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Provider numbers for health professionals in Medicare and the Provider Directory System (PDS) 012-42010010



This document explains details on provider numbers for health professionals in Medicare. It also provides details about the Provider Directory System (PDS) and describes the exceptional circumstances for expediting provider number applications.

On this page:

Search for a provider

Troubleshoot problems with address entries

Incomplete, inconsistent, or rejected applications

Letters and attachments

HPOS Messaging for Provider Registration applications

Checking registration in the Ahpra window and on the Ahpra website

Provider stem created in error

Provider number location created in error

Request for priority Provider Registration application

Remove a registration and close a provider number stem

Close a provider number location only

Issuing a second provider number at the same street address

Request for duplicate confirmation letters

Search for a provider

Table 1: this table shows how to use the provider search facility in PDS.

Step

Action

1

Check PDS + Read more ...

Open PDS and Select:

  • Provider
  • View
  • Key the practitioner’s surname in the appropriate field with a % sign either side (this is a wild card function)
  • Key the practitioner’s first name in the applicable field with a % sign at the end of the name
  • Select Profession
  • Select Search, if the search returns multiple results add the providers date of birth to the search function

Assess the search results returned:

  • Select View, this will open the provider’s stem page
  • Assess the search results returned:
    • select view to open the provider’s file

Has the medical practitioner provided or quoted a provider number?

Note: to check for issued locations see the top of the PDS page. Select the provider stem hyperlink to open a list of provider numbers issued to the practitioner.

Troubleshoot problems with address entries

Table 2: this table provides a checklist to troubleshoot any problems when using the rapid addressing tool to update addresses in PDS.

Step

Action

1

Determine type of problem + Read more ...

If the location listed on the application does not appear after entering the post code quoted go to Step 2.

2

Location listed on the application does not appear when using RAET + Read more ...

  • Key the suburb as quoted on the application form
  • Select from the dropdown box
  • Address line key as per application and select as per RAET
  • Procedure ends here

If the locality still does not appear, go to Step 3.

3

Locality still does not appear + Read more ...

Check Google using the practice name and update the location details.

If no match:

  • select Manual entry
  • key details from the application

Incomplete, inconsistent, or rejected applications

Table 3: this table shows how to action an incomplete, inconsistent or rejected application.

Step

Action

1

Application + Read more ...

If the health professional submits the application by:

2

Issuing a return letter to the provider for a manual application + Read more ...

Return using Provider Registration - we need more information (Z2306) letter or Provider Registration - Reject (Z2305) letter and where appropriate include a copy of the submitted documents.

  • Complete appropriate fields of letter template
  • Save letter as a PDF
  • Upload letter to PaNDA
  • Issue the letter to the provider via:
    • Post and
    • HPOS if the provider has an active HPOS account. See Table 5
  • In PaNDA, make sure the Surname First Name, Provider Number and Case ID fields are complete and correct
  • Add appropriate notes to the PaNDA file
  • Select Complete
  • Select Save

Note: there may be more than one reason the application cannot be processed. It is important that all the reasons are communicated to the provider.

3

Issuing a digital return letter to the provider via HPOS + Read more ...

If more details or supporting documents are needed:

In PDS

  • Select Reject
  • Select the reason for rejecting from the dropdown box
  • A letter will create and send to the provider’s HPOS mailbox

In PaNDA

  • Make sure the following are complete and correct:
    • Surname First Name
    • Provider Number, and
    • Case ID fields
  • Add any appropriate notes to the PaNDA file
  • Select Complete > Save

Letters and attachments

Table 4: this table shows how to save letters and attachments and the appropriate naming conventions.

Step

Action

1

Letters + Read more ...

  • Complete appropriate fields of the required letter template
  • Save the letter as a PDF in the Customer Information folder on your teams secure drive with the naming convention [INITIALS].[SURNAMEFIRSTNAME].LETTER
  • In cases where multiple documents need to be saved for the one application, further detail should be added to the file name to differentiate each document’. For example:
    • [INITIALS].[SURNAMEFIRSTNAME].LETTER
    • [INITIALS].[SURNAMEFIRSTNAME].DHAC DECISION
    • [INITIALS].[SURNAMEFIRSTNAME].AHPRA
  • Upload letter to PaNDA
  • Issue the letter to the provider via:
    • Post, and
    • HPOS if the provider has an active HPOS account. See Table 5
  • Once the letter has been uploaded to PaNDA, delete the PDF from the Customer Information folder.

