Recognition as a specialist or consultant physician for Medicare 012-42020100

This document explains details about recognition as a specialist or consultant physician for Medicare. Specialist recognition allows recognised medical practitioners to access specialist or consultant physician attendance items in the Medicare Benefits Schedule (MBS).

It also allows access to other relevant items in the MBS for recognised specialists or consultant physicians registered for Medicare purposes in a particular specialty.

Step	Action
1	Assess the paperwork + Read more ... Open the file. The notification will include a college banner (a list of approved colleges is included on the Resources page). An application form is not required to assess and process a 3D notification. Make sure the notification is complete. 3D notices must include the following details: The college that issued the notification The college makes reference to section 3D in the notice Name of applicant Applicant's date of birth Postal address (needs to be an Australian address. If there is no Australian address on the 3D notification or on the provider stem, evidence is needed to support the applicant will be working in Australia. For example, current provider number/s or an application for a provider number is identified in PaNDA) Specialty being requested for recognition Date of fellowship being awarded If it is: complete, go to Step 2 incomplete, go to Table 11 Note: if the 3D notification cannot be processed, the medical practitioner will need to apply through HPOS or the HW077 application form.
2	Check the Provider Directory System (PDS) + Read more ... Open PDS: Select Provider > View > Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Select profession in from the dropdown list in profession field Select Search A list of health professionals with matching details will show Select View against the medical practitioner that matches the application Does the applicant appear in the list of health professionals? Yes, go to Step 3 No, go to Table 11
3	Check PDS to make sure specialist recognition has not already been granted + Read more ... To check, view provider stem under the specialty code section to see if the specialty requested is listed on PDS record. Note: medical practitioner may have more than one specialty. If the requested specialty is not listed, go to Step 4. If the requested specialty is listed, check the start date of the specialty. Is backdating required? Yes, go to Table 14 No, add notes to PaNDA referencing the original work ID used to process the speciality, note the file as a duplicate, and mark the file as complete. If the original PaNDA file cannot be located, contact Local Peer Support (LPS) who will contact a Program Officer (PO) to check for the original email
4	Permanent residence + Read more ... Check PDS. Is the medical practitioner a permanent resident? Yes, go to Step 5 No, return using template Z2266 Your application for recognition as a specialist and consultant physician is not approved. Go to Table 11
5	Medical registration + Read more ... Check the Australian Health Practitioner Regulation Agency (Ahpra) website or unique identifier link if available. Does the practitioner have a current medical registration? Yes, go to Step 6 Note: registration can include general registration, limited, provisional or specialist No, go to Table 11
6	Medical practitioner subject to Section 19AB + Read more ... Check stem for specialty codes 180, 181, 500 and/or 519. Is the medical practitioner subject to section 19AB? Yes, Identify if there is a valid section 19AB exemption(s)/section 19AB class exemption(s) at all open locations Take note of any locations without a valid section 19AB exemption/section 19AB class exemption. This will be needed in the processing step at Table 2 > Step 1 Go to Step 7 No, go to Step 7
7	Dual recognition + Read more ... Check the stem for specialty code 104, 130, 132, 532, 530, 540 or a registered approved 3GA placement at any open location. Is the medical practitioner working as a general practitioner? Yes, the medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem The dual recognition effective date will be the same date specialist recognition is granted See Dual recognition of medical practitioners for Medicare No, the medical practitioner is not eligible for dual recognition
8	Vocational Recognition + Read more ... Check for VR specialty code 104, 130, 132, 532, 530, 540 or a registered approved 3GA placement. Is the medical practitioner endorsed to give Mental Health Skills Training (MHST), Non-directive Pregnancy Support Counselling (PSC), or Focussed Psychological Strategies (FPS)? Yes, the medical practitioner remains eligible to access the MHST, PSC or FPS items. VR specialty codes 647, 648, 649 or 650 will remain open No, the medical practitioner is not eligible to access the MHST, PSC or FPS items. Specialty codes 647, 648, 649 or 650 need to be end dated. These are GP items and not specialist items. See Table 2 > Step 1 for date of effect. See: Mental Health Skills Training (MHST) for medical practitioners Non-Directive Pregnancy Support Counselling (PSC) - medical practitioners Focussed psychological strategies for medical practitioners Note: a medical practitioner may be eligible to access MHST, PSC and FPS through the non-VR specialty codes 662, 664 and 665.

Process specialist recognition 3D notification

Table 2: this table explains how Service Officers process 3D notifications received directly from eligible colleges in PDS.

Step	Action
1	Amend details on provider stem + Read more ... Select relevant tab at top of page for editing. Qualifications Tab Key the college acronym (for example, Australasian and New Zealand college of Anaesthetists (FANZCA)) next to current qualifications. F stands for fellowship and should always be the first alpha character Contact Tab Do not update stem with contact details from college notification Send the confirmation letter to the address provided on the 3D notification Registration Tab If an AUS registration line is not present: End the current state registration line the day before processing Key a new AUS registration line using the details on the Ahpra website ensuring no gap in registration where not applicable Note: if the registration status needs amending, take a screenshot of the search result and add to the file. If there are notes in the registration requirements section on the Ahpra website, read carefully and assess. For help, contact Local Peer Support (LPS). Specialty Code tab If the registration status is Current, add specialty code (see the Resources page for a list of specialties and the associate specialty code). Key the date of effect from college notification. Date of effect can be no earlier than the date fellowship was awarded. Medical practitioners with Australasian fellowship are granted specialist recognition indefinitely. Once a medical practitioner becomes a specialist, they can no longer be identified as a non specialist. Any 19AB exemption/s granted previously for non specialist is revoked. Does the medical practitioner have an open specialty code 180 on stem? Yes, key the date before the start date of specialist recognition or Ahpra specialist recognition (whichever is the earlier) in the End Date field of specialty code 180 on stem check for any open provider locations issued for non specialist, such as DPA class exemption or temporary resident After-hours class exemption. Key the date before the start date of specialist recognition or Ahpra specialist registration (whichever is the earlier) in the End Date field of specialty code 519 at the location No, go to Step 2
2	Dual recognition + Read more ... Were specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location identified during the assessment step? Yes, the medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem. Apply dual recognition in line with the date specialist recognition is granted. See Dual recognition of medical practitioners for Medicare No, the medical practitioner is not eligible for dual recognition
3	MHST, PSC or FPS specialty codes + Read more ... Were VR specialty codes 647, 648, 649 and/or 650 or non-VR specialty codes 662, 663, 664 and/or 665 identified during the assessment step? Yes, check for specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice If one of these specialty codes is current, the medical practitioner remains eligible to access the MHST, PSC and/or FPS items If the medical practitioner does not have one of these codes, or they have been end-dated in the past, the medical practitioner is not eligible to access MHST, PSC and/or FPS items. The MHST, PSC and/or FPS specialty code/s will need to be end-dated the day before the specialist recognition date of effect Go to Step 4 No, go to Step 4
4	Section 19AB + Read more ... Is the medical practitioner subject to section 19AB? Yes, Go to the Notes tab on PDS Key note subject - Specialist recognition 19AB exemptions required Key note description - Granted specialist recognition. As Dr is subject to 19AB, an exemption is required to access Medicare benefits. Locations without an existing exemption have been service ruled Add the following comment to the end of the registration line: Granted specialist recognition subject to 19AB. See notes Go to Step 5 No, go to Step 7
5	Provider Service Rule (PSR) + Read more ... Apply a Provider Service Rule (PSR) to any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Check all locations for a current 519 specialty code and/or class exemption flag. Note: apply a 519 specialty code to location where a flag is identified. To add PSR, select: Amend corresponding to the relevant provider number Loc-Service Rules tab Add Service Rule Add Service Rule: if a current 181 was identified in Step 1 (with a current 500/519): Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank if 110 was identified in Step 1 (with a current 500/519) and the location has business structure and EFT details keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and In the End Date field, key the end of the 500 specialty code (Ten Year Moratorium - Medicare Benefits Not Payable) if 110 was identified in Step 1 (with a current 500/519) and the location does not have business structure and EFT keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank Select Add New > Save Repeat this process for all locations which do not have a current 19AB exemption or class exemption. This action will prevent Medicare claims paid at locations where a valid 19AB exemption is not in place. Note: add a service rule 569 where an assistance at operations exemption applies. Do not add a 618 PSR where assistance at operations access is required. Does the medical practitioner have current 19AB exemptions at any open locations? Yes, go to Step 6 No, go to Step 7
6	19AB exemptions current at location/s + Read more ... Where the Service Officer identifies a current 19AB exemption is recorded against a provider number, the Service Officer must identify if the medical practitioner is required to apply for a new 19AB exemption as a specialist.
7	Confirmation letter + Read more ... See Resources page for appropriate letter options. Send letter template Z2264 Recognition as a specialist and consultant physician is approved Staff must: Complete relevant fields Save the letter as a PDF to the Customer Information folder on their team's secure drive Print the letter Upload the letter to PaNDA Make sure the Surname, First Name, Provider Number and Case ID fields are completed and correct Add note to PaNDA file to indicate application was processed under section 3D and any other notes specific to the processing Select Complete Select Save Send the letter to the provider by: post, and HPOS, if the provider has an active HPOS account

Assess an application for specialist recognition 3DB received through HPOS

Table 3: this table explains how to assess a specialist and/or consultant physician 3DB application submitted through HPOS. This process commences after a Service Officer has been allocated a HPOS pending registration work item in PaNDA.

