Assignment of benefit Medicare bulk bill Webclaim form (DB020)

Use this form in conjunction with HPOS Medicare Bulk Bill Webclaims only. It cannot be submitted to us for manual processing.

Download and complete the Assignment of benefit Medicare bulk bill Webclaim form.

This form is interactive. It has 2 copies, one for the health professional and one for the patient.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 21 September 2023.
QC 21151