Simplified Billing manual claims batch header form (HW091)

Use this form to submit manual Simplified Billing claims only.

Download and complete the Simplified Billing manual claims batch header form.

Private health insurers or approved billing agents can use this 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: 10 December 2021