2

Attachments - Screenshots + Read more ...

  • Screenshots may be required to be saved and uploaded to PaNDA when assessing applications. For example, AHPRA registration and/or confirmation of address
  • When saving a screen shot and/or an attachment for uploading to PaNDA:
    • save the screen shot and/or attachment as a PDF in the Customer Information folder on the teams secure drive
    • name the screen shot and/or attachment with the following convention, [INITIALS].[SURNAMEFIRSTNAME].[DOCUMENT TYPE]
  • In cases where multiple documents need to be saved for the one application, add further detail to the file name to differentiate each document. For example:
    • [INITIALS].[SURNAMEFIRSTNAME].LETTER
    • [INITIALS].[SURNAMEFIRSTNAME].DHAC DECISION
    • [INITIALS].[SURNAMEFIRSTNAME].AHPRA
  • Upload to PaNDA. Once the screen shot has been uploaded to PaNDA, delete the PDF from the Customer Information folder.

HPOS Messaging for Provider Registration applications

Table 5: this table shows how to identify a providers HPOS status, find a PRODA RA number to send HPOS messaging and how to send a HPOS message.

Step

Action

1

Create the letter + Read more ...

Create the manual letter and save as a PDF.

Confirm if application type and letter type are in scope for send as a HPOS message - See Resources page Tables 3 and 4.

2

Checking the Provider HPOS status in PDS + Read more ...

The HPOS Registration field in PDS shows the provider's status:

  • Active - the provider has logged into HPOS in the last 6 months
  • Inactive - the provider has not logged into HPOS in the last 6 months
  • None - the provider does not have a HPOS account linked to their provider number/s

Only providers with an active HPOS status can have a message sent via HPOS.

3

Locate the provider's PRODA RA number + Read more ...

To locate a providers PRODA RA number:

  • log into PRODA - Provider Digital Access in the Medicare Portal/eBusiness system using the local source office
  • enter the provider's first name, surname and date of birth in the Demographic Search field
  • select Search

The PRODA RA number will appear under the Account details.

4

Sending a HPOS message + Read more ...

To send an HPOS message access the HPOS support function via the Medicare portal/eBusiness system. Use the usual source office.

  • from Mail Centre select Medicare > Compose New Email
  • enter the Provider's PRODA RA number in the To field
  • copy the text for the subject line and text boxes from the Z3014 template. See the Provider Registration page.
    • Subject line: Your Medicare provider registration application has been processed
    • Text box: This message is from Services Australia. Please read the attached letter about the outcome of your Medicare provider registration application
  • select Choose File
  • attach a copy of the required PDF letter
  • select Add file
    • repeat this process if any additional attachments are needed
  • select Send

Note: providers can see the attached file name.

If sending multiple documents, where possible merge all documents into one file using the naming conventions outlined in Table 4.

5

Document the letter + Read more ...

Add a processing note in the PaNDA work item of the action taken. For example, letter was sent to provider via HPOS and post.

Checking registration in the Ahpra window and on the Ahpra website

Table 6: this table shows how to access the Ahpra window and search the Ahpra website.

Step

Action

1

Check PDS + Read more ...

Open PDS:

  • Select Provider > View > Detailed Search
  • In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
  • In the Given name key the practitioner’s first name with a % sign at the end of the name
  • Select Profession > Search
  • A list of health professionals with a matching name shows. If the search returns multiple results, add the providers date of birth to the search function

Is there a PDS match for the medical practitioner?

2

Search the Ahpra website + Read more ...

The Resources page contains a link to the Ahpra website.

Use the look up a health practitioner function by searching either the Ahpra registration number or by the health practitioner’s name.

3

Check health professional's details + Read more ...

In PDS:

  • Select View against the matching health professional's details
  • Select the Unique Identifier hyperlink
  • The Ahpra Information window will show

Provider stem created in error

Table 7: this table shows how to close a provider stem that has been created in error.

Step

Action

1

Check PDS + Read more ...

Open PDS:

  • Select Provider > View > Detailed Search
  • In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
  • In the Given name key the practitioner’s first name with a % sign at the end of the name
  • Select Profession > Search
  • A list of health professionals with a matching name shows. If the search returns multiple results add the providers date of birth to the search function
  • Select the relevant match

2

Closing provider stem + Read more ...

