Medical providers: Access Gap Cover and claiming
Latrobe Health Services participates in Access Gap Cover (AGC), the medical gap scheme administered by the Australian Health Services Alliance (AHSA). Access Gap Cover rates and rules apply to admitted medical services for eligible Latrobe Health Services patients with a date of service on or after 1 October 2025. Register once with AHSA and you’re registered with us (there’s no separate Latrobe Health form). ECLIPSE is our preferred channel for simplified billing claims, and our ECLIPSE fund code is LHS.
| Detail | Latrobe Health Services |
|---|---|
| Medical gap scheme | Access Gap Cover, administered by AHSA |
| Access Gap Cover rates apply from | 1 October 2025 |
| Registration | AHSA Provider registrations here |
| Preferred claiming channel | ECLIPSE |
| ECLIPSE fund code | LHS |
| Claims, cover and product questions | sbenquiry@lhs.com.au or 1300 362 144 |
| Access Gap Cover scheme questions | access@ahsa.com.au |
What is Access Gap Cover?
Access Gap Cover is a medical gap scheme administered by the Australian Health Services Alliance on behalf of its participating funds, including Latrobe Health Services. It is both a no-gap and a known-gap scheme, and it runs on state-based fee schedules.
Here’s how it works in practice:
- you use the state fee schedule that matches your provider number (location)
- you can bill for admitted patients and for patients receiving hospital-substitute treatment
- you can opt in and out on an episode-by-episode basis
- you don’t need a separate registration to use known gap.
Access Gap Cover has defined terms and conditions and its own billing guide. Access Gap Cover billing guide
How do I register for Access Gap Cover with Latrobe Health Services?
You register directly with AHSA. AHSA passes Latrobe Health Services your current Access Gap Cover registration details, including every associated medical provider number, so there’s nothing to lodge with us separately.
Once AHSA has you registered, start submitting medical claims to Latrobe Health Services for dates of service on or after 1 October 2025 under the terms of Access Gap Cover.
Need to change your bank details, add a new provider number or updating your contact details? Use the AHSA online form for registrations and changes.
How do I submit medical claims to Latrobe Health Services?
ECLIPSE is the preferred way to send simplified billing medical claims to Latrobe Health Services. Our ECLIPSE fund code is LHS.
ECLIPSE isn’t compulsory under Access Gap Cover. We encourage every provider to use it, because electronic claims move faster than paper at both ends.
Manual claims can be submitted in PDF format via email to sbenquiry@lhs.com.au
The benefit is the same either way. Latrobe Health Services pays all claims with a date of service on or after 1 October 2025 according to the applicable Access Gap Cover schedule, whether you submit through ECLIPSE or on paper.
Do all Latrobe Health Services hospital products qualify for Access Gap Cover?
Yes. Every Latrobe Health Services hospital product qualifies for Access Gap Cover.
When do I need written informed financial consent?
Written informed financial consent (IFC) is only required when the Latrobe Health Services patient has a gap to pay. Where there’s no gap payable, written IFC isn’t required.
The full rules sit with AHSA. See the Access Gap Cover billing guide and related material in the Access Gap Cover billing guide.
How do pathology and radiology agreements work?
Latrobe Health Services participates in the AHSA no-gap radiology and pathology medical agreements. These are known as Medical Provider Purchasing Agreements (MPPA).
AHSA manages every pathology and radiology provider registration through its own agreement process. Send questions about those agreements to AHSA resources for doctors, not to Latrobe Health Services.
Who do I contact about a Latrobe Health Services patient?
Contact Latrobe Health Services about a member’s cover, product or claim. If your query is about the Access Gap Cover scheme, contact AHSA.
| Your question is about | Who to contact |
|---|---|
| Cover, product or claims for a Latrobe Health Services member | Latrobe Health Services: sbenquiry@lhs.com.au or 1300 362 144 (Monday to Friday 9:30am-3pm) |
| Access Gap Cover rules, schedules and registration | AHSA: access@ahsa.com.au |
Latrobe Health Services is listed on the AHSA Participating Funds Contact List. Give that list to your billing staff so they reach the right fund first time (it saves a phone call later).
Need to chat to a real person? We’re just a call away on 1300 362 144 (Monday to Friday 9:30 am to 3:00pm).
Can I check a patient’s Latrobe Health Services cover before treatment?
Yes. Latrobe Health Services offers eligibility checking for healthcare providers.
Check eligibility online through eCheck, via email on sbenquiry@lhs.com.au or by calling 1300 362 144 (Monday to Friday 9:30 am to 3:00pm).
Where can I find AHSA’s Access Gap Cover resources?
- About Access Gap Cover, for how the scheme works and what it covers
- AHSA resources for doctors, for fee schedules, the billing guide and the participating funds contact list
- AHSA online form for registrations and changes, for new registrations and updates to your details.
Working with Latrobe Health Services in another capacity? See our information for hospital providers and for extras providers.
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