Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits form (HW026)

Use this form to apply for late lodgement of a Simplified Billing claim for assigned Medicare benefits if you are a health professional, billing agent or private health insurer.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 10 April 2019

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