  • Select Edit > Speciality Tab
  • Select Amend on Specialty Code
  • Enter the Start Date of the specialty code into the End Date for all specialty codes
  • Select Notes Tab > New Note
  • In the Notes Subject field key Provider Stem Issued in error for [insert provider name]
  • In the Notes Description key Provider Stem Issued in error, reuse for <insert provider name> when provider submits a completed and eligible provider number request
  • Select Save

All other fields do not require any amendments. The providers full name, date of birth and registration details to be keyed accurately from the Ahpra window or application and supporting documents for non-Ahpra registered health professionals.

If a prescriber number was issued in error, contact Local Peer Support (LPS). LPS will escalate to a Program Officer to remove the prescriber number from the provider stem.

Was there a provider number(s) created in error?

  • Yes, see Table 8
  • No, procedure ends here

Provider number location created in error

Table 8: this table shows how to close a provider number that has been created in error.

Step

Action

1

Check PDS + Read more ...

Open PDS:

  • Select Provider > View > Detailed Search
  • In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
  • In the Given name key the practitioner’s first name with a % sign at the end of the name
  • Select Profession > Search
  • A list of health professionals with a matching name shows. If the search returns multiple results add the providers date of birth to the search function
  • Select the relevant match
  • Select the orange hyperlink at the top of the stem page

2

Closing provider number + Read more ...

  • Select Edit > Clear
  • Locality or post code key the states capital city for the provider number that was issued. For example, 6000 Perth 3000 Melbourne
  • Address line - key issued in error
  • Building or department - key issued in error
  • Select contact tab
  • Remove phone fax and email address if present
  • Location end - date key same as location start date
  • Select Loc-Spec Codes tab> Add Service Rule
  • In Service Rule Number field, key 618
  • In the Activity Code field, select Yes
  • Enter the Start Date of the location
  • In End Date, leave blank
  • Select Add New > Cancel > Save

If business structure and/or bank account details were saved to the location, contact Local Peer Support (LPS) who will raise the location to a Program Officer to remove the business structure and/or bank account details from the location.

Request for priority Provider Registration application

Table 9: this table explains the process for prioritising an assessment.

Step

Action

1

Check priority reason + Read more ...

If a health professional or third party calls and asks for their application to be prioritised, staff must find out the reasons. Applications can be prioritised if an exceptional circumstance applies.

An exceptional circumstance applies if the provider is ineligible or unable to apply online and one or more of the following applies:

  • the only health professional in a community or rural/remote practice leaves, and an urgent replacement health professional is required
  • a disaster has occurred, and:
    • caused damage to a practice, and the affected health professional(s) need to relocate, or
    • the community needs urgent health care near the disaster
  • a medical practitioner has reached their scaling end-date but is unable to create locations via HPOS due to a future moratorium end-date
  • a foreign graduate of an Australian medical school (with post-graduate qualifications) is unable to create provider numbers with access to Medicare benefits via HPOS, at locations which are eligible for the following:
    • Northern Territory class exemption
    • Specialist class exemption
    • Distribution Priority Area class exemption
    • District of Workforce Shortage class exemption
  • a health professional is unable to use HPOS to create a location which returns an MM classification of 6 or 7 on the Health Workforce Locator map. To determine this:
    • go to the Health Workforce Locator
    • select Modified Monash Model 2019
    • key the practice address
    • select Search
    • the map will show an MM classification from 1 to 7
  • a health professional working in an Urgent Care Clinic (UCC) approved by a Primary Health Network, state government or territory government if:
  • a health professional gets the following error message when applying through HPOS
    ‘Locality limit exceeded (no more than 24 characters exceeded)’

Note: Medicare UCCs complement existing state-run emergency diversion initiatives.

If the reason is:

2

Exceptional circumstance + Read more ...

When the reason is due to an exceptional circumstance, staff must:

  • add a note to the relevant PaNDA file with details of the request to process an application quicker, and the reason for approving
  • process the application, if scheduled on processing, or
  • contact the Team Leader via email and ask for the application to be processed by an available operator, if not scheduled on processing

3

Not an exceptional circumstance + Read more ...

When the reason is not due to an exceptional circumstance, staff must:

  • tell the caller, 'For procedural fairness, applications are assessed in the order we receive them.
  • add a note to the relevant PaNDA file with details of the request to process an application quicker, and the reason for not approving

A caller may say they want to make a complaint about an unfavourable decision and/or the time taken to process an application. If they do, tell them to contact Medicare Complaints by submitting an online or written complaint. The caller can do this by searching ‘complaint’ on the agency website for details.

