Authorised recipient's access to the Medicare Provider Data File
The Department of Human Services records information about health professionals whose services directly or indirectly generate claims for Medicare benefits. It holds information about the identity of the provider, their eligibility under Medicare arrangements and other information necessary for the processing and payment of Medicare claims.
An authorised recipient is a person or an organisation that has applied for and been granted access to the Medicare Provider Data File.
Organisations or agencies that need to verify provider details in order to pay medical benefits to the Australian public can apply to be an authorised recipient. For example, private health funds may need to verify provider details so they can pay their members’ claims for in-hospital services. Pathology companies may need to verify provider details so they can bulk bill pathology services they have provided to the public.
If you are given approval to access the Medicare Provider Data File, you will be subject to provisions in section 130 of the Health Insurance Act 1973 (HIA) which outlines your obligations as the recipient of information contained in the Medicare Provider Data File.
You should not disclose your User ID or certificate details to unauthorised people. You are obliged to protect the privacy of information you have been given access to. You should not disclose information that you access in the Medicare Provider Data File to other people.
You will need a Department of Human Services Public Key Infrastructure (PKI) site certificate before applying for access to the Medicare Provider Data File .
For information about applying for PKI certificates go to Applying for certificates.
For more information about accessing the Medicare Provider Data File for authorised recipients, call the eBusiness Service Centre on 1800 700 199 or email email@example.com
Once you have a PKI site certificate, complete the Provider Directory Data authorised recipient data release application or renewal [PDF, 249Kb] form and send it to:
Information Release Section
PO Box 1001
Tuggeranong DC ACT 2901
Your application will be considered by a delegate of the Minister for Health. If approval is granted, a delegate certificate will be issued and you will be able to access information as specified in the certificate. You will also be given a User ID which you need to access the authorised recipient link on the department’s health professionals page.
An application to become an authorised recipient must be approved by a delegate of the Minister for Health, who authorises access to the Medicare Provider Data File in accordance with legislative requirements contained in section 130 of the Health Insurance Act 1973 (HIA). The access/logon process for authorised recipients ensures only an authorised recipient can access information in the Medicare Provider Data File.
If any problems are experienced accessing the Medicare Provider Data File for authorised recipients using your certificate, the nominated officer can contact the eBusiness Service Centre on 1800 700 199 and select option 2 or email firstname.lastname@example.org.
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Last updated: 21 November, 2013