Health professionals starting with Medicare

What you need to do to get set up with Medicare and more.

Apply for your initial Medicare provider number

If you’re a medical practitioner or allied health practitioner, you’ll need to get approval for an initial Medicare provider number before you can claim Medicare benefits.

Read more about how to apply for an initial Medicare provider number.

Overseas trained doctors and foreign graduates

There are extra requirements you need to meet before you apply for a Medicare provider number if you:

  • got your medical qualification outside Australia or New Zealand, or
  • did not have citizenship when you registered

Read more about Medicare provider number for overseas trained doctors and foreign graduates.

Read more Medicare information for health professionals.

Register for the Healthcare Identifiers Service  

The Healthcare Identifiers (HI) Service is a national system that uses a unique number to match healthcare providers to individuals.

If you’re an individual healthcare provider registered with the Australian Health Practitioner Regulation Agency (AHPRA) you’ll automatically get a healthcare identifier.

If you’re practising in a healthcare profession that’s not regulated by AHPRA you’ll need to apply directly to the HI Service to get a healthcare identifier.

Read more about applying for a healthcare identifier.

Register for digital health  

Governments across Australia are committed to a national approach for a system that manages health information electronically. You need a Healthcare Identifier to be involved in digital health.

Read more about getting started with digital health.

Check your eligibility for Medicare benefits

In Australia, eligible medical services provided to an eligible person by an eligible health professional get a Medicare benefit.

If you provide a medical service that qualifies for a Medicare benefit you must:

  • hold current registration with the Medical Board of Australia
  • have a current Medicare provider number for the practice the service is provided by
  • meet eligibility requirements as set out in the Health Insurance Act 1973

Read more about Medicare benefits for health professionals.

You have legal obligations when you request or refer services under Medicare. There are certain conditions and timeframes associated with some services.

Read more about health professionals referring and requesting services under Medicare.

Register for HPOS  

Health Professional Online Services (HPOS) is a fast and secure way for health professionals and administrators to do business with us.

Read more about HPOS.

To register for HPOS you need a Provider Digital Access (PRODA) account.

Read more about PRODA.

Once you’re registered for HPOS, you can do business with us online, including:

Manage your practice

Your practice should use systems and processes that are efficient and reduce risk.

Make sure you manage your records and comply with relevant legislation and guidelines.

We do compliance audits and reviews for:

  • the Medicare Benefits Schedule (MBS)
  • the Pharmaceutical Benefits Scheme (PBS)
  • the Child Dental Benefits Schedule (CDBS)

The Department of Health (Health) audits the Practice Incentives Program (PIP).

You may receive a penalty if you haven’t met the requirements.

Read more about health provider compliance audits and reviews on the Department of Health website.

Use Health’s Medicare Billing Assurance Toolkit to help you:

  • manage the factors that can cause you to bill incorrectly under Medicare
  • understand what documents you can use to verify services for an audit or review

You can also choose how you’re going to claim under Medicare.

Read more about the online options for health professionals.

Order prescription forms  

We supply prescription forms for the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme (RPBS) to eligible prescribers free of charge.

Read more about ordering PBS and RPBS forms.

Find out about insurance

There are insurance schemes designed to suit the needs of health practitioners.

The Medical Indemnity Act 2002 provides financial support for medical practitioners to help keep medical indemnity insurance premiums affordable. This helps to make medical services available.

Read more about medical indemnity for insurers or the Midwife Professional Indemnity Scheme for midwives.

Access education resources

We have guides and other resources available to help you understand our health programs and do business with us.

Read more about Education services for health professionals.

Page last updated: 19 December 2017