On this page
- Application for prescriber number for a registered medical practitioner
- Bulk Bill claim forms
- Pay Group Link
- Medicare Allied Health and Dental Care Initiative
- Pathology Laboratory Application
- Approved Pathology Practitioner Application
- Remote Area Exemption
- EFT Payments for Claims
- Certification of Cleft Condition form
- Positron Emission Tomography (PET) Statutory Declaration
- Electronic referral requests
- Voluntary Acknowledgement of Incorrect Payments form
- Review of Decision form
- Exceptional Circumstances
The application forms in this category cover some aspects of provider, patient and equipment eligibility. Lodgment details are listed on each form.
For enquiries about provider eligibility please call 132 150 (local call rates).
For enquiries about patient eligibility please call 132 011 (local call rates).
For general PBS and stationery enquiries please call 132 290 (local call rates).
- Application for approval to prescribe medications under the Pharmaceutical Benefits Scheme (1525) [PDF, 106Kb]
On 1 September 2012, the Department of Human Services ceased printing and distribution of carbon bulk bill forms and implemented web based bulk bill forms available on the Department’s website.
Since the implementation of this project, we have consulted with peak medical bodies and received feedback from providers.
As a result of this consultation and feedback, we have made the following changes to assist providers transitioning to the new arrangements:
- Carbon bulk bill forms will continue to be printed for those providers who do not have computer or internet access or providers who undertake consultations outside of consulting rooms (for example, nursing home visits, after hours consultations). A Business Development Officer may follow up with you after an order is placed to discuss other claiming options. To order stock, please complete the stationery order form (DB6Ba) [PDF, 209Kb]
- Providers are no longer required to keep a copy of the bulk bill forms but should retain the practitioner copy until the account has been reconciled. If the Department requires a provider to demonstrate that a service was provided to a patient, it can be demonstrated through records such as notes in practice software, appointment records or the practitioner copy of the bulk bill form. Where a provider is unable to demonstrate, through any other record, that a service was provided to a patient, the practitioner copy should be retained for 2 years
- If providers have existing stock of the carbon bulk bill forms, the Department will continue to accept these forms for processing until providers have exhausted their existing stock
- Work is also underway to assess capacity to improve the mobile claiming channel – Easyclaim
- DBM(i) – Manual Bulk Bill Forms Instruction Sheet [PDF, 131Kb]
- DB1H(i) - Instruction Sheet [PDF, 106Kb]
- DB1H – In Hopsital Service Header
- DB1N(i) – Instruction Sheet [PDF, 106Kb]
- DB1N – Out of Hospital Services Header
- DB2-GP(i) - Instruction Sheet [PDF, 106Kb]
- DB2-GP – General Practitioner Voucher
- DB2-OP(i) - Instruction Sheet [PDF, 104Kb]
- DB2-OP Optometrist (assignment of benefit) Voucher
- DB2-OT(i) - Instruction Sheet [PDF, 106Kb]
- DB2-OT – Other Practioner Voucher
- DB1N-AH(i) - Instruction Sheet [PDF, 105Kb]
- DB1N-AH – Allied Health Header
- DB2-AH(i) - Instruction Sheet [PDF, 106Kb]
- DB2-AH – Allied Health Professional Voucher
- DB3(i) – Instruction Sheet [PDF, 106Kb]
- DB3 – Pathologist (assignment of benefit) Voucher
- DB4(i) – Instruction Sheet [PDF, 138Kb]
- DB4 - General Specialist and Diagnostic (assignment of benefit) Voucher
- DB4E(i) – Instruction Sheet [PDF, 104Kb]
- DB4E – Electronically Transmitted claims (assignment of benefit) Voucher
Dental forms and instructions can be found on our website under Medicare forms for dentists.
Alternatively, to discuss electronic claiming options that would suit your practice or to organise a visit from a Business Development Officer, you can contact the eBusiness Service Line on 1800 700 199 (calls from mobile phones may be charged at a higher rate). The eBusiness Service Line is available Monday to Friday, between 8:30am and 5:00pm, Australian Eastern Standard Time.
A pay group link enables a practitioner to have Medicare benefit cheques, which would have been issued payable to that practitioner at his/her practice address, made payable to another payee associated with the practice and/or another address.
Where the payee is a third party, the payee (or person properly authorised in the case of a body corporate or other entity) must agree to the arrangement by counter-signing the application form.
The new Medicare allied health and dental care initiative allows chronically ill people who are being managed by their GP under a Chronic Disease Management (CDM) plan access to Medicare rebates for allied health services.
Referral forms are available on the Department of Health website or by faxing a request to 02 6289 7120.
- Application to become an approved pathology practitioner or to renew approved pathology practitioner status form [PDF, 76Kb]
- Application for Remote Area Exemption for 'R Type' Diagnostic Imaging Services for a Medical Practitioner (1515) [PDF, 172Kb]
If you would like to transmit, scan and/or store Referrals or Requests electronically, please refer to the following Medicare IT standards.
- Notice of Information Technology Standards under the Electronic Transactions Act 1999 for Electronic and Paper [PDF, 39Kb]
Should you become aware of any incorrect payments you may have received under the Medicare program, you can now voluntarily tell the Department of Human Services. To do this you must fill out the approved Voluntary acknowledgement of incorrect payments form (4703) [PDF, 126Kb]. This form can be used at any stage you become aware of receiving an incorrect payment.
Note: when you are voluntarily acknowledging incorrect payments, clinical notes or money should not be sent with the form. We will contact you to confirm the amount owing.
Where you become aware of incorrect payments you may have received under other programs, private health insurers or concerning payment for a patient who received cover or medical treatment under a compensation scheme after the consultation occurred, refer to the information below:
- Department of Veterans' Affairs claims contact the Department of Human Services Veterans' Affairs Processing enquiry line on 1300 550 017 and select Option 1
- the private health insurer directly
- if the incorrect payment relates to a patient who received cover or medical treatment under a compensation scheme after the consultation occurred, contact the Medicare Provider enquiry line 132 150 and select Option
Under the amended Health Insurance Act 1973, health professionals have the opportunity to seek a review of decision relating to a Medicare compliance audit outcome if there is an amount recoverable. The request for a review of decision must be received within 28 days of receipt of a notice of decision.
To request a review of decision, the approved Application to Review Compliance Audit Decision (HW051) [PDF, 178Kb] form must be completed.
If a health professional is eligible for a review of decision they will be notified of the outcome, generally, within 28 days of the Department of Human Services receiving the application.
If you have feedback in relation to a Medicare compliance audit finding then please email:
Alternatively you can mail your feedback to:Mail
Department of Human Services
PO Box 1001
Tuggeranong ACT 2901
The Compliance Audit – Exceptional Circumstances Statutory Declaration form (MO020) [PDF, 139Kb] allows health professionals an opportunity to tell the department and provide information about circumstances beyond their control that affect their ability to participate in a Medicare compliance audit.
Should you be facing circumstances beyond your control, it is recommended that you tell the department as soon as you can.
Some documents on this page may require the free Adobe PDF reader.
Last updated: 29 July, 2014