Step	Action
1	Assessing the paperwork + Read more ... Open the application in PaNDA. Make sure the application includes: Residency status The specialty(ies) in which recognition is sought If an Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) or via HPOS is received with the Application for recognition as a specialist or consultant physician, make sure this application is also completed in full. Note: ensure all documentation has been received. Is the application complete? Yes, go to Step 2 No, return the application. See Table 11
2	Locate pending registration + Read more ... Go to the Provider Directory System (PDS) Select Work items > Pending Registrations Select View for the health professional that matches the PaNDA work item Select View to open Pending Registration Supporting Documents Note: if unable to identify the health professional, contact Local Peer Support (LPS).
3	Check PDS + Read more ... Open PDS: Select Provider > View > Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Enter date of birth in Date of Birth field Select Search. A list of health professionals with a matching name shows Select View against the medical practitioner's name that matches the application Does the applicant appear in the list of health professionals? Yes, go to Step 4 No, check PaNDA for an application submitted via HPOS or ‘Application for a Medicare provider number and, or prescriber number for a medical practitioner’ form (HW019) and if available, associate documents in PaNDA. Both applications can then be assessed together Note: If an Application for a Medicare provider cannot be located in PaNDA and the medical practitioner is not registered in PDS make one phone call to the medical practitioner advising they must send a HW019 form or use HPOS to submit an online application for an initial provider number. If contact is made: If submitting using HPOS: Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted If submitting using HW019: Ask for the email address sender will use, or Ask that the sender quotes the doctors name in the subject line Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted Leave notes ‘Awaiting application - application to be sent by (DD/MM/YYYY)’. Also include the sender email address where applicable to help inbox searches Pend the application ‘validate information’ and un-assign the work item Once released back into the queue check PaNDA for the application. If unable to locate the HW019, request an inbox search If contact is not made: The medical practitioner cannot be contacted or has not provided an online application or HW019 application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without a Medicare provider number. See Table 11 > Step 1 to return the application, or If an initial application is received, go to step 5
4	Check PDS to make sure specialist recognition has not already been granted + Read more ... To check, view provider stem under the Specialty Code section to see if the specialty requested is listed on the PDS record. Medical practitioners may have more than one specialty. If the: requested specialty is not listed, go to Step 5 specialty code is listed, check if: the medical practitioner has indicated their residency status has changed, or there is an end date against the specialty code The medical practitioner may be applying for an extension for the previously approved specialist recognition period. Is an end date recorded against current specialty code? Yes, go to Step 5 No, Compare the medical practitioner’s residency status on PDS to the documents they have supplied. If these do not match, go to Step 5 If the medical practitioner has submitted a new application, but specialist recognition has previously been processed, issue a confirmation letter using Z2269 Confirming your specialist/consultant physician status. Send the confirmation letter by Post and HPOS if the provider has an active HPOS account
5	Check the medical practitioner’s residency status on both application and PDS + Read more ... If the medical practitioner selected temporary resident, assess the application under 3E of the Act. See Table 7 for 3E assessment of a HPOS application. If the medical practitioner selected Permanent resident or Australian citizen, are they a permanent resident or Australian Citizen on PDS? Yes, continue to assess under 3DB. Go to Step 7 No, go to Step 6
6	Updating residency status + Read more ... If the medical practitioner selected either Australian Citizen or Permanent resident but the residency status is different on PDS, check evidence of residency status supplied (this may be a VISA document, Australian passport or Australian citizenship certificate). Note: evidence of residency status needs to be provided only if the residency status declared is different from residency status on PDS. If: evidence has been provided, go to Step 7 no evidence of residency is supplied, respond through HPOS mailbox to get the residency documents, or make one phone call to get the residency documents If contact is made, ask: for the email address sender will use, and that the sender quotes the doctors name in the subject line Leave note ‘Awaiting residency document - documents to be sent by (DD/MM/YYYY)’. Allow 2 days for the details to be supplied Pend the application ‘validate information’ Un-assign the work item Once released back into the queue check PaNDA for the application. If the Service Officer cannot locate the required documents, request an inbox search
7	Continue to assess the application + Read more ... Make sure all documents have been provided. If the fellowship certificate or letter options have been selected, make sure fellowship evidence from a Schedule 1 college is attached. See Resources page for colleges list. This should indicate the medical practitioner is qualified in the specialty being requested and the date fellowship was granted for that specialty. Check if the medical practitioner has requested more than one specialty but has only provided fellowship evidence in relation to one of those specialities. Has the medical practitioner supplied fellowship evidence from a Schedule 1 college or their Ahpra registration to support the additional specialty/ies? Yes, fellowship evidence supplied, go to Step 11 Ahpra registration supplied, go to Step 8 Ahpra registration supplied for and fellowship evidence supplied for different specialties, take note and go to Step 8 for assessing Ahpra registration No, return the application for the additional specialty/ies using letter Z2266 Your application for recognition as a specialist and consultant physician is not approved Medical practitioners with Australasian fellowship are granted specialist recognition indefinitely from the date of effect. Note: a fellowship letter from the ANZCA confirming the medical practitioner is ‘eligible for admission to fellowship of the college’ can be used as evidence of fellowship. If the medical practitioner has not supplied evidence of Schedule 1 college fellowship and they do not have specialist registration on Ahpra, go to Step 8.
8	If no evidence for Schedule 1 college fellowship supplied + Read more ... If the medical practitioner does not hold fellowship through a Schedule 1 college, check the Ahpra website or Ahpra window (if available) to confirm if the medical practitioner holds specialist registration for the specialty requested. Does the medical practitioner hold specialist registration for the specialty requested? Yes, the medical practitioner is eligible for specialist recognition, go to Step 10 No, go to Step 9 Note: fellowship obtained through the paediatrics and child health division of the RACP does not automatically mean the applicant is eligible for specialist recognition in general paediatrics. The specialty fields must state ‘general paediatrics’ on Ahpra in addition to the specialty reflecting ‘paediatrics and child health’.
9	Limited Ahpra registration + Read more ... Check Ahpra for limited registration. Confirm if registration includes the registration subtype Area of Need (AoN) - Ahpra notation including: Medical practitioner approved to work in a specialist position Which location/s Does the medical practitioner hold limited registration with the above eligibility requirements? Yes, go to Step 11 No, go to Step 10
10	Provisional Ahpra registration + Read more ... Specialist recognition can be processed for medical practitioners with the Aphra registration type: Provisional, Pathway: Competent Authority Pathway. Check Ahpra to see if medical practitioner is registered with provisional registration and confirm if on a Competent Authority Pathway (CAP). Ahpra Registration Requirements notation must state: Medical practitioner is approved to work in a specialist position Approved sites (location/s) Does the medical practitioner hold provisional registration with the above eligibility requirements? Yes, go to Step 11 No, application cannot be processed and will need to be returned using Z2266 Your application for recognition as a specialist and consultant physician is not approved. See Table 11 > Step 1 to return the application Note: specialist recognition cannot be processed if limited registration reflects a specialist pathway.
11	Medical practitioner subject to section 19AB + Read more ... Check stem for specialty codes 181, 500 and/or 519. Is the medical practitioner subject to section 19AB? Yes, Identify if there is a valid section 19AB exemption(s)/section 19AB class exemption(s) at all open locations Take note of any locations without a valid section 19AB exemption/section 19AB class exemption. This will be needed in the processing step at Table 4 > Step 11 Go to Step 12 No, go to Step 12
12	Dual recognition + Read more ... Check the stem for specialty code 104, 130, 132, 532, 530, 540 or an approved general practice 3GA placement open at any location. Is the medical practitioner working as a general practitioner? Yes, Take note the medical practitioner is eligible for dual recognition. Specialty code 165 will need to be added to stem in the processing step at Table 4 > Step 10 Go to Step 13 No, the medical practitioner is not eligible for dual recognition. Go to Step 13
13	MHST, PSC and FPS specialty codes + Read more ... Check the stem for Mental Health Skills Training (MHST), Non-directive Pregnancy Support Counselling (PSC), or Focussed Psychological Strategies (FPS) VR specialty codes 647, 648, 649 or 650 and non-VR specialty codes 662, 663, 664 or 665. Is the medical practitioner endorsed with MHST, PSC or FPS specialty codes? Yes, and the medical practitioner: has a specialty code 104, 130, 132, 532, 530, 540 or an approved 3GA placement open at any location. The medical practitioner remains eligible to access the MHST, PSC or FPS items. Go to Step 14 does not have an open 104, 130, 132, 532, 530, 540 or an approved 3GA placement open at any location. The medical practitioner is not eligible to access the MHST, PSC or FPS items. Take note of any specialty codes to be end dated during the processing step at Table 4 > Step 10. Go to Step 14 No, go to Step 14
14	Check address + Read more ... Check for an Australian address on the application. If there is an Australian address continue to assess the application under 3DB. If there is not an Australian address, check for evidence the medical practitioner will be working in Australia. For example, current provider number/s or an application for a provider number can be located in PaNDA. Is there an Australian address on the application or the provider stem? Yes, see Table 4 No, Return the application Do not process

Process an application for specialist recognition 3DB received through HPOS

Table 4: this table explains how Service Officers process 3DB applications received from a medical practitioner or their authorised representative.

