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

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?

• Yes, enter the first 6 digits in the Search ID field under Basic Search and press Search
• No, see Processing provider number applications for Interns in Medicare to create 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.

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

• 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.

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

If no match:

• select Manual entry
• key details from the application

If the health professional submits the application by:

• Manual application, go to Step 2
• HPOS online, go to Step 3

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 by:
• 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.

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

• 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 by:
• 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

• 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

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.

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.

To locate a provider’s 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.

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.

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

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 provider’s date of birth to the search function

Is there a PDS match for the medical practitioner?

• Yes, go to Step 3
• No, go to Step 2

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.

In PDS:

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

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 provider’s date of birth to the search function
• Select the relevant match

• 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 provider’s 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

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 provider’s date of birth to the search function
• Select the relevant match
• Select the orange hyperlink at the top of the stem page

• 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.

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:
• application form states the practice is a UCC, and
• the location is listed within the Medicare Urgent Care Clinics (UCC) Directions under Subsection 19(2)
• 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:

• due to an exception circumstance, go to Step 2
• not due to an exceptional circumstance, go to Step 3

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

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.

Check that the request meets closure request criteria:

• an email (only) from the health professionals accrediting body
• a signed written request from the health professional
• a phone call from the health professional or their authorised representative. See Perform telephone security check for Medicare health professionals

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

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

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

• 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

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.

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:

• Health Professional Online Services (HPOS), the preferred option, or
• Signed written request from the health professional, or
• Phone call from the health professional or an authorised representative. Perform telephone security check for Medicare health professionals

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

• 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?

• Yes, go to Step 4
• No, go to Step 5

• 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.

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.

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 Service Delivery Support Team (PESDST) - Pathology Team when a new Accredited Pathology Laboratory (APL) approval is granted at the same location as an existing APL the provider is linked to for billing purposes

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?

• Yes,
• requests for a Medicare UCC/PPCC clinic, issue a second provider number as per Medicare Urgent Care Clinics (UCC)
• requests for a GPRC clinic, issue a second provider number as per General Practitioner Respiratory Clinics (GPRC)
• if one of the other conditions have been met, issue a second provider number for the address, making sure the relevant field is changed which differentiates the 2 provider numbers. Add relevant note to PaNDA
• No, go to Step 2

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

• 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

Requests can be received by:

• Signed written request from health professional . Go to Step 2
• Phone call from health professional or authorised representative
• Perform telephone security check for Medicare health professionals
• Go to Step 3

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 match 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:
• applicant’s details are incomplete, or
• address is not a valid address

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

• 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

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:

• create a new work item
• upload the letter in PaNDA
• update the work status to Complete

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.