Simplified Billing or ECLIPSE adjustment claim form (HW023)

Use this form to adjust a previously processed claim which needs to be amended with new or altered information.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

Download and complete the Simplified Billing or ECLIPSE adjustment claim form.

This form should be used by medical practices, providers, private health insurers and billing agents.

ECLIPSE is the Electronic Claim Lodgement and Information Processing Service Environment.

Page last updated: 17 November 2022.
QC 20596