Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits form (HW026)
Use this form to apply for late lodgement of a Simplified Billing claim for assigned Medicare benefits if you are a health professional, billing agent or private health insurer.
Download and complete the Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits form.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
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Page last updated: 4 February 2020