Step	Action
1	Amend information on provider stem + Read more ... Check all personal, registration and specialty details on PDS against supporting documentation Select Approve Add comments ‘assessed under 3DB’ Select Approve
2	Residency Tab + Read more ... If a medical practitioner has supplied residency documents, see Processing a change in residency status for a medical practitioner for details on updates in residency.
3	Qualifications Tab + Read more ... Key the college acronym (for example, FANZCA for the Australasian and New Zealand college of Anaesthetists) next to current qualifications. F stands for fellowship and should always be the first alpha character. If the medical practitioner has not supplied a fellowship document, do not add an acronym.
4	Contact Tab + Read more ... Do not update/change contact information.
5	Registration Tab + Read more ... If an AUS registration line is not present: End the current state registration line the day before processing Enter a new AUS registration line using the details on the Ahpra website making sure there is no gap if none identified Note: if the registration status is to be amended take a screenshot of the search result and add to the file. If there are notes in the registration requirements section on the Ahpra website, read carefully and assess. For help, contact Local Peer Support (LPS).
6	Specialty Code tab + Read more ... Once a medical practitioner becomes a specialist, they can no longer be identified as a non specialist. Any 19AB exemption/s granted previously for non specialist are revoked. Check for an open specialty code 180 on stem. If presented, key the date before the start date of specialist recognition or Ahpra specialist registration (whichever is the earlier) in the End Date field of specialty code 180 on stem. Check for any open provider locations issued for non specialist, such as DPA class exemption or temporary resident After-hours class exemption. If presented, key the date before the start date of specialist recognition or Ahpra specialist registration (whichever is the earlier) in the End Date field of specialty code 519 at the location. Does the medical practitioner have a registration type of provisional, limited or specialist with approved site(s) on Ahpra? Yes, for: limited registration, go to Step 8 provisional registration, go to Step 9 specialist with approved site(s) registration, add a 510 speciality code to the stem using the date of first registration with Ahpra as the start date. Go to Step 7 No, go to Step 7
7	No provisional or limited registration + Read more ... See the Resources page to confirm the specialty code for the requested specialty. Check the application form for the date needed for Medicare claiming. Specialist recognition can be applied up to 2 years before the date of lodgement of the application if it can be confirmed the medical practitioner had obtained fellowship at that date. For example, if an application is received 02/10/2020, specialist recognition can be granted from 02/10/2018 providing their fellowship certificate or Ahpra registration supports this. Note: Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. For medical practitioners who do not hold fellowship and are recognised as a specialist with Ahpra, recognition can only be granted for a period of 2 years. If already recognised and an application for an extension to specialist recognition has been received, make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension or removed as needed. Has a date been provided in the Date of recognition required for Medicare claiming section? Yes, specialist recognition is granted from date requested provided the date is not: before to the date on the Schedule 1 college fellowship letter (if supplied), or before the date of specialist registration in the AHPRA window (if no fellowship letter is supplied) In these cases, use the date of college fellowship letter or the specialist registration as the start date No, if no date has been requested, key the date as: the date on the Schedule 1 college fellowship letter (if supplied), or the date of specialist registration in the AHPRA window (if no fellowship letter is supplied)
8	Limited Ahpra registration + Read more ... Note: medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for limited registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the limited registration includes approval for the medical practitioner to work in a specialist position, and the registration subtype shows Area of Need (AoN), and any approved locations are listed If these criteria are met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023 The start date will be the day after the end date of the existing line if specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying: Add the specialty code as a new line if the existing line has already ended Do not remove the end date Add a new line the day after the end date of the original specialty If the existing line is still current, the end date can be amended in line with the extension The date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later Go to Step 10.
9	Provisional Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for provisional or limited registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the provisional registration includes approval for the medical practitioner to work in a specialist position, and the registration confirms the medical practitioner is on a competent authority pathway (CAP), and any approved locations are listed If these criteria are met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023 The start date will be the day after the end date of the existing line if specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying: Add the specialty code as a new line if the existing line has already ended Do not remove the end date Add a new line the day after the end date of the original specialty If the existing line is still current, the end date can be amended in line with the extension The date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later
10	Dual recognition + Read more ... Were specialty codes 104, 130, 132, 532, 530, 540 or an approved general practice 3GA placement open at any location identified during the assessment step? Yes, The medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem. Apply dual recognition in line with the date specialist recognition is granted. See Dual recognition of medical practitioners for Medicare Go to Step 11 No, The medical practitioner is not eligible for dual recognition Go to Step 11
11	MHST, PSC or FPS specialty codes + Read more ... Were VR specialty codes 647, 648, 649 and/or 650 or non-VR specialty codes 662, 663, 664 and/or 665 identified during the assessment step? Yes, check for specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement. If: one of these codes is current, the medical practitioner remains eligible to access the MHST, PSC and/or FPS items the medical practitioner does not have one of these codes, or they have been end-dated in the past, the medical practitioner is not eligible to access MHST, PSC and/or FPS items. The MHST, PSC and/or FPS specialty code/s will need to be end-dated the day before the specialist recognition date of effect No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... Is the medical practitioner subject to 19AB? Yes, Go to the Notes tab on PDS Key note subject - Specialist recognition 19AB exemptions needed Key note description - Granted specialist recognition. As Dr is subject to 19AB, an exemption is needed to access Medicare benefits. Locations without an existing exemption have been service ruled Add the following comment to the end of the registration line - ‘Granted specialist recognition subject to 19AB. See notes’ Go to Step 13 No, go to Step 14
13	Provider Service Rule (PSR) + Read more ... Apply a Provider Service Rule (PSR) to any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Check all locations for a current 519 specialty code and/or class exemption flag. Note: apply a 519 specialty code to location where a flag is identified. To add a PSR, select: Amend corresponding to the relevant provider number Loc-Service Rules tab Add Service Rule Add Service Rule If the medical practitioner has a current 181 (with a current 500/519): Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank If the medical practitioner has a current 110 (with a current 500/519) and the location has business structure and EFT details keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and In the End Date field, key the end of the 500 specialty code (Ten Year Moratorium - Medicare Benefits Not Payable) If the medical practitioner has a current 110 (with a current 500/519) and the location does not have business structure and EFT keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank Select Add New > Save Repeat this process for all locations which do not have a current 19AB exemption or class exemption. This action will prevent Medicare claims paid at locations where a valid 19AB exemption is not in place. Note: add a service rule 569 where an assistance at operations exemption applies. Do not add a 618 PSR where assistance at operations access is needed.
14	Sleep Medicine Assessment (if applicable) + Read more ... Is the medical practitioner seeking recognition in Sleep Apnoea (spec code 192)? Yes: The medical practitioner is Applying for recognition in Sleep and Respiratory Medicine, and has supplied a letter from the Royal Australasian College of Physicians (RACP) advising of training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Go to Step 15 No, the medical practitioner is not eligible for Sleep Apnoea recognition and specialty code 192 cannot be added to PDS Go to Step 15 Note: medical practitioners who Medicare already recognise as being a specialist or consultant physician may request access to sleep apnoea item numbers. A request in writing is needed, along with evidence that training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine.
15	Magnetic Imaging + Read more ... Is the medical practitioner applying for recognition in Diagnostic Radiology, does not hold Schedule 1 college fellowship and has a current specialty code 118 (magnetic Imagining) on stem? Yes, amend end date of specialty code 118 (Magnetic Imaging) in line with 047 (Diagnostic Radiology) No, go to Step 16
16	Confirmation letter + Read more ... See Resources page for appropriate letter options. Prepare confirmation letter using template Z2264 Recognition as a specialist and consultant physician is approved. Staff must: Complete relevant fields: Delegate information supplied in letter option of the Standard Letter Template (SLT) must be specified as an APS5 Program Officer Unselect the Auto Capitalisation option in the address and signatory tab of the SLT Do not include any staff names, such as team leader’s name Save the letter as a PDF to the Customer Information folder on their team's secure drive Upload the letter to PaNDA Make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct Add a note to the PaNDA file to indicate application was processed under 3DB and any other processing specific notes. Add an additional note advising APS5 delegation is needed Assign the PaNDA file to a delegate using the Send for Delegation function in PaNDA. The delegate will print and send the letter upon approval by: post, and HPOS, if the provider has an active HPOS account Note: where specialist recognition is updated due to a change of residency status, the start date on the confirmation letter should be the date residency changed. When specialist recognition is being revoked under 3E and applied under 3DB, ensure this option is selected on the letter.

Assess a manual application for Specialist Recognition 3DB

Table 5: this table explains how to assess an application for specialist recognition under 3DB of the Act to make sure all requested documents have been received and the application can be processed. This application is a HW077 Application for Specialist Recognition.

Step	Action
1	Assessing the paperwork + Read more ... Open the application. Make sure the application includes: Medical practitioner's name and date of birth Residency status The specialty(ies) in which recognition is sought Medical practitioner's signature If an online Medicare provider number application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) is received with the Application for recognition as a specialist or consultant physician form (HW077), make sure this application is also completed in full. Note: review Q16 on HW077 to make sure checklist all documentation has been received. Is the application complete? Yes, go to Step 2 No, return the application. See Table 11
2	Check PDS + Read more ... Open PDS: Select Provider > View > Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Enter date of birth in Date of Birth field Select Search. A list of health professionals with a matching name shows Select View against the medical practitioner's name that matches the application Does the applicant appear in the list of health professionals? Yes, go to Step 3 No, check PaNDA for an application submitted via HPOS or ‘Application for a Medicare provider number and, or prescriber number for a medical practitioner’ form (HW019) and if available, associate documents in PaNDA. Both applications can then be assessed together If an Application for a Medicare provider number cannot be located in PaNDA and the medical practitioner is not registered in PDS make one phone call to the medical practitioner advising they must submit an online application or send a HW019 form for an initial provider number. If contact is made If submitting using HPOS: Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted If submitting using HW019: Ask for the email address sender will use or Ask that the sender quotes the doctors name in the subject line Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted Leave notes ‘Awaiting application - application to be sent by (DD/MM/YYYY)’ Also include the sender email address where applicable to help inbox searches Pend the application ‘validate information’ and un-assign the work item Once released back into the queue check PaNDA for the application. If unable to locate the HW019, request an inbox search If the medical practitioner cannot be contacted and has not provided a Medicare provider number application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without an established provider stem. See Table 11 > Step 1 to return the application If an initial application is received, go to Step 5
3	Check PDS to make sure specialist recognition has not already been granted + Read more ... To check, view provider stem under the Specialty Code section to see if the specialty requested is listed on the PDS record. Medical practitioners may have more than one specialty. If the: requested specialty is not listed, go to Step 4 specialty code is listed, check if: the medical practitioner has indicated their residency status has changed, or there is an end date against the specialty code The medical practitioner may be applying for an extension for the previously approved specialist recognition period. Is an end date recorded against current specialty code? Yes, go to Step 4 No, compare the medical practitioner's residency status on PDS to question 8 on the HW077 application form. If these do not match, go to Step 4 if the medical practitioner has submitted a new application, but specialist recognition has previously been processed, issue a confirmation letter using Z2269 Confirming your specialist/consultant physician status send a confirmation letter by post and HPOS if the provider has an active HPOS account
4	Check the medical practitioner's residency status on both application and PDS + Read more ... If the medical practitioner selected temporary resident on the form, assess the application under 3E of the Act. See Table 9 for 3E assessment. If the medical practitioner selected permanent resident or Australian citizen on the form, are they a permanent resident or Australian Citizen on PDS? Yes, continue to assess under 3DB. Go to Step 6 No, go to Step 5
5	Updating residency status + Read more ... If the medical practitioner selected either Australian Citizen or Permanent resident but the residency status is different on PDS, check if evidence of residency status has been supplied (this may be a VISA document, Australian passport or Australian citizenship certificate). Note: evidence of residency status needs to be provided only if the residency status declared on the application is different from residency status on PDS. If evidence has been provided, go to Step 6. If no evidence of residency is supplied, make one phone call to get the residency documents. Contacting the customer If contact is made: Ask for the email address sender will use Ask that the sender quotes the doctors name in the subject line Leave note ‘Awaiting residency document - documents to be sent by (DD/MM/YYYY)’ (allow 2 days for the details to be supplied) Pend the application ‘validate information’ Un-assign the work item Once released back into the queue, check PaNDA for the application. If the Service Officer cannot locate the required documents, request an inbox search. If contact is not made and evidence cannot be obtained or was not provided, the application cannot be processed. Return the application.
6	Continue to assess the application + Read more ... Review the checklist at question 16 on the HW077 to make sure all documents have been provided. If the fellowship certificate or letter options have been selected, make sure fellowship evidence from a Schedule 1 college is attached (see Resources for list of colleges). This should indicate the medical practitioner is qualified in the specialty being requested and the date fellowship was granted for that specialty. Check if the medical practitioner has requested more than one specialty but has only provided fellowship evidence in relation to one of those specialities. Has the medical practitioner supplied fellowship evidence from a Schedule 1 college or their Ahpra registration to support the additional specialty/ies? Yes, fellowship evidence supplied, go to Step 11 Ahpra registration supplied, go to Step 8 Ahpra registration supplied for and fellowship evidence supplied for different specialties, take note and go to Step 8 for assessing Ahpra registration No, return the application for the additional specialty/ies using letter Z2266 Your application for recognition as a specialist and consultant physician is not approved Medical practitioners with Australasian fellowship are granted specialist recognition indefinitely from the date of effect. Note: a fellowship letter from the ANZCA confirming the medical practitioner is 'eligible for admission to fellowship of the college' can be used as evidence of fellowship.
7	If no evidence for Schedule 1 college fellowship supplied + Read more ... If the medical practitioner does not hold fellowship through a Schedule 1 college, check the Ahpra website or Ahpra window (if available) to confirm if the medical practitioner holds specialist registration for the specialty requested. Does the medical practitioner hold specialist registration for the specialty requested? Yes, the medical practitioner is eligible for specialist recognition. Go to Step 10 No, go to Step 8 Note: fellowship obtained via the paediatrics and child health division of the RACP does not automatically mean the applicant is eligible for specialist recognition in general paediatrics. The specialty fields must state 'general paediatrics' on Ahpra in addition to the specialty reflecting 'paediatrics and child health'.
8	Limited Ahpra registration + Read more ... Check Ahpra for limited registration. Confirm if registration includes the registration subtype Area of Need (AoN) - Ahpra notation including: Medical practitioner approved to work in a specialist position Which location/s Does the medical practitioner hold limited registration with the above eligibility requirements? Yes, go to Step 10 No, go to Step 9
9	Provisional Ahpra registration + Read more ... Specialist recognition can be processed for medical practitioners with the Ahpra registration type: Provisional, Pathway: Competent Authority Pathway. Check Ahpra to see if medical practitioner is registered with provisional registration and confirm if on a Competent Authority Pathway (CAP). Ahpra Registration Requirements notation must state: Medical practitioner is approved to work in a specialist position Approved sites (location/s) Does the medical practitioner hold provisional registration with the above eligibility requirements? Yes, go to Step 10 No, application cannot be processed and will need to be returned using Z2266 Your application for recognition as a specialist and consultant physician is not approved Note: specialist recognition cannot be processed if limited registration reflects a specialist pathway.
10	Medical practitioner subject to section 19AB + Read more ... Check stem for specialty codes 181, 500 and/or 519. Is the medical practitioner subject to section 19AB? Yes, Identify if there is a valid section 19AB exemption(s)/section 19AB class exemption(s) at all open locations Take note of any locations without a valid section 19AB exemption/section 19AB class exemption. This will be needed in the processing step at Table 6 > Step 11 Go to Step 11 No, go to Step 11
11	Dual recognition + Read more ... Check the stem for specialty code 104, 130, 132, 532, 530, 540 or an approved general practice 3GA placement open at any location. Is the medical practitioner working as a general practitioner? Yes, Take note the medical practitioner is eligible for dual recognition. Specialty code 165 will need to be added to stem in the processing step at Table 6 > Step 10 Go to Step 12 No, the medical practitioner is not eligible for dual recognition. Go to Step 12
12	MHST, PSC and FPS specialty codes + Read more ... Check the stem for Mental Health Skills Training (MHST), Non-directive Pregnancy Support Counselling (PSC), or Focussed Psychological Strategies (FPS) VR specialty codes 647, 648, 649 or 650 and non-VR specialty codes 662, 663, 664 or 665. Is the medical practitioner endorsed with MHST, PSC or FPS specialty codes? Yes, and the medical practitioner, has a specialty code 104, 130, 132, 532, 530, 540 or an approved 3GA placement open at any location. The medical practitioner remains eligible to access the MHST, PSC or FPS items does not have an open 104, 130, 132, 532, 530, 540 or an approved 3GA placement open at any location. The medical practitioner is not eligible to access the MHST, PSC or FPS items. Take note of any specialty codes to be end dated during the processing step at Table 6 > Step 10 No, go to Step 13
13	Check address + Read more ... Check for an Australian address on the application. If there is an Australian address continue to assess the application under 3DB. If there is not an Australian address, check for evidence the medical practitioner will be working in Australia. For example, current provider number/s or an application for a provider number can be located in PaNDA. Is there an Australian address on the application or the provider stem? Yes, see Table 6 No, Return the application Do not process

