Bulk bill payments to health professionals

Information to help you with Medicare bulk billing.

Bulk billing

Bulk billing is when you bill Medicare directly for a patient’s medical or allied health service.

In a bulk billing arrangement:

  • you accept the Medicare benefit as full payment for the service, and
  • the patient assigns their right to a Medicare benefit to you, so we pay the benefit to you

Assignment of benefit

A patient assigns their right to a Medicare benefit to you by signing a completed assignment of benefit form.

You can use the approved assignment of benefit form for manual or online claiming.

The patient or other responsible person must not sign a blank or incomplete assignment of benefit form.

Signature by a third party

If the patient can’t assign their right to a Medicare benefit for manual and online claiming, we can accept a signature on the assignment form from a third party – for example, the patient's:

  • parent
  • guardian
  • power of attorney
  • other responsible person

You must:

  • note in the ‘Patient signature’ field that the patient is ‘unable to sign’
  • note in the ‘Provider Use’ field, why the patient is unable to sign - e.g. unconscious, injured hand
  • initial or sign your notes

With Medicare Easyclaim, a patient assigns their right to a Medicare benefit to you by pressing the OK or YES button on the EFTPOS terminal in the practice.

Additional charges and bulk billing

If you bulk bill a patient, you can’t make additional charges for that service.

This includes, but isn’t limited to:

  • any consumables used, including bandages and dressings
  • record keeping fees
  • a booking fee to be paid before each service
  • an annual administration or registration fee

An exception is where you give the patient a vaccine or vaccines from your own supply held at your premises.

This exception only applies to general practitioners and other non-specialist providers for attendance items 3 to 96 and 5000 to 5267 (inclusive).

It only relates to vaccines not available to the patient free of charge through Commonwealth or state funding arrangements or available through the Pharmaceutical Benefits Scheme.

The additional charge must only be to cover the supply of the vaccine.

Bulk billing and private billing together

Where you provide a number of services on a single occasion, you can choose to bulk bill some or all of those services.

The exception is when the Multiple Operational Rule affects the services. In this case the provider can use only 1 claiming channel. This also applies to the diagnostic imaging multiple services rules (DIMSR).

Where some but not all of the services are bulk billed, a fee may be privately charged for the other service or services. This fee can’t be used for additional charges.

Claiming bulk bill payments

You must lodge a bulk bill claim within 2 years, from the date of service. Read more about bulk bill late lodgements for claims older than 2 years.

Electronic claims

You can submit bulk bill claims electronically:

To claim both in-hospital and out of hospital services, you’ll need to complete a separate DB1 header form for each.

For services provided in-hospital or day hospital use the In Hospital Services Header form (DB1H).

For services provided out of hospital use the Out of Hospital Services (DB1N) form.

Both forms enable payment to go to a provider other than the one who provided the service.

This is for situations where a short term locum is acting on behalf of the provider. You can’t use this option for payments to or through a person who doesn’t have a provider number.

Payment through Electronic Funds Transfer only

We no longer send cheques for bulk bill and Department of Veterans' Affairs (DVA) payments to providers.

You must give us your bank details to get your bulk bill and DVA claims paid through Electronic Funds Transfer (EFT).

If you practise at more than one location you must submit bank details for each location.

Providing your details

Provide your bank details to us by registering for EFT payments using Medicare online claiming or Medicare Easyclaim.

To register for EFT payments, fill in and submit these forms:

Bulk bill late lodgements

The Health Insurance Act 1973 section 20B(2)(b) states that a Medicare claim must be lodged with us within 2 years from the date of service.

Read more about bulk bill late lodgements.

Bulk bill adjustments

You can call the Medicare provider enquiries line to delete a claim you lodge on that day.

You can change an item number or other details on a processed claim that’s under 2 years old. To do this submit a manual request for adjustment and provide:

Any changes to information must be signed by the patient, because you are changing the original agreement you made with the patient to accept the patient’s assigned benefits.

You can’t request an adjustment unless a new assignment of benefit form has been signed by your patient or a third party.

Claiming omitted Bulk Bill incentive or PEI items

We won’t accept requests to add omitted item(s) to previously paid bulk billed claims if the date of service of the claim is over 2 years old.

Electronic claims

You can lodge a claim for omitted bulk bill incentives or patient episode initiation (PEI) items with a date of service under 2 years old through your electronic claiming system.

You’ll need to send the same details as the original claim but you must only submit the omitted bulk bill incentive or PEI item. You mustn’t include the original service item number(s).

Manual claims

If you can’t submit the claim electronically, you must submit a bulk bill claim adjustment form.

You’ll also need to send a printed copy of a spreadsheet containing:

  • patient details - full name, Medicare card number and IRN
  • original date of service
  • servicing and payee provider details, and
  • item number/s to be paid

Bulk bill latter day adjustment provider statements

When we process an adjustment for bulk billing, we’ll now show all service lines for the patient on the bulk bill adjustment statements sent to health professionals.

Previously, the statements only showed the service lines that had been adjusted.

The result line will show the difference between the original and revised service lines.

The tables below show the reason codes on the provider statement for an underpayment, overpayment or statistical bulk bill adjustment.

Underpayment – an underpayment of the previous benefit paid
Original Line 888 Details of previous Medicare assessment
Restated Line 816 Details of revised Medicare assessment – underpayment
Result Line 861 Adjustment of Medicare benefit previously paid
Overpayment – an overpayment of previous benefit paid
Original Line 888 Details of previous Medicare assessment
Restated Line 818 Details of revised Medicare assessment – overpayment
Result Line 819

Overpayment of benefit recorded

Statistical bulk bill adjustment – no change to benefit previously paid
STATISTICAL – no change to benefit previously paid STATISTICAL – no change to benefit previously paid STATISTICAL – no change to benefit previously paid
STATISTICAL – no change to benefit previously paid STATISTICAL – no change to benefit previously paid STATISTICAL – no change to benefit previously paid

Contact us

For more information call the eBusiness service centre.

Page last updated: 18 September 2017