Child Dental Benefits Schedule for health professionals

Claiming

How to claim Child Dental Benefits Schedule for health professionals. You will need a Medicare provider number to make claims.

You can only claim services using your dentist or dental specialist's Medicare provider number.

Provider number

You need the Medicare provider number associated with specialty code 107.

You must have both:

  • general or specialist registration, 112 or 106
  • a Medicare provider number, associated with specialty code 107.

Read more about provider numbers and Medicare benefits.

Item numbers for your claim

Use the Child Dental Benefit Schedule item numbers on the Department of Health's website for your claims. They are Dental Benefits Schedule items 88011-88943.

How to claim services

You can bulk bill or provide your patient an account for your services. You must complete services before you bill your patient or submit a bulk billing claim. Service restrictions are in the Guide to the Child Dental Benefits Schedule on the Department of Health website.

Read more about online options for health professionals.

Electronic claiming channels are a convenient and quick way to lodge claims directly with us from your surgery. They include Medicare Online and Medicare Easyclaim.

You can also submit your Medicare bulk bill claims electronically using either:

  • your practice software
  • Medicare Bulk Bill Webclaim.

You can access Medicare Bulk Bill Webclaim using Health Professional Online Services (HPOS).

If you don’t have HPOS access, you need to apply for a Provider Digital Access (PRODA) first.

If you’re unable to submit an electronic claim, you can submit claims manually, but these take longer to process.

You can order approved bulk billing Medicare claim forms using the Medicare stationery order form.

Bulk billing your patient

You must complete the assignment of benefit form in full and include:

  • your patient's name
  • the date of the service
  • the Dental Benefits Schedule item number that corresponds to the service
  • your name and provider number
  • the amount of the dental benefit assigned to you
  • your patient's or their parent or guardian's signature.

Issuing an account to your patient

If you privately bill with an account, your patient can claim their Medicare benefit electronically at your surgery if you offer Medicare Online or Medicare Easyclaim. If you don’t offer electronic claiming options, your patient can claim their benefit through us.

For us to pay your patient, the account or receipt you issue must include:

  • your patient's name
  • the date of service
  • the Dental Benefits Schedule item number that corresponds to the service
  • your name and provider number
  • amount charged for the service, total amount paid and any amount outstanding in relation for the service.

A service is complete once you've provided all parts of the service.

This information was printed Friday 24 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/child-dental-benefits-schedule-health-professionals/claiming It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 6 May 2019