Process specialist recognition 3DB manual application

Table 6: this table explains how Service Officers process 3DB applications received from a medical practitioner or their authorised representative.

Step	Action
1	Amend details on provider stem + Read more ... Check all personal, registration and specialty details on PDS against application Amend if required by selecting Edit at the bottom left of the screen
2	Residency Tab + Read more ... If a medical practitioner has supplied residency documents, see Processing a change in residency status for a medical practitioner for details on updates in residency.
3	Qualifications Tab + Read more ... Key the college acronym (for example, FANZCA for the Australasian and New Zealand college of Anaesthetists) next to current qualifications. F stands for fellowship and should always be the first alpha character. If the medical practitioner has not supplied a fellowship document, do not add an acronym.
4	Contact Tab + Read more ... Key contact details from the application Accept if the Rapid Entry Addressing Tool (RAET) suggests changes but keep the same street address details Note this on the PaNDA file for QC purposes
5	Registration Tab + Read more ... If an AUS registration line is not present: End the current state registration line the day before processing Enter a new AUS registration line using the details on the Ahpra website ensuring there is no gap if none identified Note: if the registration status is to be amended take a screenshot of the search result and add to the file. If there are notes in the registration requirements section on the Ahpra website, read carefully and assess. For help, contact Local Peer Support (LPS).
6	Specialty Code tab + Read more ... Once a medical practitioner becomes a specialist, they can no longer be identified as a non specialist. Any 19AB exemption/s granted previously for a non specialist are revoked. Check for an open specialty code 180 on screen. If presented, key the date before the start date of specialist recognition or Ahpra specialist registration (whichever is the earlier) in the End Date field of specialty code 180 on stem. Check for any open provider locations issued for non specialist, such as DPA class exemption or temporary resident After-hours class exemption. Key the date before the start date of the specialist recognition or Ahpra specialist registration (whichever is the earlier) in the End Date field of specialty code 519 at the location. On Aphra, does the medical practitioner have a registration type of provisional, limited or specialist with approved site(s)? Yes, for: specialist with approved site(s) registration, add a 510 speciality code to the stem using the date of first registration with Ahpra as the start date. Go to Step 7 limited registration, go to Step 8 provisional registration, go to Step 9 No, go to Step 7
7	No provisional or limited registration + Read more ... See the Resources page to confirm the specialty code for the requested specialty. Check the application form for the date needed for Medicare claiming. Has a date been provided in the Date of recognition required for Medicare claiming section? Yes, specialist recognition is granted from date requested provided the date is not: before to the date on the Schedule 1 college fellowship letter (if supplied), or before the date of specialist registration in the Ahpra window (if no fellowship letter is supplied) In these cases, use the date of college fellowship letter or the specialist registration as the start date No, if no date has been requested, key the date as: the date on the Schedule 1 college fellowship letter (if supplied), or the date of specialist registration in the Ahpra window (if no fellowship letter is supplied) Note: Specialist recognition can be applied up to 2 years before the date of lodgement of the application if it can be confirmed the medical practitioner had obtained fellowship at that date. For example, if an application is received 02/10/2020, specialist recognition can be granted from 02/10/2018 providing their fellowship certificate or Ahpra registration supports this. Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. For medical practitioners who do not hold fellowship and are recognised as a specialist with Ahpra, recognition can only be granted for a period of 2 years. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form HW019 along with the Application for recognition as a specialist or consultant physician form HW077 and no date is supplied on the HW077, the date of effect will be either: the date of first registration with Ahpra, or the date location is approved to start, whichever is later If already recognised and an application for an extension to specialist recognition has been received, make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension or removed as needed.
8	Limited Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for limited registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the limited registration includes approval for the medical practitioner to work in a specialist position, and the registration subtype shows Area of Need (AoN), and any approved locations are listed If this criteria are met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming. If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023. The start date will be the day after the end date of the existing line if specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying: Add the specialty code as a new line if the existing line has already ended Do not remove the end date Add a new line the day after the end date of the original specialty If the existing line is still current, the end date can be amended in line with the extension If processing an Application for a Medicare provider along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied on the HW077, the date of effect will be either the: date of lodgement of the application, or date location is approved to start, whichever is later Go to Step 10.
9	Provisional Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for provisional registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the provisional registration includes approval for the medical practitioner to work in a specialist position, and the registration confirms the medical practitioner is on a competent authority pathway (CAP), and any approved locations are listed If this criteria is met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023 The start date will be the day after the end date of the existing line if specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying: Add the specialty code as a new line if the existing line has already ended Do not remove the end date Add a new line the day after the end date of the original specialty If the existing line is still current, the end date can be amended in line with the extension If processing an Application for a Medicare provider number along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied on the HW077, the date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later
10	Dual recognition + Read more ... Were specialty codes 104, 130, 132, 532, 530, 540 or an approved general practice 3GA placement open at any location identified during the assessment step? Yes, The medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem Apply dual recognition in line with the date specialist recognition is granted. See Dual recognition of medical practitioners for Medicare Go to Step 11 No, the medical practitioner is not eligible for dual recognition. Go to Step 11
11	MHST, PSC or FPS specialty codes + Read more ... Were VR specialty codes 647, 648, 649 and/or 650 or non-VR specialty codes 662, 663, 664 and/or 665 identified during the assessment step? Yes, check for specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement. If: one of these codes is current, the medical practitioner remains eligible to access the MHST, PSC and/or FPS items the medical practitioner does not have one of these codes, or they have been end-dated in the past, the medical practitioner is not eligible to access MHST, PSC and/or FPS items. The MHST, PSC and/or FPS specialty code/s will need to be end-dated the day before the specialist recognition date of effect No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... Is the medical practitioner subject to 19AB? Yes, Go to the Notes tab on PDS Key Note subject: ‘Specialist recognition 19AB exemptions needed’ Key Note description: ‘Granted specialist recognition. As Dr is subject to 19AB, an exemption is needed to access Medicare benefits. Locations without an existing exemption have been service ruled’ Add the following comment to the end of the registration line: ‘Granted specialist recognition subject to 19AB. See notes’ Go to Step 13 No, go to Step 14
13	Provider Service Rule (PSR) + Read more ... Apply a Provider Service Rule (PSR) to any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Check all locations for a current 519 specialty code and/or class exemption flag. Note: apply a 519 specialty code to location where a flag is identified. To add a PSR, select: Amend corresponding to the relevant provider number Loc-Service Rules tab Add Service Rule Add Service Rule: if the medical practitioner has a current 181 (with a current 500/519): Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank if the medical practitioner has a current 110 (with a current 500/519) and the location has business structure and EFT details keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and In the End Date field, key the end of the 500 specialty code (Ten Year Moratorium - Medicare Benefits Not Payable) if the medical practitioner has a current 110 (with a current 500/519) and the location does not have business structure and EFT keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank Select Add New > Save Repeat this process for all locations which do not have a current 19AB exemption or class exemption. This action will prevent Medicare claims paid at locations where a valid 19AB exemption is not in place. Note: add a service rule 569 where an assistance at operations exemption applies. Do not add a 618 PSR where assistance at operations access is needed.
14	Sleep Medicine Assessment (if applicable) + Read more ... Is the medical practitioner seeking recognition in Sleep Apnoea (spec code 192)? Yes: The medical practitioner is Applying for recognition in Sleep and Respiratory Medicine and has supplied a letter from the Royal Australasian College of Physicians (RACP). They are advising of training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Go to Step 15 No, the medical practitioner is not eligible for Sleep Apnoea recognition and specialty code 192 cannot be added to PDS. Go to Step 15 Note: medical practitioners who Medicare already recognise as being a specialist or consultant physician may request access to sleep apnoea item numbers. A request in writing is needed, along with evidence that training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine.
15	Magnetic Imaging + Read more ... Is the medical practitioner applying for recognition in Diagnostic Radiology, does not hold Schedule 1 college fellowship and has a current specialty code 118 (magnetic Imagining) on stem? Yes, amend end date of specialty code 118 (Magnetic Imaging) in line with 047 (Diagnostic Radiology) No, go to Step 16
16	Confirmation letter + Read more ... See Resources page for appropriate letter options. Prepare confirmation letter using template Z2264 Recognition as a specialist and consultant physician is approved. Staff must: Complete relevant fields: Delegate details supplied in letter option of the Standard Letter Template (SLT) must be specified as an APS5 Program Officer Untick the Auto Capitalisation option in the address and signatory tab of the SLT Do not include any staff names, such as team leader's name Save the letter as a PDF to the Customer Information folder on their team's secure drive Upload the letter to PaNDA Make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct Add a note to the PaNDA file to indicate application was processed under 3DB and any other processing specific notes. Add an additional note advising APS5 delegation is needed Assign the PaNDA file to a delegate using the Send for Delegation function in PaNDA. The delegate will print and send the letter upon approval by: post, and HPOS, if the provider has an active HPOS account Note: where specialist recognition is updated due to a change of residency status, the start date on the confirmation letter should be the date residency changed. When specialist recognition is being revoked under 3E and applied under 3DB, make sure this option is selected on the letter.

