PHI 41/12

This circular issued by the Private Health Insurance Branch contains information about Hospital Casemix Protocol

Page last updated: 08 May 2013

Printable version of 41/12 (PDF 102 KB)

18 June 2012

Hospital Casemix Protocol (Hcp) Updates And Submissions

Under the Private Health Insurance Act 2007 (the Act), Hospital Casemix Protocol (HCP) data is required to be submitted to the Department of Health and Ageing (the Department) in respect of all privately insured hospital episodes. The specifications for HCP data have generally been updated annually on 1 July. In response to requests from industry the Department will be expanding the options for submitting HCP data to include automated collection using the “ECLIPSE” system, which has required a change to the effective date of HCP changes on this occasion to 1 November 2012. This circular provides a brief update on the ECLIPSE (Electronic Claim Lodgment and Information Processing Service Environment) project that is being undertaken by the Department of Health and Ageing (DoHA) in consultation with stakeholders.

ECLIPSE is part of the Department of Human Services (DHS) Medicare Program’s online claiming services which provides a fast, secure connection for information transfer between participating general practices, public hospitals, private hospitals, billing agents, DHS, Department of Veterans’ Affairs and private health insurers.

The HCP Health Fund Working Group has for some time recommended using ECLIPSE for the transmission of HCP data by private hospitals to private health insurers, and this was further reinforced by a recommendation in the Private Hospitals Data Collection Review. Consequently, it has been decided to update ECLIPSE to enable capture and transmission of HCP data to health insurers.

A project team consisting of representatives from health insurers, hospital groups, software vendors, Private Healthcare Australia, DHS and the Department have worked collaboratively on this initiative. The 1 November 2012 ECLIPSE release will incorporate this capability reflecting the new HCP specification which will be effective from that date also.

A DHS Business Requirements Statement (BRS) to enable the programming work to occur can be used to commence planning and scoping for the 1 November 2012 ECLIPSE release. DHS will be providing user and technical specs from 1 August 2012 via CD ROM in a BETA release version.

All private health insurers must implement the new version prior to hospitals taking up the new version to avoid error messages being received. The target date for private health insurers to implement the ECLIPSE update is 1 November 2012. Due to time and testing constraints some private health insurers may not be able to incorporate the change in this time frame. Whilst the transition to using ECLIPSE for the submission of HCP data is strongly encouraged, manual transmissions will still be accepted.

Action required

It would be appreciated if private health insurers that are not be able to incorporate the change by 1 November 2012, provide advice on when they will be able to do so.

Please contact the Department on (02) 6289 8058 or email the hcp inbox if you have any questions regarding this project.

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2012 Private Health Insurance (PHI) Circulars.

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