Application For An Initial Medicare Provider/ Registration Number For An Allied Health Professional printable pdf download

Application for an initial Medicare

provider/registration number

for an Allied Health Professional

Purpose of this form

An application from a physiotherapist, osteopath, chiropractor or

podiatrist for a provider/registration number using this form will be

This application is to be used only by an Allied Health Professional

treated as an application to participate in the allied health initiative

when applying for an initial Medicare provider/registration number.

and activate eligibility to request certain Diagnostic Imaging services

If you have an existing provider/registration number issued by

Medicare you should complete the Application for an additional

as listed in the MBS.

location Medicare provider/registration number form (HW062)

humanservices.gov.au

available from our website

Personal contact details (email and/or mail address

www.

if different from practice location)

Access to Medicare benefits

Personal contact details are optional. If provided, your email or

Allied health professionals must apply for a unique provider/

mailing address will be used for general correspondence. These

registration number for each required location. In addition a separate

details must be kept up-to-date to ensure important Medicare

application form must also be completed for a unique provider/

Australia information reaches you.

registration number for each discipline in which they practice.

You can update your contact details on Medicare’s Provider Directory

Medicare provider/registration numbers are allocated to allied health

System using your health professional smart card or ikey issued by

professionals to enable them to participate in the Medicare allied

Medicare through the Health eSignature Authority (HeSA)

health and dental care initiative and to provide a method of

hesa.gov.au

identifying the place from which a service is provided.

www.

Medicare provider/registration numbers are also allocated to

For more information

physiotherapists, osteopaths, chiropractors or podiatrists for the

purposes of enabling these health professionals to request certain

For more information go to our website

diagnostic imaging services as set out in the Medicare Benefits

humanservices.gov.au/healthprofessionals or call 132 150

Schedule (MBS) Book. Please note that only these health

www.

Monday to Friday, between 8.30 am and 5.00 pm, Australian Eastern

professionals may request such services. The allocation of a

Standard Time.

provider/registration number will enable these health professionals

to participate in the allied health initiative as above and to request

Note: Call charges apply – calls from mobile phones may be charged

certain diagnostic imaging services. Please refer to the MBS for

at a higher rate.

details.

The Health Insurance Regulations provide that, for Medicare

Filling in this form

purposes, a valid account/receipt must contain the practitioner’s

•

Please use black or blue pen

name and either:

•

Print in BLOCK LETTERS

•

the address of the place of practice from which the service was

provided, or

✓

•

Mark boxes like this

with a

•

the provider number for the place of practice from which the

service was provided.

Returning your form

Allied health professionals should note that payment of claims could

Check that you have answered all the questions you need to answer

be delayed or disallowed where it is not possible from account

and that you have signed and dated this form.

details to clearly identify the services that qualify for Medicare

Send the complete form to:

benefits, or identify the allied health professional as a registered

allied health professional at the place of practice.

Department of Human Services

Provider Eligibility Section

Electronic funds transfer (EFT) payments

PO Box 9822

in your capital city

You can request that your Medicare and DVA benefits for bulk bill

claims be paid into a nominated bank account by completing the EFT

details at question 19.

Fax:

NSW/ACT 02 9895 3439

SA/TAS

08 8274 9307

Eligibility

03 9605 7984

08 9214 8201

VIC/NT

An allied health professional applying for registration under the allied

07 3004 5634

health and dental initiative must be in private practice, and services

QLD

claimed under this initiative must be performed while working in a

Your application and supporting documentation should be

private capacity.

submitted to us as soon as possible prior to your proposed

An allied health professional is also eligible for registration under the

commencement date.

allied health and dental care initiative where they are employed by,

Your application will be returned if all relevant documentation/

or under contract to, an Aboriginal and Torres Strait Islander

information is not supplied.

Community Controlled Health Service or State/Territory clinic, that

Where applications are faxed, you must retain your original

has been granted an exemption under subsection 19(2) of the

documents for auditing purposes.

Health Insurance Act 1973.

1 of 3

HW063.1503 (formerly 1449)

Application For An Initial Medicare Provider/ Registration Number For An Allied Health Professional

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