Application Form For An Additional Location Medicare Provider/ Registration Number printable pdf download

Information sheet for an application for an additional

location Medicare provider/registration number

benefits for your professional services or that an extension

Important information

to your eligibility is automatically granted.

This application is to be used only by a Health

Medical practitioner

Professional when applying for an additional Medicare

provider/registration number with Medicare Australia.

Eligibility to access Medicare benefits is determined by

Your application and supporting documentation (if

the Health Insurance Act 1973 and related regulations. In

required) should be sent to Medicare Australia prior to

particular, the requirements of sections 19AA and 19AB

your proposed commencement date.

must be satisfied before access to Medicare benefits can

You must have a current registration in the State or Territory

be granted. The Health Insurance Act 1973 can be found

in which the required location is situated. Allied health

at More information can be found

professionals must meet the eligibility requirements for the

on the Department of Health and Ageing’s website at

Medicare Allied Health and Dental Initiative.

You should not commence billing until Medicare Australia

Medical practitioners with time and location specific

has advised you of your provider/registration number and

Medicare eligibility should take note of the expiry dates as

Medicare eligibility.

Medicare Australia does not send reminder notices. You

can access your record on the Provider Directory System

If you fax your application, you must retain your original

available at

documents for auditing purposes.

Other organisations such as the Department of Health

Note: this application will be returned if all relevant

and Ageing, the Rural Workforce Agencies, General

documentation/information is not supplied. Please print

Practice Education and Training Limited, the specialist

clearly and complete all sections.

medical colleges, the Royal Australian College of General

Assistance

Practitioners and the Australian College of Rural and

If you need assistance in completing this form call Medicare

Remote Medicine may be involved in approving your

Australia on 132 150* (8.30 am to 5.00 pm Monday to

access to Medicare benefits.

Friday) or visit

Practice Incentives Program (medical

Lodgement

practitioners only)

Send the completed and signed form to:

If you are currently participating in the Practice Incentives

Medicare Australia

Program or if the new location for which you are

Provider Eligibility Section

requesting a provider number participates in the Practice

GPO Box 9822

Incentives Program, please call 1800 222 032** to ensure

in your capital city

that your provider number is linked to the practice.

or fax to:

(02) 9895 3439

(08) 8922 6322

NSW

Optometrists

(02) 9895 3439

(08) 8274 9307

ACT

Optometrists who intend to provide a professional

VIC

(03) 9605 7984

(08) 9214 8201

service that attracts a Medicare benefit must submit an

(07) 3004 5634

(03) 6215 5700

QLD

TAS

Optometrical undertaking to be a participating optometrist

or provide a schedule of optometrists form available at

* Call charges apply

** Call charges apply from mobile and pay phones only.

Personal contact details

This form can be used to request a provider/registration

number for an additional location or to re-open a closed

If you tick the general correspondence box in question

location.

6, your postal or email address will be used for general

correspondence. Please keep your details up to date to

Access to Medicare benefits

ensure important Medicare Australia information reaches you.

A provider/registration number uniquely identifies the health

You can update your contact details on Medicare

professional and the location from which a service is rendered.

Australia’s Provider Directory System using your health

Claims for Medicare benefits should only be made

professional smartcard eCertificate issued by Medicare

while working in a private capacity and where no other

Australia or alternatively with your ACIR user ID and

government funding is received for these services.

password.

We will advise you of your provider/registration number for

the location and your Medicare billing eligibility.

Do not presume that the allocation of a provider/

registration number means you can attract Medicare

Page 1 of 6

1413.26.10.07

Application Form For An Additional Location Medicare Provider/ Registration Number

Related Articles

Related forms

Related Categories