Application for bulk bill claim adjustment form (DB018)

Use this form when applying for a bulk bill claim adjustment for assigned Medicare benefits where the original date of service is less than 2 years old.

Download and complete the Application for bulk bill claim adjustment form.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

You can upload or complete this form online through HPOS. Read more about form upload in HPOS.

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: 31 January 2020