Assignment of Benefit Medicare Bulk Bill Webclaim form (DB020)

This form is for use in conjunction with Medicare Bulk Bill Webclaims only and cannot be submitted to us for manual processing.

This form is not interactive. It has two copies, one for the health professional and one for the patient. Health professionals will need to print the form and complete both copies by hand, before that patient assigns their benefit to them.

Instructions to complete the Assignment of benefit form

  1. Only one patient is allowed per form
  2. check date of service is before Medicare card expiry date – indicate with an X in the Expiry Date Checked box
  3. complete patient details and all other fields that relate to the service provided
  4. The Practitioner use box must indicate where required name of hospital, emergency, lost referral, time of service, information about anesthetists or service duration
  5. Patient must sign the Assignment of benefit form after the service has taken place and the form has been completed (legislative requirement)
  6. If the patient is unable to assign their right to benefit to the servicing provider, tick the box beside Patient is unable to sign. An explanation should be given as to why the patient was unable to sign in the relevant box
  7. A copy of the Assignment of benefit form must be provided to the patient (legislative requirement)
  8. When an internet connection is available, access HPOS and Submit a Medicare Bulk Bill Webclaim

Page last updated: 8 June 2016

This information was printed Wednesday 28 September 2016 from humanservices.gov.au/health-professionals/forms/db020 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.