Assess an application for Specialist Recognition 3E through HPOS

Table 7: this table explains how to assess an application for specialist recognition under 3E of the legislation to make sure all requested documents have been received and the application can be processed.

Step	Action
1	Assessing the paperwork + Read more ... Open the application. Make sure the application includes: residency status the specialty(ies) in which recognition is sought If a HW019 Application for a Medicare provider number and / or prescriber number for a medical practitioner form or through HPOS is received with the Application for recognition as a specialist or consultant physician, make sure this application is also completed in full. Make sure all documentation has been received. Does the application appear complete? Yes, go to Step 2 No, Return the application. See Table 11 Procedure ends here
2	Locate pending registration + Read more ... Go to the Provider Directory System (PDS) Select Work items > Pending Registrations Select View for the health professional that matches the PaNDA work item Select View to open Pending Registration Supporting documents Note: if unable to identify the health professional, contact Local Peer Support (LPS).
3	Check PDS + Read more ... Open PDS: Select Provider > View > Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Enter date of birth in Date of Birth field Select Search. A list of health professionals with a matching name shows Select View against the medical practitioner's name that matches the application Does the applicant appear in the list of health professionals? Yes, go to Step 4 No, check PaNDA for an application submitted via HPOS or ‘Application for a Medicare provider number and, or prescriber number for a medical practitioner’ form (HW019) and if available, associate documents in PaNDA. Both applications can then be assessed together If an Application for a Medicare provider cannot be located in PaNDA and the medical practitioner is not registered in PDS make one phone call to the medical practitioner advising they must send a HW019 form or use HPOS to submit an online application for an initial provider number. Successful contact If submitting using HPOS: Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted If submitting using HW019: Ask for the email address sender will use or Ask that the sender quotes the doctors name in the subject line Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted Leave notes ‘Awaiting application - application to be sent by (DD/MM/YYYY)’. Also include the sender email address (where applicable) to help inbox searches Pend the application ‘validate information’ and un-assign the work item Once released back into the queue check PaNDA for the application. If unable to locate the HW019, request an inbox search Unsuccessful contact If the medical practitioner cannot be contacted or has not provided the Medicare provider number application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without an established provider stem. See Table 11 > Step 1 to return the application If an initial application is received, go to step 5
4	Check PDS to make sure specialist recognition has not already been granted + Read more ... Check the medical practitioner’s stem under the Specialty Code section to see if the specialty requested is listed on the PDS record. Medical practitioners may have more than one specialty. If the: requested specialty is not listed, go to Step 6 specialty code is listed, and there is an end date against the specialty code, the medical practitioner may be applying for an extension of the previously approved specialist recognition period, or their residency status may have changed Is an end date recorded? Yes, go to Step 5 No, compare the medical practitioner's residency status on PDS to question 8 on the HW077 application form. If these do not match, go to Step 5. if the medical practitioner has submitted a new application, but specialist recognition has previously been processed, issue a confirmation letter using Z2269 Confirming your specialist/consultant physician status by post, and HPOS, if the provider has an active HPOS account send confirmation letter by Post and HPOS if the provider has an active HPOS account
5	Check the medical practitioner’s residency status on both the application and PDS + Read more ... Is the medical practitioner a temporary resident in PDS and selected temporary resident? Yes, continue to assess under 3E. Go to Step 6 No, the medical practitioner may be eligible for specialist recognition under section 3DB. See Table 3 > Step 1
6	Continue to assess the application + Read more ... Check that all supporting documents have been received. If the fellowship certificate or letter options have been selected, make sure fellowship evidence from a Schedule 1 college (see Resources for list of colleges) is attached. This should indicate the medical practitioner is qualified in the specialty being requested and the date fellowship was granted for that specialty. Check if the medical practitioner has requested more than one specialty but has only provided fellowship evidence in relation to one of those specialities. Has the medical practitioner supplied fellowship evidence from a Schedule 1 college and their Ahpra registration support the additional specialty/ies? Yes, fellowship evidence supplied, go to Step 11 Ahpra registration supplied, go to Step 8 Ahpra registration supplied for and fellowship evidence supplied for different specialties, take note and go to step 8 for assessing Ahpra registration No, process the specialty with evidence and return the application for the additional specialty/ies using letter Z2266 Your application for recognition as a specialist and consultant physician is not approved by: post, and HPOS, if the provider has an active HPOS account Note: Medical practitioners with Schedule 1 college fellowship are granted specialist recognition indefinitely from the date of effect. A fellowship letter from the ANZCA confirming the medical practitioner is ‘eligible for admission to fellowship of the college’ can be used as evidence of fellowship. If the medical practitioner has not selected the appropriate checklist box and/or supplied evidence of Schedule 1 college fellowship, go to Step 7. If Schedule 1 college fellowship was supplied, go to Step 11.
7	Checklist box not selected and/or no Schedule 1 college fellowship supplied + Read more ... If the medical practitioner has not selected the appropriate checklist box and/or does not hold fellowship through a Schedule 1 college, check the Ahpra website or Ahpra window (if available) to confirm if the medical practitioner holds specialist registration for the specialty requested. Does the medical practitioner hold specialist registration for the specialty requested? Yes, the medical practitioner is eligible for specialist recognition, go to Step 11 No, go to Step 8 Note: fellowship obtained via the paediatrics and child health division of the RACP does not automatically mean the applicant is eligible for specialist recognition in general paediatrics. The specialty fields must state ‘general paediatrics’ on Ahpra in addition to the specialty reflecting ‘paediatrics and child health’.
8	Specialist registration in Anaesthesia + Read more ... A medical practitioner who holds a specialist registration in Anaesthesia may be approved by the medical board and the Australian and New Zealand College of Anaesthetists (the College) (ANZCA) to practice under supervision and access MBS items for Pain Medicine when undertaking specialist training program towards Pain Medicine fellowship. The information is recorded under notations of their Ahpra registration. Example text: The practitioner is also permitted to practice under supervision within the scope of Pain Medicine as defined by the College in a supervised position approved by the College for the purpose of undertaking the specialist training program requirements. Does the medical practitioner hold specialist registration in Anaesthesia and have above text recorded under notations of their Ahpra registration? Yes, the medical practitioner is eligible for specialist recognition in Pain Medicine. Recognition can be granted for a period of 2 years. Go to Step 11 No, go to Step 9
9	Limited Ahpra registration + Read more ... Check Ahpra for limited registration. Confirm if registration includes the registration subtype Area of Need (AoN) - Ahpra notation including: Medical practitioner approved to work in a specialist position Which location/s Does the medical practitioner hold limited registration with the above eligibility requirements? Yes, go to Step 11 No, go to Step 10 Note: specialist recognition cannot be processed if limited registration reflects registration subtype Postgraduate training or supervised practice.
10	Provisional Ahpra registration + Read more ... Specialist recognition can be processed for medical practitioners on a competent authority pathway. Check Ahpra for provisional registration. Confirm if on a competent authority pathway (CAP) - Ahpra notation (Registration Requirements) must include: Medical practitioner is approved to work in a specialist position Which location/s Does the medical practitioner hold provisional registration with the above eligibility requirements? Yes, go to Step 11 No, application cannot be processed and will need to be returned using Z2266 Your application for recognition as a specialist and consultant physician is not approved
11	Medical practitioner subject to section 19AB + Read more ... Check stem for specialty codes 180, 181, 500 and/or 519. Is the medical practitioner subject to section 19AB? Yes, Identify if there is a valid section 19AB exemption(s)/section 19AB class exemption(s) at all open locations Take note of any locations without a valid section 19AB exemption/section 19AB class exemption. This will be needed in the processing step at Table 8, Step 13 Go to Step 12 No, go to Step 12
12	Dual recognition + Read more ... Check the stem for specialty code 104, 130, 132, 180, 532, 530, 540 or an approved general practice 3GA placement open at any location. Is the medical practitioner working as a general practitioner? Yes, Take note that the medical practitioner is eligible for dual recognition. Specialty code 165 will need to be added to stem in the processing step at Table 8 > Step 10 Go to Step 13 No, the medical practitioner is not eligible for dual recognition Go to Step 13
13	MHST, PSC and FPS specialty codes + Read more ... Check the stem for Mental Health Skills Training (MHST), Non-directive Pregnancy Support Counselling (PSC), or Focussed Psychological Strategies (FPS) VR specialty codes 647, 648, 649 or 650 and non-VR specialty codes 662, 663, 664 or 665. Is the medical practitioner endorsed with MHST, PSC or FPS specialty codes? Yes, and the medical practitioner: has a specialty code 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location. The medical practitioner remains eligible to access the MHST, PSC or FPS items. Go to Step 13, or does not have an open 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location. The medical practitioner is not eligible to access the MHST, PSC or FPS items. Take note of any specialty codes to be end dated during the processing step at Table 8 > Step 11. Go to Step 14 No, go to Step 14
14	Check address + Read more ... Check for an Australian address on the application or the provider stem. If there is an Australian address continue to process the application under 3E. If there is not an Australian address, is there evidence the medical practitioner will be working in Australia. For example, current provider number/s or application for a provider number is in PaNDA. Is there an Australian address on the application or the provider stem? Yes, see Table 8 No, return the application. Do not process

Process specialist recognition 3E application received through HPOS

Table 8: this table explains how Service Officers process 3E applications received from medical practitioners or their authorised representatives in PDS.

