Access Medical Gap

From 1 October 2025 Latrobe Health will participates in the Access Gap Cover Scheme maintained by
the Australian Health Services Alliance (AHSA). Access Gap Cover (AGC) is a medical gap cover scheme administered by AHSA on behalf of its participating funds.

It consists of state-based fee schedules.Your provider number (location) determines which fee schedule to use. It can be used for admitted patients or patients receiving Hospital-Substitute Treatment.

You can opt in and out on an episode-by-episode basis.

It is a ‘no gap’ and a ‘known gap’ scheme (no additional registration is required for ‘known gap’). It has defined terms and conditions and a billing guide to which you must adhere if you wish to participate.

AGC benefits and the allowable patient co-payment (where the doctor charges a co-payment) are
maximum fees only under the terms of AGC and are not prescribed or recommended fees.

Find out more at AHSA;

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.

Frequently asked Questions

1. When does AGC commence for Latrobe Health Services?

  • AGC rates and rules will apply for any admitted medical services provided to an eligible Latrobe Health Services patient, from 1 October 2025.
  • For admitted medical services prior to 1 October 2025, the previous Latrobe Health Services benefits and rules will apply.

2. Do I still need to register with Latrobe Health Services via Australian Regional Health Group (ARHG) and/or inform them when there are changes to my account?

  • No, you just need to be registered with AHSA. AHSA will inform Latrobe Health Services about your current AGC registration details.
  • For any future changes to your details such as a change of bank details, a new provider number or changes to contact details, please use the appropriate form which can be obtained here: AHSA Doctors

3. How do I submit medical claims to Latrobe Health Services?

  • ECLIPSE is the preferred mechanism for the submission of simplified billing medical claims.

4. What is the ECLIPSE code for Latrobe Health Services?

  • LHS

5. Is it a requirement to use ECLIPSE under AGC?

  • No but we encourage all providers to use ECLIPSE to submit simplified billing claims.

6. Is there a different benefit payable depending on whether I submit claims via ECLIPSE or manually on paper?

  • No. All claims will be payable according to the applicable AGC schedule, on or after 1 October 2025.

7. Do I need to provide written Informed Financial Consent (IFC) to the Latrobe Health Services patient?

  • Written IFC is only required when there is a gap payable by the patient. · Please refer to the AGC Billing Guide for more information (Page 11).

8. Do all Latrobe Health Services hospital products qualify for AGC?

  • Yes

9. Do I need to do anything else?

  • No, you do not need to do anything, as Latrobe Health Services will be provided with the details of your AGC registrations, including all associated medical provider numbers.
  • You can simply start submitting medical claims with a date of service on or after 1 October 2025 to Latrobe Health Services under the terms of AGC.

10. Who do I contact if I have any questions relating to the private health insurance product, coverage or claims for a Latrobe Health Services member? · Please refer to the updated AHSA Participating Funds Contact List which now lists Latrobe Health Services. This list should be provided to your billing staff.

  • For any general enquiries relating to the transition, please contact Latrobe Health Services by emailing sbenquiry@lhs.com.au or call 1300 362 144.

11. Who do I contact if I have any general questions relating to AGC?

  • Please contact AHSA via email access@ahsa.com.au