CBHS eClaim (Fast tracked and Standard) Terms and Conditions

In addition to the Terms of Use and Additional Conditions of Use of CBHS Member Centre and CBHS Mobile App, the following conditions apply to the use of the CBHS eClaim facility.

Please read the CBHS eClaim (Fast Tracked and Standard) Terms and Conditions carefully. Your use of the CBHS eClaim facility signifies your acceptance of the CBHS eClaim (Fast Tracked and Standard) Terms and Conditions

About eClaim

• Using eClaim, you can submit a claim online for all Extras services claimable from CBHS. For Ambulance claims, please complete a claim form and email it to claims@cbhs.com.au along with your invoice.
• eClaims are subject to the per service and overall category limits as outlined in the CBHS Health Benefit Fund Rules.
• eClaims can be submitted provided they are not subject to a Workers Compensation, third party insurance or damages claim.
• CBHS will only pay a benefit for services that have been paid in full. If you submit an eClaim for an unpaid service, CBHS reserves the right to deduct any benefit paid immediately.
• An eClaim may only be submitted for services received within the last 24 months.
• CBHS may contact your service provider to validate the service and obtain all information required to assess and process the eClaim which includes, but is not limited to, patient records and clinical notes.
• eClaims can only be paid by direct credit into your nominated CBHS direct credit account.
• eClaims must include a valid receipt which includes the service provider details, item numbers and/or description of the service, date and cost of each service, amount paid, payment method, full name of patient, written in English and on the service provider’s official stationery or have the service provider’s official stamp.

Fast Tracked eClaim

• A Fast Tracked eClaim service is a service item number that is flagged as a web claimable item.
• For paid services, where the sum of all items flagged as a web claimable item totals less than $500, you should typically expect to receive the benefit within 1-2 business days.
• You must attach a valid receipt in order to submit a Fast Tracked eClaim.

Standard eClaim

• A Standard eClaim service is a service item number that is not flagged as a web claimable item.
• For paid services, with receipts attached and irrespective of the amount, you should typically expect to receive the benefit within 3-5 business days.
• You must attach a valid receipt in order to submit a Standard eClaim.
• Alternatively, you can post, email or fax copies of the receipts. CBHS recommends retaining a copy of receipts in the event of loss during the postal process.

Authorisation

By using eClaim:

• you declare and acknowledge the information supplied in connection with the eClaim is true and correct and you are authorised to lodge an eClaim on behalf of all dependants on the membership.
• you authorise CBHS to contact the provider of any service claimed and to obtain all information required to assess and process the eClaim, which may include, but is not limited to, patient records and clinical notes.
• you consent and are authorised to consent to the collection, use and disclosure of all personal and health information in accordance with the CBHS Privacy Policy which can be accessed on the CBHS website at www.cbhs.com.au/policies/privacy-policy or by calling 1300 654 123.

Last updated: 17/08/2022