Step	Action
1	Amend information on provider stem + Read more ... Check all personal, registration and specialty details on PDS against the supporting documentation Select Approve Add comments ‘assessed under 3E’ Select Approve
2	Residency tab + Read more ... If a change of residency is provided, select the dropdown box on the Residency Status tab. Add the date of Permanent Residency and any other relevant residency details. See Processing a change in residency status for a medical practitioner for full assessment and processing instructions. If the residency status has changed, go to Table 4 and continue processing specialist recognition under 3DB. The medical practitioner may be eligible for specialist recognition under section 3DB.
3	Qualifications Tab + Read more ... Key the college acronym (for example, Australasian and New Zealand college of Anaesthetists (FANZCA)) next to current qualifications. F stands for fellowship and should always be the first alpha character. If no fellowship documentation supplied and the agency can grant specialist recognition, the agency is unable to add the college acronym.
4	Contact Tab + Read more ... Do not update/change contact information.
5	Registration Tab + Read more ... If an AUS registration line is not present: End the current state registration line the day before processing Date and key a new AUS registration line using the details on the Ahpra website Note: if the registration status is to be amended take a screenshot of the search result and add to the file. If there are registration limitations notes on the Ahpra website, read carefully and assess. If assistance is needed, contact Local Peer Support (LPS).
6	Specialty Code tab + Read more ... Does the medical practitioner have provisional or limited registration? Yes, for: limited registration, go to Step 8 provisional registration, go to Step 9 No, go to Step 7
7	No provisional or limited registration + Read more ... See the Resources page to confirm the specialty code for the requested specialty. Check the application form for the date needed for Medicare claiming. Has a date been provided in the Date of recognition required for Medicare claiming section? Yes, specialist recognition is granted from date requested provided the date is not: before to the date on the Schedule 1 college fellowship letter (if supplied), or before the date of specialist registration in the AHPRA window (if no fellowship letter is supplied) in these cases, use the date of college fellowship letter or the specialist registration as the start date No, if no date has been requested, key the date as the: date on the Schedule 1 college fellowship letter (if supplied), or date of specialist registration in the AHPRA window (if no fellowship letter is supplied) Note: Specialist recognition can be applied up to 2 years before the date of lodgement of the application if it can be confirmed the medical practitioner had obtained fellowship at that date. For example, if an application is received 02/10/2020, specialist recognition can be granted from 02/10/2018 providing their fellowship certificate or Ahpra registration supports this. Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. For medical practitioners who do not hold fellowship and are recognised as a specialist with Ahpra, recognition can only be granted for a period of 2 years. Anaesthetists under training in Pain Medicine may also be granted recognition for a period of 2 years. See Table 7 > Step 7. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician and no date is supplied the date of effect will be either: the date of first registration with Ahpra, or the date location is approved to start, whichever is later If already recognised and an application for an extension to specialist recognition has been received, make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension or removed as needed.
8	Limited Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for limited registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the limited registration includes approval for the medical practitioner to work in a specialist position, and the registration subtype shows Area of Need (AoN), and any approved locations are listed If this criteria is met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming. If no date has been requested: key as date of lodgement of the application, and record an end date 2 years in the future, for example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023 If specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying, the start date will be the day after the end date of the existing specialty code. Make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty If the existing line is still current, the end date can be amended in line with the extension. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied the date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later Go to Step 9.
9	Provisional Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for provisional registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the provisional registration includes approval for the medical practitioner to work in a specialist position, and the registration confirms the medical practitioner is on a competent authority pathway (CAP), and any approved locations are listed If this criteria is met, go to the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming. If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023. If specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying, the start date will be the day after the end date of the existing code. Make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension. If processing an Application for a Medicare provider number and/or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician form (HW077), the date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later
10	Dual recognition + Read more ... Were specialty codes 104, 180, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location identified during the assessment step? Yes, the medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem. Apply dual recognition in line with the date specialist recognition is granted. See Dual recognition of medical practitioners for Medicare No, the medical practitioner is not eligible for dual recognition. Go to Step 11
11	MHST, PSC or FPS specialty codes + Read more ... Were VR specialty codes 647, 648, 649 and/or 650 or non-VR specialty codes 662, 663, 664 and/or 665 identified during the assessment step? Yes, check for specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement. If: one of these codes is current, the medical practitioner remains eligible to access the MHST, PSC and/or FPS items the medical practitioner does not have one of these codes, or they have been end-dated in the past, the medical practitioner is not eligible to access MHST, PSC and/or FPS items. The MHST, PSC and/or FPS specialty code/s will need to be end-dated the day before the specialist recognition date of effect No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... Is the medical practitioner subject to 19AB? Yes, Go to the Notes tab on PDS Key note subject - Specialist recognition 19AB exemptions needed Key note description - Granted specialist recognition. As Dr is subject to 19AB, an exemption is needed to access Medicare benefits. Locations without an existing exemption have been service ruled Add the following comment to the end of the registration line: ‘Granted specialist recognition subject to 19AB. See notes.’ Go to Step 13 No, go to Step 14
13	Provider Service Rule (PSR) + Read more ... Apply a Provider Service Rule (PSR) to any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Check all locations for a current 519 specialty code and/or class exemption flag. Note: apply a 519 specialty code to location where a flag is identified. To add a PSR, select: Amend corresponding to the relevant provider number Loc-Service Rules tab Add Service Rule Add Service Rule: if the medical practitioner has a current 180 or 181 (with a current 500/519): Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank if the medical practitioner has a current 110 (with a current 500/519) and the location has business structure and EFT details keyed in full: Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and In the End Date field, key the end of the 500 specialty code (Ten Year Moratorium - Medicare Benefits Not Payable) if the medical practitioner has a current 110 (with a current 500/519) and the location does not have business structure and EFT keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank Select Add New Select Save Repeat this process for all locations which do not have a current 19AB exemption or class exemption. This action will prevent Medicare claims paid at locations where a valid 19AB exemption is not in place. Note: add a service rule 569 where an assistance at operations exemption applies. Do not add a 618 PSR where assistance at operations access is needed.
14	Sleep Medicine Assessment (if applicable) + Read more ... Is the medical practitioner seeking recognition in Sleep Apnoea (Spec code 192)? Yes, The medical practitioner is applying for recognition in Sleep and Respiratory Medicine and has supplied a letter from the Royal Australasian College of Physicians (RACP) advising of training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Go to Step 15 No, The medical practitioner is not eligible for Sleep Apnoea recognition and specialty code 192 cannot be added to PDS Go to Step 15 Note: medical practitioners who are already recognised with Medicare as being a specialist or consultant physician may request access to Sleep Apnoea item numbers. A request is needed in writing along with evidence that training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine.
15	Magnetic Imaging + Read more ... Is the medical practitioner applying for recognition in Diagnostic Radiology, does not hold Schedule 1 college fellowship and has a current specialty code 118 (magnetic Imagining) on stem? Yes, amend end date of specialty code 118 (Magnetic Imaging) in line with 047 (Diagnostic Radiology) No, go to Step 16
16	Confirmation letter + Read more ... See Resources page for appropriate letter options. Standard Letter Template (SLT) Z2264 Recognition as a specialist and consultant physician is approved. Staff must: Complete relevant fields Delegate information supplied in letter option of the SLT must be specified as an APS5 Program Officer. Untick the Auto Capitalisation option in the address and signatory tab of the SLT. Do not include any staff names, such as team leader’s name Save the letter as a PDF to the Customer Information folder on their team's secure drive Upload the letter to PaNDA Make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct Add note to PaNDA file to indicate that application was 3E and any other notes specific to the processing, for example, “Delegate approval required” Assign the PaNDA file to the delegate using the Send for Delegation function in PaNDA
17	Finalise + Read more ... Once the delegate has approved the application, they will add the note Approved in PaNDA. Print only the approved confirmation letter and send it to the medical practitioner by: post, and HPOS, if the provider has an active HPOS account On the PaNDA file, select Complete > Save

Assess a manual application for Specialist Recognition 3E

Table 9: this table explains how to assess an application for specialist recognition under 3E of the legislation to make sure all requested documents have been received and the application can be processed.

Step	Action
1	Assessing the paperwork + Read more ... Open the application. Make sure the application includes: Medical practitioner's name and date of birth Residency status The specialty(ies) in which recognition is sought Medical practitioner's signature If an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) is received with the Application for recognition as a specialist or consultant physician form (HW077), make sure this application is also completed in full. This includes any supporting documentation and signature of the medical practitioner. Review Q16 on HW077 to make sure checklist all documentation has been received. Does the application appear complete and include a signature? Yes, go to Step 2 No, return application. See Table 3 on Process page in Provider numbers for health professionals in Medicare and the Provider Directory System (PDS) Procedure ends here.
2	Check PDS + Read more ... Open PDS: Select Provider Select View Select Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Enter date of birth in Date of Birth field Select Search. A list of health professionals with a matching name shows Select View against the medical practitioner that matches the application Does the applicant appear in the list of health professionals? Yes, go to Step 3 No, check PaNDA for an application submitted via HPOS or ‘Application for a Medicare provider number and, or prescriber number for a medical practitioner’ form (HW019) and if available, associate documents in PaNDA. Both applications can then be assessed together If an Application for a Medicare provider number cannot be located in PaNDA and the medical practitioner is not registered in PDS, make one phone call to the medical practitioner advising they must submit an online application or send a HW019 for an initial provider number. If contact is made If submitting using HPOS: Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted If submitting using HW019: Ask for the email address sender will use or Ask that the sender quotes the doctors name in the subject line Tell the medical practitioner the work item will be pended until the next business day to allow for the application to be submitted Leave notes ‘Awaiting application - application to be sent by (DD/MM/YYYY)’. Also include the sender email address where applicable to help inbox searches Pend the application ‘validate information’ and un-assign the work item Once released back into the queue check PaNDA for the application. If the Service Officer cannot locate the HW019, request an inbox search If the medical practitioner cannot be contacted or has not provided the Medicare provider application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without an established provider stem. See Table 11 > Step 1 to return the application If an initial application is received, go to Step 4
3	Check PDS to make sure specialist recognition has not already been granted + Read more ... Check the medical practitioner's stem under the Specialty Code section to see if the specialty requested is listed on the PDS record. Note: medical practitioners may have more than one specialty. If the requested specialty is not listed, go to Step 5. If the specialty code is listed and there is an end date against the specialty code, the medical practitioner may be applying for an extension of the previously approved specialist recognition period, or their residency status may have changed. Is an end date recorded? Yes, go to Step 4 No, Compare the medical practitioner's residency status on PDS to question 8 on the HW077 application form. If these do not match, go to Step 4 If the medical practitioner has submitted a new application, but specialist recognition has previously been processed, issue a confirmation letter using Z2269 Confirming your specialist/consultant physician status either by post or HPOS, if the provider has an active HPOS account
4	Check the medical practitioner's residency status on both the application and PDS + Read more ... Is the medical practitioner a temporary resident in PDS and selected temporary resident at question 8 on the HW077 form? Yes, continue to assess under 3E. Go to Step 5 No, the medical practitioner may be eligible for specialist recognition under section 3DB. See Table 5 > Step 1
5	Continue to assess the application + Read more ... Review question 16 checklist to make sure all documents have been provided. If the fellowship certificate or letter options have been selected, make sure fellowship evidence from a Schedule 1 college is attached, see Resources for list of colleges. This should indicate the medical practitioner is qualified in the specialty being requested and the date fellowship was granted for that specialty. Check if the medical practitioner has requested more than one specialty but has only provided fellowship evidence in relation to one of those specialities. Has the medical practitioner supplied fellowship evidence from a Schedule 1 college or their Ahpra registration support the additional specialty/ies? Yes, Fellowship evidence supplied, go to Step 11 Ahpra registration supplied, go to Step 8 Ahpra registration supplied for and fellowship evidence supplied for different specialties, take note and go to Step 8 for assessing Ahpra registration No, process any specialties where evidence is provided and return the application for the additional specialty/ies using letter Z2266 Your application for recognition as a specialist and consultant physician is not approved by: post, and HPOS, if the provider has an active HPOS account Note: medical practitioners with Schedule 1 college fellowship are granted specialist recognition indefinitely from the date of effect. A fellowship letter from the ANZCA confirming the medical practitioner is 'eligible for admission to fellowship of the college' can be used as evidence of fellowship.
6	Checklist box not selected and/or no Schedule 1 college fellowship supplied + Read more ... If the medical practitioner has not selected the appropriate checklist box and/or does not hold fellowship through a Schedule 1 college, check the Ahpra website or Ahpra window (if available) to confirm if the medical practitioner holds specialist registration for the specialty requested. Does the medical practitioner hold specialist registration for the specialty requested? Yes, the medical practitioner is eligible for specialist recognition. Go to Step 10 No, go to Step 7 Note: fellowship obtained via the paediatrics and child health division of the RACP does not automatically mean the applicant is eligible for specialist recognition in general paediatrics. The specialty fields must state 'general paediatrics' on Ahpra in addition to the specialty reflecting 'paediatrics and child health'.
7	Specialist registration in Anaesthesia + Read more ... A medical practitioner who holds a specialist registration in Anaesthesia may be approved by the medical board and the Australian and New Zealand College of Anaesthetists (the College) (ANZCA) to practice under supervision and access MBS items for Pain Medicine when undertaking specialist training program towards Pain Medicine fellowship. The details are recorded under notations of their Ahpra registration. Example text: ‘The practitioner is also permitted to practice under supervision within the scope of Pain Medicine as defined by the College in a supervised position approved by the College for the purpose of undertaking the specialist training program requirements.’ Does the medical practitioner hold specialist registration in Anaesthesia and have above text recorded under notations of their Ahpra registration? Yes, the medical practitioner is eligible for specialist recognition in Pain Medicine. Recognition can be granted for a period of 2 years. Go to Step 10 No, go to Step 8
8	Limited Ahpra registration + Read more ... Check Ahpra for limited registration. Confirm if registration includes the registration subtype Area of Need (AoN) - Ahpra notation including: Medical practitioner approved to work in a specialist position Which location/s Does the medical practitioner hold limited registration with the above eligibility requirements? Yes, go to Step 10 No, go to Step 9 Note: specialist recognition cannot be processed if limited registration reflects registration subtype Postgraduate training or Supervised practice.
9	Provisional Ahpra registration + Read more ... Specialist recognition can be processed for medical practitioners on a competent authority pathway. Check Ahpra for provisional registration. Confirm if on a competent authority pathway (CAP) - Ahpra notation (Registration Requirements) must include: Medical practitioner is approved to work in a specialist position Which location/s Does the medical practitioner hold provisional registration with the above eligibility requirements? Yes, go to Step 10 No, application cannot be processed and will need to be returned using Z2266 Your application for recognition as a specialist and consultant physician is not approved
10	Medical practitioner subject to section 19AB + Read more ... Check stem for specialty codes 180, 181, 500 and/or 519. Is the medical practitioner subject to section 19AB? Yes, Identify if there is a valid section 19AB exemption(s)/section 19AB class exemption(s) at all open locations Take note of any locations without a valid section 19AB exemption/section 19AB class exemption. This will be needed in the processing step at Table 10 > Step 13 Go to Step 11 No, go to Step 11
11	Dual recognition + Read more ... Check the stem for specialty code 104, 130, 132, 180, 532, 530, 540 or an approved general practice 3GA placement open at any location. Is the medical practitioner working as a general practitioner? Yes, Take note that the medical practitioner is eligible for dual recognition. Specialty code 165 will need to be added to stem in the processing step at Table 10 > Step 10 Go to Step 12 No, the medical practitioner is not eligible for dual recognition Go to Step 12
12	MHST, PSC and FPS specialty codes + Read more ... Check the stem for: Mental Health Skills Training (MHST) Non-directive Pregnancy Support Counselling (PSC), or Focussed Psychological Strategies (FPS) VR specialty codes 647, 648, 649 or 650, and Non-VR specialty codes 662, 663, 664 or 665 Is the medical practitioner endorsed with MHST, PSC or FPS specialty codes? Yes, and the medical practitioner has a specialty code 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location. The medical practitioner remains eligible to access the MHST, PSC or FPS items. Go to Step 13, or does not have an open 104, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location. The medical practitioner is not eligible to access the MHST, PSC or FPS items. Take note of any specialty codes to be end dated during the processing step at Table 10 > Step 11. Go to Step 13 No, go to Step 13
13	Check address + Read more ... Check for an Australian address on the application or the provider stem. If there is an Australian address continue to process the application under 3E. If there is not an Australian address, is there evidence the medical practitioner will be working in Australia. For example, current provider number/s or application for a provider number is in PaNDA. Is there an Australian address on the application or the provider stem? Yes, see Table 10 No, return the application. Do not process

