When creating any Medicare transaction, you can set referring provider name, number, issue date and period.
Note: Referral details are typically not required or applicable for General Practitioners and select general services such as Dentistry and Optometry.
In both bulk bill and patient claims, “Yes” is selected by default under “Do you have a referral?” If there is no referral, select “No”.
Patient with a referral
If your patient has a referral, select the "Referrer type" (GP or specialist). This will affect the Referral period. Standard referral times for a GP is typically 12 months. Referral times for a Specialist is 3 months.
This information can be seen when clicking on the blue question mark next to "Referral period".
The other required information is the "Referring provider number", "Referral issue date" and "Referred service type". This information can be found on the referral document.
Note: for allied health providers the Referred service type will need to be the "Specialist (including Allied)" option.
If the referral contains a specific referral period, you can enter this by selecting 'Non standard' and manually entering the amount of months the referral is valid for.
Patient without a referral
If your patient does not have a referral for the claim, select "No" when asked: "Do you have a referral?".
Then select a "Non-referral reasons". You may also need to provide additional details (such as the case of Hospital non-referral reason code) in 'Service text' as noted below:
Once the referral information is complete, you can add the "Services" details.
Reference Australian Government Guidelines on referring and requesting Medicare services, for details on referral requirements.