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Provider location details for health professionals in Medicare 012-42010020

This document explains details on provider number location details for health professionals in Medicare.

Issuing 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 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, If the request is for a Medicare UCC/PPCC clinic, issue a second provider number for a UCC as per Medicare Urgent Care Clinics (UCC) If the request is for a GPRC clinic, issue a second provider number for a GPRC 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
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, Service Officers should use discretion to make a determination on whether the application is a true duplicate and if information is needed to be updated within PDS. Service Officers should also use discretion to determine if a confirmation letter confirming the locations is needed If unsure, Service Officers should escalate to a LPS Add any appropriate comments to the PaNDA file Make sure the Surname, First Name, Provider Number and Case ID fields are completed 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 using the reject letter template Z2305 and include a copy of the submitted documents Complete the appropriate fields of the letter template Save the letter as a PDF to the Customer Information folder on the teams secure drive Upload the letter to PaNDA In PaNDA, make sure the Surname, First Name, Provider Number and Case ID fields are completed and correct Print the letter and send to the medical practitioner Send the letter to the provider via: Post, and HPOS, if the provider has an active HPOS account Add any appropriate notes to the PaNDA file Select Complete Select Request Rejected Select Save or Save and Next, as appropriate