology Providers
Please contact registration@gmhba.com.au to update any payment details, agreement providers, or contact information.
Frequently Asked Questions
No. GMHBA/Frank Health Insurance receive updated provider files from the Department of Health via our software vendor every week.
GMHBA/Frank Health Insurance accepts in-patient medical claims via ECLIPSE.
Electronic Claim Lodgment and Information Processing Service Environment (ECLIPSE) is an electronic platform maintained by Services Australia. ECLIPSE allows practitioners, Medicare, and health funds to securely transmit claims data.
Please speak with your software vendor about your practice becoming ECLIPSE enabled.
PO Box 761
Geelong VIC 3220
GMHBA/Frank Health Insurance issue Electronic Remittance Advice (ERA) for all ECLIPSE claims on the date the payment is released.
All manual claims will be issued with a remittance advice via post. These are printed on the day the payment is released. Please allow up to 14 business days for delivery.
Any medical claims submitted via Eclipse are released within 3 business days.
GMHBA/Frank Health Insurance are not able to release any medical benefits for in-patient medical services submitted more than 2 months after the service date if we have not yet received the hospital account. Before you resubmit your account we recommend confirming with the hospital that the accommodation invoice has been sent to GMHBA/Frank Health Insurance.
Simplified billing claims that are older than 2 years not received by the fund must be approved by Medicare before any fund benefits can be paid. Please contact Services Australia for more information.
GMHBA/Frank Health Insurance submit all inpatient-medical claims to Medicare for assessment. The fund portion of the inpatient medical service is dependent on the schedule fee determined by Medicare.
We recommend you refer to the ERA or remittance advice for the patient and review any applicable Medicare messages.
If you believe you are entitled to additional benefits from the fund because you have an active fund own agreement or you adhered to the access gap cover scheme for the services provided please send an email to providers@gmhba.com.au
Contact AHSA directly for more information on Access Gap Cover
Please respond to the email notification from our Payment Integrity Team, or email audit@gmhba.com.au
Provider line: 1300 301 437
Membership Checks: 1300 301 437
Fax: 03 5221 4582