Find a patient using HPOS

A guide to using HPOS to verify patient Medicare details.

Who can use the service

The find a patient service lets you search and immediately confirm patient Medicare numbers, concessional eligibility and details. It saves time by removing the need to call us to confirm these details.

You must have a Provider Digital Access (PRODA) account or a PKI site certificate to verify patient details using HPOS. There may be limited situations where PRODA is not an option, please contact the eBusiness Service Centre for assistance.

Confirming patient details

When a patient’s Medicare card number, Individual Reference Number (IRN) and first name are supplied, HPOS confirms these details and the Medicare card number, IRN and patient’s first name is displayed on the screen.

If the first 9 digits of the Medicare number and the patient's first name match then a result will be displayed. This feature corrects:

  • issue number errors i.e. the 10th digit in the Medicare number
  • IRN errors i.e. the correct IRN for the patient name is provided, and
  • minor spelling errors in the patient's first name

If a mismatch occurs between the patient’s first name and the IRN fields, the result returns the correct IRN for the patient name entered.

The date of birth field helps with the identification of the correct patient. If 2 patients on the card have the same name - for example, the father and son are both called John - the date of birth field is used to confirm the patient's details.

How to confirm patient details

  • Select find a patient from the main menu
  • Select Medicare card details from the use dropdown menu
  • Enter patient details using Medicare data
  • Select the declaration check box - by selecting the declaration check box, you’re declaring the search is for claiming purposes only
  • Select find
  • Patient Medicare details will display in the results table and the system will prompt you if the information supplied needs you to update your records
  • From the results table select next to view the patient’s profile page
  • From the patient’s profile page select claims to create a new Medicare bulk bill webclaim for the searched patient

Searching a patient’s details

When a Medicare card number is unavailable, you can enter personal information such as surname, first name and date of birth for the patient. The postcode, locality and suburb fields are used to further refine a search when more than one member of the public matches the information entered.

The mandatory fields used for searching are:

  • surname/family name
  • first name
  • date of birth

The optional fields are:

  • if the patient is legally known only by one name
  • postcode
  • locality or suburb

The successful search patient details screen displays if a unique match is found. A successful search result returns the correct Medicare card number, IRN and first name.

It’s important to note:

  • where a unique match is found but the Medicare card first name is different, you’ll get an information message indicating that differences were identified and asking you to check the information and update your records
  • where the identified patient is associated with more than one Medicare card, you’ll get an information message indicating a match was made but the patient is associated with more than one Medicare card

If a message is returned indicating that no record can be found it means a unique record couldn’t be identified. It doesn’t always mean the person is not enrolled or not eligible for Medicare.

Contact our Medicare provider enquiries line if you’re unable to locate a match. We have access to more fields that may help identify your patient in the system.

How to search patient details

  • select find a patient from the main menu
  • select patient name and date of birth from the use dropdown
  • enter patient details using patient's name and date of birth
  • select the declaration check box - by selecting the declaration check box, you are declaring the search is for claiming purposes only
  • select find
  • patient Medicare details will display in the results table and the system will prompt you if the information supplied needs you to update your records
  • from the results table select next to view the patient’s profile page
  • from the patient’s profile page select claims to create a new Medicare bulk bill webclaim for the searched patient

Multiple details request

You can:

  • search and confirm multiple patient details in a single request
  • search and confirm up to 500 card numbers in a request
  • only submit 1 request per day and the results will be delivered to your HPOS Messages inbox within 24 hours.

How to submit a multiple details request

  • select the menu item
  • select multiple details request
  • download and complete the multiple details request template file - we recommend you save this file to your computer
  • select browse and find your saved the file
  • select the declaration check box - by selecting the declaration check box, you’re declaring the search is for claiming purposes only
  • select upload to upload the file - the results will be delivered into the HPOS Mail Centre within 24 hours

Concessional verification service

  • from 1 July 2016 a new service to confirm a patient’s concessional eligibility for Medicare services is available to health professionals through HPOS
  • a patient is considered to be concessional if they hold or are listed on a Commonwealth concessional card at the date of service
  • a patient’s concessional entitlement eligibility is based on the information known by the department at the time of checking
  • the concessional entitlement verification service is accessible through the patient profile page once the patient has been uniquely matched

How to confirm a patient’s concessional status

  • perform a search on the patient’s details in the find a patient service
  • from the results table select next to view the patient’s profile page
  • select the concessional entitlement tab on the left hand menu
  • enter date of service
  • tick the declaration box to confirm you’re accessing the service for verification and claiming purposes
  • select verify

The check will return:

  • the date of service
  • a concessional entitled result of Yes or No, and
  • the verification receipt number

You can use the verification receipt number to contact us about the verification results.

The concessional entitlement verification results can be printed.

Page last updated: 10 October 2016

This information was printed Tuesday 6 December 2016 from humanservices.gov.au/health-professionals/enablers/find-patient-using-hpos It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.