Online claiming provider agreement form (HW027)

Use this form to register for online claiming with us and the Department of Veterans' Affairs.

We may contact you for security reasons if you're adding or changing your bank details recorded with us.

It's quicker to update your bank details online through Health Professional Online Services (HPOS). You'll be able to check your changes within 24 hours. You don’t need to use a paper form.

You'll need a PRODA account to access HPOS.

Learn about PRODA (Provider Digital Access) and Managing your banking details.

If you can’t use HPOS download and complete the Online claiming provider agreement form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

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: 17 June 2024.
QC 20821