Remove a registration and close a provider number stem

Table 10: this table explains the process to remove a registration and close a provider number.

Step

Action

1

Assess the request and locate health professional in the PDS + Read more ...

Check that the request meets closure request criteria:

If the closure request is from a representative of an estate where the health professional is deceased, escalate to a Program Officer through Local Peer Support (LPS)

To locate the health professional in the Provider Directory System (PDS):

  • Open the PDS
  • Search for the health professional using the existing stem or name provided

Note: for the End date fields in the following steps, use the:

  • date advised/requested, or
  • date of receipt of advice

2

Check member's registration + Read more ...

In PDS scroll to the bottom of the Provider Stem record to view the Specialty codes

Is if the Registration line present or current (no end date listed)?

  • Yes, go to the Step 3
  • No,
    • add a processing note
    • select Complete
    • select Save
    • procedure ends here

3

End date the registration + Read more ...

In the Registration tab:

  • Select Amend under the current registration line
  • Change the Status field from Current to Other
  • Key the End Date field as the day before the advice was received
  • Enter the reason for closure in Comments field, for example 'AASW advised no longer eligible DD.MM.YYYY'
  • Select Update
  • Select Save

4

Make a Note + Read more ...

  • In the Notes tab:
  • Select New Note
  • Key 'Closure of provider number' in Subject
  • in Description key the details of the reason for the closure. Include:
    • how closure was communicated to Services Australia
    • date received, and
    • any other information that should be recorded. For example, deceased
  • Select Save

5

Issue confirmation letter and finalise + Read more ...

A confirmation letter must be sent to all applicants advising the outcome of their application.

  • Select and complete the appropriate letter template from the letters template index. See Letters in Allied health and non-medical health professionals' provider number applications and requests
  • Convert the letter to PDF format and Save the letter to the Customer Information folder on your teams secure drive
  • Upload the letter to the original file making sure that the file name is correct. See Associate document to a work item in Processing and National Demand Allocation (PaNDA)
  • Select Save
  • Print the letter and send it to the provider by:
    • Post, and
    • HPOS, if the provider has an active HPOS account
  • Select Complete
  • Select Save
  • Close the file
  • File the application as processed in line with current workflow procedures

Note: letters must be converted to PDF before attaching to the application.

Close a provider number location only

Table 11: this table explains how to close a provider number location only

Step

Action

1

Request to close provider number + Read more ...

Encourage the health professional to close location using HPOS where request received by telephone.

Requests to close a provider number for a specific location can only be received by the following:

2

Locate the health professional in the Provider Directory System (PDS) + Read more ...

  • Open PDS
  • Search for the health professional using the existing stem or name provided

3

Locate and close location/s + Read more ...

  • Go to the Provider Location View page. This page lists locations the health professional has opened
  • Locate the location to be closed, and select the Amend hyperlink
  • On the Contact tab, enter one of the below in the Location End Date field:
    • Future date, where the future date was requested by email or a signed written request
    • Date of lodgement or date of telephone call, where either no date has been provided or the date is in the past
      Note: provider locations cannot be closed retrospectively
  • Select Save

Repeat this process to close any additional locations.

Has the request been received by telephone?

4

Make a note in the PDS record for telephone request + Read more ...

  • Go to the Provider Stem and select Amend page
  • Select the Note tab
  • Select New Note
  • In the Notes Subject key 'Closure of [insert location provider number]'
  • In the Notes Description key 'Location closed at the request of the health professional on [date of call] at [time of call]'
  • Do not send a confirmation letter when actioning a closure from a phone request

Procedure ends here.

5

Issue confirmation letter and finalise for written request + Read more ...

A confirmation letter must be sent to all applicants advising the outcome of their application.

  • Select and complete the appropriate letter template from the letters template index. See Letters in Allied health and non-medical health professionals' provider number applications and requests
  • Convert the letter to PDF format and Save the letter to the Customer Information folder on your teams secure drive
  • Upload to the original file make sure that the file name is correct. See Associate document to a work item in Processing and National Demand Allocation (PaNDA)
  • Print the letter and send the letter to the provider by:
    • Post, and
    • HPOS, if the provider has an active HPOS account
  • Add appropriate notes to the PaNDA file
  • Select Complete
  • Select Save

Note: letters must be converted to PDF before attaching to the application.

