Bulk bill payments to health professionals

Information to help you with Medicare bulk billing.

Bulk billing is when you bill Medicare directly for your patient’s medical or allied health service.

In a bulk billing arrangement both of the following apply:

  • you accept the Medicare benefit as full payment for the service
  • your patient assigns their right to a Medicare benefit to you, so we pay the benefit to you.

Assigning the benefit

A patient assigns their right to a Medicare benefit to you by signing a completed assignment of benefit form.

Use the approved assignment of benefit form for manual claims. For online claiming you can print the assignment of benefit statement from your practice management software.

By signing the form, your patient assigns their right to a Medicare benefit to you.

A patient or other responsible person must not sign a blank or incomplete assignment of benefit form.

Assignment of benefit and signature requirements

You need your patient's agreement to bulk bill the items before we can pay you the Medicare benefit.

Read more about Assignment of benefit signature requirements and permissible exemptions.

Making additional charges

If you bulk bill a patient, you can’t charge the patient an additional amount for that service.

This includes, but isn’t limited to:

  • any consumables used, including bandages and dressings
  • record keeping fees
  • a booking fee to be paid before each service
  • an annual administration or registration fee.

An exception applies only to general practitioners and other non-specialist health professionals for attendance items 3 to 96 and 5000 to 5267 (inclusive): when you give the patient a vaccine or vaccines from your own supply at your practice.

It only relates to vaccines not available free of charge through Commonwealth or state funding, or Pharmaceutical Benefits Scheme. The additional charge can only cover the supply of the vaccine.

Bulk billing and private billing together

If you provide a number of services on a single occasion, you can both:

  • bulk bill some or all of those services
  • privately bill any you haven't bulked billed.

There's an exception if the Multiple Operational Rule affects any of these services. In this case you can use only one claiming channel for all the services, either bulk bill or private bill.

This also applies to the diagnostic imaging multiple services rules (DIMSR).

If you bulk bill a service, both of these apply:

  • you accept the patient's Medicare benefit as full payment for the service
  • you can't charge an additional fee.

If you only bulk bill some of the services, you can charge an additional fee privately for the other services.

Choosing to bill this way means you can set the charge.

This includes the amount to compensate for the use of consumables or to cover other costs. You can only charge the additional fee if it relates to the service you're claiming.

Claiming bulk bill payments

You need to lodge a bulk bill claim within 2 years from the date of service. Read about bulk bill late lodgements for claims older than 2 years.

Electronic claims

You can submit bulk bill claims electronically through either:

If you want to claim both in-hospital and out of hospital services, you'll need to submit them in separate claims.

If you need the patient’s consent on the assignment of benefit before submitting your claim electronically, use the HPOS bulk bill Webclaim form.

You can submit claims electronically if the health professional getting the payment is a short-term locum and doesn't have a provider number.

Getting your bulk bill payment

We no longer send cheques for bulk bill and Department of Veterans' Affairs (DVA) payments to health professionals.

You must give us your bank details to get your bulk bill and DVA claims paid through Electronic Funds Transfer (EFT).

If you practice at more than one location, you must submit bank details for each location.

Providing your details

Give us your bank details by registering for EFT payments using Medicare online claiming or Medicare Easyclaim.

To register for EFT payments, fill in and submit both these forms:

Lodging a bulk bill claim late

You must lodge a Medicare claim with us within 2 years from the date of service. This is outlined in the Health Insurance Act 1973 section 20B(2)(b).

Read about bulk bill late lodgements.

Adjusting a bulk bill claim

You can call the Medicare provider enquiries line to delete a claim you lodge on that day.

You can change an item number or other details on a processed claim that’s under 2 years old.

The table below shows how to submit a request for an adjustment.

How to request an adjustment forWhen to make changeHow to make changesItems to submit
Electronic or Manual claimWithin 2 years of date of service.Use the Application for bulk bill claim adjustment form (DB018)
  • a new assignment of benefit form, completed with the correct information and signed by the patient or a third party.

Your patient must sign any changes to their information. This is because you’re changing the original agreement you made with the patient to accept the patient’s assigned benefits.

You can’t request an adjustment unless a new assignment of benefit form has been signed by your patient or a third party.

Changing a paid or omitted bulk bill incentive or PEI item

We’ll accept requests to change a previously paid bulk bill claim if the date of service is within 2 years. This applies to both omitted items and item changes.

The table below shows how to submit changes to previously paid bulk bill incentive or patient episode initiation (PEI) items.

How to request a changeWhen to make changesHow to make changesItems to submit
Electronic claimsWithin 2 years of date of serviceUse the electronic claiming system

Make sure you send the same details as the original claim.

This includes either:

  • the omitted bulk bill incentive
  • PEI item
Manual claims
  • Within 2 years of date of service
  • When you can't submit the claim electronically.
Use the Application for bulk bill claim adjustment form (DB018)

Send a printed copy of a spreadsheet containing all of the following:

  • patient details - full name, Medicare number and IRN
  • original date of service
  • servicing and payee provider details
  • item numbers to be paid

Bulk bill adjustment statements

When we process an adjustment for bulk billing, we’ll send you a bulk bill adjustment statement.

These statements now show all service lines for the patient, rather than just the service lines that had been adjusted.

The result line will show the difference between the original and revised service lines.

The following tables show the reason codes we use in adjustment statements. They include codes for:

  • an underpayment
  • an overpayment
  • statistical bulk bill adjustment.

Underpayment of the previous benefit paid

LineReason codeDescription
Original Line888Details of previous Medicare assessment
Restated Line816Details of revised Medicare assessment - underpayment
Result Line861Adjustment of Medicare benefit previously paid

Overpayment of the previous benefit paid

LineReason codeDescription
Original Line888Details of previous Medicare assessment
Restated Line818Details of revised Medicare assessment - overpayment
Result Line819Overpayment of benefit recorded

Statistical bulk bill adjustment

LineReason codeDescription
Original Line888Details of previous Medicare assessment
Restated Line821No change to original benefit - recorded for history purposes

Contact the eBusiness service centre for more information.

Page last updated: 16 January 2024.
QC 22921