Process specialist recognition 3E manual application

Table 10: this table explains how Service Officers process 3E applications received from medical practitioners or their authorised representatives in PDS.

Step	Action
1	Amend details on provider stem + Read more ... Check all personal, registration and specialty details on PDS against the Application for recognition as a specialist or consultant physician form (HW077) and amend if needed by selecting Edit at the bottom left of the screen.
2	Residency tab + Read more ... If a change of residency is provided, select the dropdown box on the Residency Status tab. Add the date of Permanent Residency and any other relevant residency details. See Processing a change in residency status for a medical practitioner for full assessment and processing instructions. If the residency status has changed, go to Table 6 and continue processing specialist recognition under 3DB. The medical practitioner may be eligible for specialist recognition under section 3DB.
3	Qualifications Tab + Read more ... Key the college acronym (for example, Australasian and New Zealand college of Anaesthetists (FANZCA)) next to current qualifications. F stands for fellowship and should always be the first alpha character. If no fellowship documentation supplied and the agency can grant specialist recognition, the agency is unable to add the college acronym.
4	Contact Tab + Read more ... Key contact details from the application. Accept if the Rapid Entry Addressing Tool (RAET) suggests changes but keep the same street address details. Note this on the PaNDA file for QC purposes.
5	Registration Tab + Read more ... If an AUS registration line is not present: End the current state registration line the day before processing Date and key a new AUS registration line using the details on the Ahpra website Note: if the registration status is to be amended take a screenshot of the search result and add to the file. If there are registration limitations notes on the Ahpra website, read carefully and assess. If help is needed, contact Local Peer Support (LPS).
6	Specialty Code tab + Read more ... On Ahpra, does the medical practitioner have a registration type of provisional, limited or specialist with approved site(s) registration? Yes, for: specialist with approved site(s) registration, add a 510 speciality code to the stem using the date of first registration with Ahpra as the start date. Go to Step 7 limited registration, go to Step 8 provisional registration, go to Step 9 No, go to Step 7
7	No provisional or limited registration + Read more ... See the Resources page to confirm the specialty code for the requested specialty. Check the application form for the date needed for Medicare claiming. Has a date been provided in the Date of recognition required for Medicare claiming section? Yes, specialist recognition is granted from date requested provided the date is not before the date: on the Schedule 1 college fellowship letter (if supplied), or of specialist registration in the Ahpra window (if no fellowship letter is supplied). In these cases, use the date of college fellowship letter or the specialist registration as the start date No, if no date has been requested, key the date as the date: on the Schedule 1 college fellowship letter (if supplied), or of specialist registration in the Ahpra window (if no fellowship letter is supplied) Note: Specialist recognition can be applied up to 2 years before the date of lodgement of the application if it can be confirmed the medical practitioner had obtained fellowship at that date. For example, if an application is received 02/10/2020, specialist recognition can be granted from 02/10/2018 providing their fellowship certificate or Ahpra registration supports this. Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. For medical practitioners who do not hold fellowship and are recognised as a specialist with Ahpra, recognition can only be granted for a period of 2 years. Anaesthetists under training in Pain Medicine may also be granted recognition for a period of 2 years. See Table 9 > Step 7. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied on the HW077, the date of effect will be either: the date of first registration with Ahpra, or the date location is approved to start, whichever is later If already recognised and an application for an extension to specialist recognition has been received, make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension or removed as needed.
8	Limited Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for limited registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met: the limited registration includes approval for the medical practitioner to work in a specialist position, and the registration subtype shows Area of Need (AoN), and any approved locations are listed If this criteria is met, see the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming. If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023. If specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying, the start date will be the day after the end date of the existing specialty code. Make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied on the HW077, the date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later Go to Step 9.
9	Provisional Ahpra registration + Read more ... Medical practitioners who hold Schedule 1 college fellowship are granted recognition indefinitely. If the medical practitioner does not have specialist registration or fellowship through a Schedule 1 college, check for provisional registration on the Ahpra website. Specialist recognition can be granted for a 2 year period if the following criteria is met the: provisional registration includes approval for the medical practitioner to work in a specialist position, and registration confirms the medical practitioner is on a competent authority pathway (CAP), and any approved locations are listed If this criteria is met, go to the Resources page to confirm the specialty code for the requested specialty. Check the application form to confirm the date needed for Medicare claiming. If no date has been requested, key as date of lodgement of the application. Record an end date 2 years in the future. For example, if specialist recognition is applied from 12/08/2021 the end date will be 11/08/2023. If specialist recognition has previously been issued for a 2 year period and the medical practitioner is reapplying, the start date will be the day after the end date of the existing code. Make sure the specialty code is added as a new line if the existing line has already ended. Do not remove the end date. Add a new line the day after the end date of the original specialty. If the existing line is still current, the end date can be amended in line with the extension. If processing an online application or Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) along with the Application for recognition as a specialist or consultant physician form (HW077) and no date is supplied on the HW077, the date of effect will be either: the date of lodgement of the application, or the date location is approved to start, whichever is later
10	Dual recognition + Read more ... Were specialty codes 104, 180, 130, 132, 532, 530, 540 or an approved 3GA placement in general practice open at any location identified during the assessment step? Yes, the medical practitioner is eligible for dual recognition and specialty code 165 must be added to the stem. Apply dual recognition in line with the date specialist recognition is granted. See Dual recognition of medical practitioners for Medicare No, the medical practitioner is not eligible for dual recognition. Go to Step 11
11	MHST, PSC or FPS specialty codes + Read more ... Were VR specialty codes 647, 648, 649 and/or 650 or non-VR specialty codes 662, 663, 664 and/or 665 identified during the assessment step? Yes, check for specialty codes 104, 130, 132, 532, 530, 540 or an approved 3GA placement, if: one of these codes is current, the medical practitioner remains eligible to access the MHST, PSC and/or FPS items the medical practitioner does not have one of these codes, or they have been end-dated in the past, the medical practitioner is not eligible to access MHST, PSC and/or FPS items. The MHST, PSC and/or FPS specialty code/s will need to be end-dated the day before the specialist recognition date of effect No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... Is the medical practitioner subject to 19AB? Yes, Go to the Notes tab on PDS Key note subject - Specialist recognition 19AB exemptions needed Key note description - Granted specialist recognition. As Dr is subject to 19AB, an exemption is needed to access Medicare benefits. Locations without an existing exemption have been service ruled Add the following comment to the end of the registration line - ‘Granted specialist recognition subject to 19AB. See notes’ Go to Step 13 No, go to Step 14
13	Provider Service Rule (PSR) + Read more ... Apply a Provider Service Rule (PSR) to any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Check all locations for a current 519 specialty code and/or class exemption flag. Note: apply a 519 specialty code to location where a flag is identified. To add a PSR, select: Amend corresponding to the relevant provider number Loc-Service Rules tab Add Service Rule Add Service Rule: if the medical practitioner has a current 180 or 181 (with a current 500/519): Key 618 in the Service Rule Number field In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank if the medical practitioner has a current 110 (with a current 500/519) and the location has business structure and EFT details keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and In the End Date field, key the end of the 500 specialty code (Ten Year Moratorium - Medicare Benefits Not Payable) if the medical practitioner has a current 110 (with a current 500/519) and the location does not have business structure and EFT keyed in full: Key 618 in the Service Rule Number In the Activity Code field, select YES from the dropdown menu In the Start Date field, key the date of specialist recognition and leave the End Date blank Select Add New > Save Repeat this process for all locations which do not have a current 19AB exemption or class exemption. This action will prevent Medicare claims paid at locations where a valid 19AB exemption is not in place. Note: add a service rule 569 where an assistance at operations exemption applies. Do not add a 618 PSR where assistance at operations access is needed.
14	Sleep Medicine Assessment (if applicable) + Read more ... Is the medical practitioner seeking recognition in Sleep Apnoea (Spec code 192)? Yes, The medical practitioner is applying for recognition in Sleep and Respiratory Medicine and has supplied a letter from the Royal Australasian College of Physicians (RACP) advising of training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Specialty code 192 cannot be added before the date of specialist recognition and must not be added before the date on the college letter Go to Step 15 No, The medical practitioner is not eligible for Sleep Apnoea recognition and specialty code 192 cannot be added to PDS Go to Step 15 Note: Medical practitioners who are already recognised with Medicare as being a specialist or consultant physician may request access to Sleep Apnoea item numbers. A request is needed in writing along with evidence that training equivalent to Level I or Level II of the Advanced training program in either Adult Paediatric Sleep Medicine or post fellowship specialty recognition in Sleep Medicine.
15	Magnetic Imaging + Read more ... Is the medical practitioner applying for recognition in Diagnostic Radiology, does not hold Schedule 1 college fellowship and has a current specialty code 118 (magnetic Imagining) on stem? Yes, amend end date of specialty code 118 (Magnetic Imaging) in line with 047 (Diagnostic Radiology) No, go to Step 16
16	Confirmation letter + Read more ... See Resources page for appropriate letter options. Send letter template Z2264 Recognition as a specialist and consultant physician is approved. Staff must: Complete relevant fields: Delegate details supplied in letter option of the Standard Letter Template (SLT) must be specified as an APS5 Program Officer Deselect the Auto Capitalisation option in the address and signatory tab of the SLT Do not include any staff names, such as team leader's name Save the letter as a PDF to the Customer Information folder on their team's secure drive Upload the letter to PaNDA Make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct Add note to PaNDA file to indicate that application was 3E and any other notes specific to the processing, for example, ‘Delegate approval required’ Assign the PaNDA file to the delegate using the Send for Delegation function in PaNDA
17	Finalise + Read more ... Once the delegate has approved the application, the delegate will add the note Approved in PaNDA. Print only the approved confirmation letter and send to the medical practitioner by: post, and HPOS, if the provider has an active HPOS account On the PaNDA file, select Complete > Save