Issuing a second provider number at the same street address

Table 12: this table explains the process to issue a second provider number at the same street address.

Step

Action

1

Health professional requests a second provider number for the same location + Read more ...

A second provider number for the same health professional can be issued at the same street address where one of the below conditions are met:

  • The suite/floor/shop number or department the health professional is working in is different
  • The business name is different
  • A differing ABN is provided in the application
  • A second 3GA placement different from the first is received
  • A medical centre is located is located within hospital facility/grounds
  • Specific services are provided, for example, angiography, where the cardiologist provides both surgical and radiological service, yet the radiology service is to be paid to the radiology practice
  • Health professional is working at an approved Medicare Urgent Care Clinic (UCC) or Priority Primary Care Centre (PPCC)
  • Government funded General Practitioner Respiratory Clinic (GPRC), or
  • location under a section 19(2) or 19(5) direction where the second provider number is to be used for any after-hours services
  • A request escalated from the Provider Engagement - Pathology Team as the health professional is a new Approved Pathology Practitioner (APP) and requires a separate provider number to provide pathology services

Note: Medicare benefit payments for these after-hours services are not paid to the relevant community or organisation but instead are paid to the health professional

Is the health professional requesting a second provider number for one of the reasons above?

2

Duplicate application or not an approved reason for a second provider number + Read more ...

Check the details of the location in PDS (for example, start date/end date requested access, etc.) against the details of the application.

Has a provider number application already been completed for this location?

  • Yes,
    • use discretion to determine if the application is a true duplicate and if information needs to be updated in PDS
    • use discretion to determine if a confirmation letter is needed to confirm the location
    • escalate to a LPS if unsure
    • add appropriate comments to the PaNDA file
    • make sure the Surname, First Name, Provider Number and Case ID fields are complete and correct
    • Select Complete
    • Select Already Complete
    • Select Save or Save and Next, as appropriate
  • No, go to Step 3

3

Not an approved reason for a second provider number + Read more ...

  • Return a copy of the submitted documents using the reject letter template Z2305
  • Save the letter as a PDF to the Customer Information folder on your teams secure drive
  • Upload the letter to the PaNDA file
  • Make sure the Surname, First Name, Provider Number and Case ID fields are complete and correct
  • Print the letter and send the letter to the provider by:
    • Post, and
    • HPOS, if the provider has an active HPOS account Select Complete
  • Select Request Rejected
  • Select Save or Save and Next, as appropriate

Request for duplicate confirmation letters

Table 13: this table explains how to process requests for duplicate confirmation letters.

Step

Action

1

Duplicate letter request + Read more ...

Requests can be received by:

2

Written request - work item through PaNDA + Read more ...

Check the request:

  • Is the request signed by the health professional?. If not signed, check if it was sent from the email address recorded on the Provider Stem
  • Does the provider number and/or address matches details in PDS?

If the returned mail indicator is selected, update the details with the provided information.

If the details:

  • match, go to Step 3
  • do not match, or any aspect of the request is incomplete, return the request selecting the most appropriate reason/s from the Incomplete letter template. For example the:
    • applicants details are incomplete, or
    • address is not a valid address

For a link to the current letter templates see Provider Registration letters.

3

Retrieve the original letter from PaNDA + Read more ...

  • Conduct a search with appropriate work type and surname
    See Processing and National Demand Allocation (PaNDA)
  • Select the record and make sure the letter is for the appropriate location
  • Print the letter and send the letter to the provider by:
    • Post, and
    • HPOS, if the provider has an active HPOS account
  • Add appropriate notes to the PaNDA file
  • Select Complete
  • Select Save
  • Add a note indicating the work ID of the original letter (if written request received)
  • Update work status to Complete
  • Select Save or Save and Next as appropriate

4

Original letter cannot be located in PaNDA + Read more ...

If unable to locate the original letter in PaNDA, generate a new letter with the appropriate letter template.

If a written request is received:

  • upload the letter to the current work item in PaNDA
  • update the work status to Complete
  • Select Save or Save and Next as appropriate

If the enquiry is by telephone:

Send the letter. Print the letter and send the letter to the health professional at the nominated address by:

  • Post, and
  • HPOS, if the provider has an active HPOS account

Add an appropriate notes to the PaNDA file

  • Select Complete
  • Select Save

If this is not supplied, send it to the preferred mailing address on Provider Stem.