Health professionals starting with Medicare
What you need to do to get set up with Medicare and more.
Apply for your initial Medicare provider number
If you’re a medical practitioner or allied health practitioner, you’ll need to get approval for an initial Medicare provider number before you can claim Medicare benefits.
Read more about how to apply for an initial Medicare provider number.
Overseas trained doctors and foreign graduates
There are extra requirements you need to meet before you apply for a Medicare provider number if you either:
- got your medical qualification outside Australia or New Zealand
- did not have citizenship when you registered.
Register for the Healthcare Identifiers Service
The Healthcare Identifiers (HI) Service is a national system that uses a unique number to match healthcare providers to individuals.
If you’re an individual healthcare provider registered with the Australian Health Practitioner Regulation Agency (AHPRA) you’ll automatically get a healthcare identifier.
If you’re practising in a healthcare profession that’s not regulated by AHPRA you’ll need to apply directly to the HI Service to get a healthcare identifier.
Read more about applying for a healthcare identifier.
Register for digital health
Governments across Australia are committed to a national approach for a system that manages health information electronically. You need a Healthcare Identifier to be involved in digital health.
Read more about getting started with digital health.
Check your eligibility for Medicare benefits
In Australia, eligible medical services provided to an eligible person by an eligible health professional get a Medicare benefit.
If you provide a medical service that qualifies for a Medicare benefit you must:
- hold current registration with the Medical Board of Australia
- have a current Medicare provider number for the practice the service is provided by
- meet eligibility requirements as set out in the Health Insurance Act 1973.
Read more about Medicare benefits for health professionals.
You have legal obligations when you request or refer services under Medicare. There are certain conditions and timeframes associated with some services.
Read more about health professionals referring and requesting services under Medicare.
Register for HPOS
Health Professional Online Services (HPOS) is a fast and secure way for health professionals and administrators to do business with us.
Read more about HPOS.
To register for HPOS you need a Provider Digital Access (PRODA) account.
Read more about PRODA.
Once you’re registered for HPOS, you can do business with us online, including:
- request access to the Australian Immunisation Register (AIR)
- update your details with Medicare
- change location details
- submit claims using web claim in HPOS
- access the Practice Incentives Program.
Manage your practice
Your practice should use systems and processes that are efficient and reduce risk.
Make sure you manage your records and comply with relevant legislation and guidelines.
We do compliance audits and reviews for:
- the Medicare Benefits Schedule (MBS)
- the Pharmaceutical Benefits Scheme (PBS)
- the Child Dental Benefits Schedule (CDBS).
The Department of Health (Health) audits the Practice Incentives Program (PIP).
You may receive a penalty if you haven’t met the requirements.
Read more about health provider compliance audits and reviews on the Department of Health website.
Use Health’s Medicare Billing Assurance Toolkit to help you:
- manage the factors that can cause you to bill incorrectly under Medicare
- understand what documents you can use to verify services for an audit or review.
You can also choose how you’re going to claim under Medicare.
Read more about the online options for health professionals.
Order prescription forms
We supply prescription forms for the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme (RPBS) to eligible prescribers free of charge.
Read more about ordering PBS and RPBS forms.
Find out about insurance
There are insurance schemes designed to suit the needs of health practitioners.
The Medical Indemnity Act 2002 provides financial support for medical practitioners to help keep medical indemnity insurance premiums affordable. This helps to make medical services available.
Access education resources
We have guides and other resources available to help you understand our health programs and do business with us.
Read more about Education services for health professionals.
Page last updated: 4 November 2020
This information was printed 20 July 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/subjects/health-professionals-starting-medicare. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.