Instructions on completing the Provider Agreement

In order to make it easier to get set up for claiming with Medicare Online and the Department of Veterans Affairs’ (DVA), Medipass will pre-populate the Medicare Online Claiming Provider Agreement, which you are required to finalise and send to Medicare. This is also known as form HW027.

While Medipass will pre-populate the Agreement using the information we hold, you will need to complete additional details required by Medicare. Here are some important things to note:

  • Item 1 - Name: Use your full name as registered with Medicare for the given provider number.
  • Item 2 - Provider number: This provider number must match that registered in Medipass. 
  • Item 3 - PKI registration number: Leave this field blank.
  • Item 13 - Practice name: If you operate as a sole practitioner in your own name, use your own name.
  • Item 14 - Practice address: The address should match the address registered with the provider number. This is usually the practice location and not the provider’s home address.
  • Item 16 - Practice contact name: This could be the provider, a practice manager, owner or other administrative contact.
  • Item 23 - Bank account details: These details will be used for Medicare bulk bill payments to providers.
  • Item 24 - Type of transactions: Tick Medicare Bulk bill and Department of Veterans' Affairs claims.

Complex arrangements

Further forms may be required if you have a complex business structure. Contact us if you have providers who:

  • Operate out of multiple locations, or
  • Need to be paid into multiple bank accounts, or 
  • Have previously used Medicare Online for claiming (excluding PRODA).

In these scenarios, we’ll guide you through what other information you may be required to send to Medicare.

Next steps

  • Forward the completed and signed forms to Medicare directly by emailing them to provider.forms@humanservices.gov.au
  • Please note that even if your Medicare provider numbers have been enabled in Medipass, it takes around 5 business days for Medicare to process your Provider Agreement, and they do not typically contact you (or us) to advise that you have been approved.
  • We therefore recommend that you do not attempt to process Medicare transactions until 5 days after you have sent the forms.

Getting help from Medicare

If you have questions about completing the form, or would like to enquire if your forms have been processed, you can contact Medicare e-business directly:

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