Returning an incomplete specialist recognition application

Table 11: this table explains how Service Officers process incomplete or rejected applications for provider registration in PDS.

Step

Action

Issuing a return letter to a medical practitioner + Read more ...

When more details are needed, return using the Z2270 Your application for recognition as a specialist/consultant physician cannot be processed letter. This must be sent to the medical practitioner advising them of the outcome of their application
When the application is rejected, return using the Z2266 Your application for recognition as a specialist and consultant physician is not approved letter. This must be sent to the medical practitioner advising them of the outcome of their application
Complete the relevant letter with all the required details
Print and send the letter to the medical practitioner and where appropriate include a printed copy of the application with the return letter
If the medical practitioner is registered with HPOS a copy should also be sent automatically to their HPOS mail

There may be more than one reason the application cannot be processed. All reasons must be communicated to the medical practitioner.

For 3D notification:

If provider is a temporary resident return using letter Z2266
If a provider has no stem return using letter Z2270
If no mailing address is available, contact Local Peer Support (LPS), who will escalate to a PO
For reasons other than residency and no stem, note the reason for returning and send the work item for delegation. A Program Officer will arrange an appropriate letter

Finalising the application + Read more ...

Staff must:

Convert the letter to PDF format and upload to the original file. Save the letter to the Customer Information folder on their team's secure drive
Upload the letter to PaNDA
Make sure the Surname, First Name, Provider Number and Case ID fields are completed and correct
Mark the work item as Complete in PaNDA
Send the letter to the provider by:

post, and
HPOS, if the provider has an active HPOS account

Assess a request to revoke specialist recognition

Table 12: this table explains how to assess a request to revoke specialist recognition for Medicare purposes.

Step	Action
1	Request received + Read more ... A medical practitioner may have their specialist recognition revoked for a variety of reasons. Reasons for revocation of specialist recognition can include: a written request is received from the medical practitioner requesting their specialist recognition is end dated the medical practitioner stops to be a medical practitioner as defined in the Health Insurance Act 1973 advice is received from the relevant Australasian specialist medical college medical practitioner has a new determination approved under a different section of the Act. For example, 3E revoked as 3DB determination now in place following the medical practitioner becoming a permanent resident
2	Assess request + Read more ... Determine whether recognition was granted under section 3D, section 3DB or section 3E. Open PaNDA and search for the original determination to confirm which section of legislation the specialist recognition was issued under 3D, 3DB or 3E. If specialist recognition granted before this work type being added to PaNDA, escalate request to Local Peer Support (LPS). Once the determination has been confirmed, go to Step 3. Note: revocation of specialist recognition under 3D does not need a determination.
3	Check PDS + Read more ... Open PDS: Select Provider > View > Detailed Search In the Family name field enter the first 3 letters of the last name followed by a % In the Given name field enter the first 3 letters of the first name followed by a % Enter profession in Profession field Select Search. A list of health professionals with a matching details will show Select View against the medical practitioner that matches the application Note: if revocation of a determination under 3E is required due to the medical practitioner becoming a permanent resident, see Table 13 > Step 2. Does the applicant appear in the list of health professionals? Yes, see Table 13 No, escalate to LPS for help

Process a request to revoke specialist recognition

Table 13: this table explains how to process a request to revoke specialist recognition for Medicare purposes.

Step	Action
1	Processing the request + Read more ... In PDS, in Provider View select: Edit Qualifications tab, remove the post graduate qualification acronym. For example, FANZCA Specialty tab, if the request was submitted by: a specialist college, apply the end date listed on the notice the medical practitioner, apply the end date requested or date of lodgement of the application, whichever is later
2	Revoking a 3E determination due to change in residency status + Read more ... A medical practitioner will need to have their specialist recognition extended on PDS when they were previously recognised under 3E as a temporary resident but is now applying under 3DB as an Australian Citizen/permanent resident. Check the existing specialist or consultant physician specialty code on stem. If it has an end date in the past: add a new line by selecting Add specialty code key the start date in line with the date of permanent residency or two years before date of lodgement, whichever is later If the existing specialist or consultant physician specialty code has an end date in the future, see Table 5 > Step 6 and follow the assessing steps
3	Confirmation letter + Read more ... Send letter template Z2268 Revoking your specialist/consultant physician status and Determination Template. Staff must: Complete relevant fields Save the letter as a PDF to the Customer Information folder on their team's secure drive Upload the letter to PaNDA Make sure the Surname, First Name, Provider Number and Case ID fields are completed and correct Add a note to PaNDA - Delegate approval required Assign the PaNDA file to the delegate using the Send for Delegation button in PaNDA
4	Finalise + Read more ... Once the delegate has approved the application, they will add a note in PaNDA Approved. Print only the approved confirmation letter and send to the medical practitioner by: post, and HPOS, if the provider has an active HPOS account On the PaNDA file, select Complete > Save.

Assess backdating specialist recognition assessment and escalation

Table 14: explains how to assess a request to backdate specialist recognition and the escalation process.

Step	Action
1	Request for back date received + Read more ... To be a valid backdating request for specialist recognition the request must: be in writing contain reasons why backdating is needed and the reasons need to relate to the access of Medicare benefits provide evidence to support their request - including evidence that patients were seen and their claims were rejected request date for backdating within 2 years (as Medicare claims beyond this time period will not be payable) Is the request a valid backdating request? Yes, go to Step 2 No, return the request to the medical practitioner
2	Search PANDA for the request to back date + Read more ... Has a request to back date been received? Yes, go to Step 3 No, send to Local Peer Support (LPS) LPS will establish what section of the legislation the specialist recognition was previously granted under. If LPS is unable to establish what section of the legislation the specialist recognition as granted under. If needed, LPS will escalate to a PO The application should be re-categorised to the National Office Escalation folder in PaNDA Procedure ends here
3	Assess request + Read more ... Establish if the previous specialist recognition application was granted under 3D, 3DB or 3E. Is the request to backdate the specialist recognition greater than 2 years? Yes, Escalate to LPS to get approval from a Program Officer to determine eligibility to backdate Re-categorise the application to the National Office Escalation folder in PaNDA until advice received No, see Table 15 Note: if granted under 3D - no determination is needed. Escalate requests to backdate a 3D notification to LPS.

Process backdating specialist recognition

Table 15: explains how to process a request from a medical practitioner to back date specialist recognition.

Step	Action
1	Determine date for specialist recognition to be backdated + Read more ... Was the medical practitioner eligible for specialist recognition at the date requested? Yes, go to Step 3 No, specialist recognition cannot be backdated to requested date. The earliest date for backdating is the date the medical practitioner is eligible for specialist recognition
2	Determine date for specialist recognition to be backdated, continued: + Read more ... Was the medical practitioner restricted by section 19AB at the time of the date being requested? Yes, and the medical practitioner: had a valid section 19AB exemption at the time of the date being requested, go to Step 4 did not have a valid section 19AB exemption at the time of the date being requested. The date for recognition should be the date when a valid section 19AB exemption was granted. (If no valid section 19AB exemption was granted, specialist recognition cannot be backdated as no Medicare benefits were payable) No, go to Step 4
3	Amend specialty code start date + Read more ... In PDS, in Provider View select: Edit Specialty tab, amend the specialty code start date to reflect approved request
4	Confirmation letter + Read more ... Send letter template Z2264 Recognition as a specialist and consultant physician is approved. Staff must: complete relevant fields save the letter as a PDF to the Customer Information folder on their team's secure drive upload the letter to PaNDA make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct add note to PaNDA - Delegate approval required assign the PaNDA file to the delegate using the Send for Delegation button in PaNDA
5	Finalise + Read more ... Once the delegate has approved the application, they must add a note in PaNDA ‘Approved’. Print only the approved confirmation letter and send to the medical practitioner by: post, and HPOS, if the provider has an active HPOS account On the PaNDA file, select Complete > Save

Process a request to remove expediated pathway restrictions

Table 16: explains how to process a request from a medical practitioner to remove the HPOS restrictions once their expediated pathway restriction have been removed by Ahpra.

Step

Action

Assess request + Read more ...

A request to remove the ‘New location creation restricted in HPOS’ (510 speciality code) can be received as:

a signed letter from the medical practitioner
an email from the email address listed on the stem from the medical practitioner
a phone call from a medical practitioner
an email from Ahpra

Check Ahpra website + Read more ...

Check the Ahpra Register of practitioners, see External contacts on Resources page for a link:

Enter the medical practitioner's registration number
Select Search

If there is no match, contact Local Peer Support (LPS).

If there a match for the medical practitioner, check the ‘conditions’ section on the registration.

Are there restrictions listed?

Yes, contact LPS
No, key an end date in the 510 speciality code on the providers stem using today as the end date
Select Save

Process ends here.

Operational Information