ECLIPSE Order Form

Electronic Claim Lodgment and Information Processing Service Environment (ECLIPSE) is an extension of Medicare Online claiming. ECLIPSE can be used for both paid and unpaid Inpatient Medical Claims which can be lodged directly through Medtech Evolution software. ECLIPSE can also be used to lodge In Hospital Claims from public and private hospitals and day facilities in relation to the patient's hospital stay.

Eclipse enables faster completion and remittance of claims improving cash flow for the practice.

Annual Pricing

How many licenses do you currently have?

	Evolution 1-10
	Evolution 11-20
	Evolution 21-30
	Evolution 31-40
	Evolution 41-50
	Evolution 50 Plus

Implementation & Training

Once you have submitted the completed form, a Medtech representative will contact you to organize the next steps. You will need to get a new license key from Medtech to enable Eclipse functionality on the software

Is training required? (Recommended):*

	Yes
	No

Preferred training date:

Sign Up

I have read and agree to the terms and conditions for the use of the Medtech Eclipse service and would like to request Eclipse for use with our Medtech system.

Practice Name (Required)*

Name of Authorized Person:*

Email*

Position: *

Exact number of users: *

Please provide any additional information which may be of value.

Privacy Policy*

I have read and accept the Privacy Policy and I am authorised to make this commitment on behalf of my organisation.

See Privacy Policy