What's new?

July 2014

Improvements will be made to the way some PBS medicines are processed under the Highly Specialised Drugs Programme from 1 July 2015.

Medicare forms

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 prescriber number for a registered medical practitioner

Bulk Bill claim forms

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:

For further information about the new forms read about the changes, or email bulk.bill.forms.feedback@humanservices.gov.auEmail

If you are experiencing any issues please try these steps [PDF, 39Kb]PDF reader required

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.

Application for bulk bill claim adjustment

Pay Group Link

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.

Medicare Allied Health and Dental Care Initiative

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

Referral forms are available on the Department of HealthExternal link website or by faxing a request to 02 6289 7120.

Eligibility

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

If you would like to transmit, scan and/or store Referrals or Requests electronically, please refer to the following Medicare IT standards.

Voluntary Acknowledgement of Incorrect Payments form

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]PDF reader required. 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

Review of Decision form

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]PDF reader required 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:
compliance.review@humanservices.gov.auEmail

Alternatively you can mail your feedback to:

Mail
Compliance Review
Department of Human Services
PO Box 1001
Tuggeranong ACT 2901

Exceptional Circumstances

The Compliance Audit – Exceptional Circumstances Statutory Declaration form (MO020) [PDF, 139Kb]PDF reader required 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: 12 June, 2014