Start with Medicare

Starting with Medicare as a health professional.

When starting with Medicare, you’ll need to have professional recognition and meet eligibility rules. You’ll also need to apply for Medicare provider number, check your eligibility and recognition rules before you can bill patients and claim payments from Medicare.

To claim Medicare benefits you can either:

  • bulk bill the patient
  • issue a private account to the claimant.

Claims need to clearly show:

  • the address and provider number of the place of practice
  • that the service qualifies for Medicare benefits
  • that the person who provided the service is a registered medical practitioner at the place of practice.

You should only claim if you’re either:

  • working in a private capacity
  • not getting other government funding for your services.

If you’re a health professional, 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.

If you already have a provider number, you may be able to apply for an additional provider number.

You’ll need an additional provider number if you work:

  • in a new practice location
  • for a new service at the same location
  • in a new health profession or discipline.

Read more about how to apply for an additional provider number.

The Healthcare Identifiers (HI) Service is a national system that uses a unique number to match health care providers to individuals.

If you’re an individual health care provider registered with the Australian Health Practitioner Regulation Agency (Ahpra) you’ll automatically get a health care identifier.

If you’re practising in a health care profession that’s not regulated by Ahpra you’ll need to apply directly to the HI Service to get a health care identifier.

Read more about how to register for the Healthcare Identifiers Service.

Digital health is the electronic management of health and health-related information. You need a health care identifier to be involved in digital health.

Read more about online services.

In Australia to get a Medicare benefit for medical services you need to meet eligibility rules.

Read more about Medicare benefit eligibility for health professionals.

You’ll need a Provider Digital Access (PRODA) account to access Health Professional Online Services (HPOS). PRODA is an online authentication system used to securely access a number of government online services, including HPOS. Read more about PRODA.

HPOS is an online portal for health professionals to securely do business with government services. Read more about HPOS.

Page last updated: 24 June 2024.
QC 74002