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.

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

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: 20 February 2020