Medical providers
St Lukes Medical Gap
IMPORTANT INFORMATION
From January 1, 2022, St Lukes introduced a maximum out-of-pocket cost per provider per episode of $500.
The latest Schedule of Fees (SL Fee Schedule 1 November 2024) is available for medical providers to assist in providing informed financial consent (using current MBS) to patients.
The latest Terms and Conditions (here) provide more information on the maximum allowable out-of-pocket cost.
Information for medical providers
St Lukes Medical Gap is designed to provide medical practitioners with the option to eliminate or reduce the medical gap for eligible St Lukes members requiring hospital inpatient services. This is done through the payment of an additional benefit over and above the Medicare Benefits Schedule (MBS) fee for those members who receive in-hospital treatment from a participating practitioner.
Eclipse Information
St Lukes uses ECLIPSE billing as the primary process for submission of medical gap claims. Using this form of billing has some significant benefits, particularly ensuring claims are processed in a timely manner, clear provision of information and once a claim is paid, electronic statement issuing. Most practice billing software has the ability to submit accounts via ECLIPSE. Further information on ECLIPSE billing can be found here.
Fund ID: SLM Location ID: HSL00799
Provider Registration
From Thursday 01 August 2019, the Australian Regional Health Group (ARHG) handle all provider applications on behalf of St Lukes. This means that from this date, ARHG member funds will not accept provider registrations directly from medical providers.
If you have any questions regarding the St Lukes Medical Gap Scheme please contact our Customer Care Centre by emailing general@stlukes.com.au or call 1300 651 988.
If you have any enquiries in relation to the change to provider registrations, please contact ARHG on medicalproviders@arhg.com.au or visit www.arhg.com.au
Online Provider Registration
To update provider information, please complete the provider registration form above.
Other registration and claiming forms
Find a Provider Listing
As a condition of provider registration for St Lukes Medical Gap, providers are requested to participate in the Fund’s Find a Provider listing.
It is important to understand that this information assists our members in identifying participants of St Lukes Medical Gap, which provides more transparency to our members around out-of-pocket costs. The information collected and used includes provider name, practice address, contact details, specialities and other information (including) program participation and is managed by a third party to publish this in a manner that empowers our members.
If a provider does not wish to participate in our provider listing, a separate opt out form is available above. If a provider registers and then opts out later, changes may take up to 90 days to action.
Benefit schedules and supplements
IMPORTANT - Prior to downloading new schedule, please read Important Information at the top of this page.