Simplified Billing Manual Claims batch header form (HW091)

Use this form to submit manual Simplified Billing claims only.

Private health insurers or approved billing agents can use this form.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
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Page last updated: 13 March 2017

This information was printed Monday 24 July 2017 from humanservices.gov.au/health-professionals/forms/hw091 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.