Forms and letters for Practice Incentives Program (PIP) and Workforce Incentive Program (WIP) - Practice Stream 012-10010070

Form number and version

Form name

Old form version cut-off date

IP001.2211

Practice Incentives application form

Earlier versions are no longer accepted.

IP002.2103

Practice Incentives Program eHealth application

Note: Program Management will issue this form in exceptional circumstances.

IP003.2107

Practice Incentives Individual general practitioner, nurse practitioner or health professional details form

Earlier versions are no longer accepted.

IP004.2107

Practice Incentives Program Procedural General Practitioner Payment application form

Earlier versions are no longer accepted

IP005.2205

Practice Incentives Change of practice details form

Earlier versions are no longer accepted

IP006.2305

Practice Incentives Program Teaching Payment claim form

IP006.2011 - 31 December 2023

If the version of the form was dated by the university before the cut-off date, that form is acceptable.

Earlier versions are no longer accepted.

IP007.2107

Practice Incentives Practice closure or withdrawal form

Earlier versions are no longer accepted:

IP008.2107

Practice Incentives Practice ownership details and declaration form

Earlier versions are no longer accepted.

IP010.2107

Practice Incentives Change of practice ownership form

Earlier versions are no longer accepted.

IP011.2107

Practice Incentives Program Service Incentive Payments banking details form

Earlier versions are no longer accepted.

IP017.2311

Practice Incentives Program Indigenous Health Incentive patient registration and consent form

IP017.2211 – 30 June 2024

IP017.2309 – 30 June 2024

IP017.2310 – 31 October 2024 – after 31/10/2024 if a parent or guardian is providing the consent because the patient does not have capacity to do so, they need to use form IP017.2311. In all other situations IP017.2310 will be acceptable. Earlier versions are no longer accepted.

IP025.2107

Practice Incentives Additional practice branch

Earlier versions are no longer accepted.

IP026.2211

Practice Incentives Program Indigenous Health Incentive practice application form

Earlier versions are no longer accepted.

IP027.2107

Practice Incentives Review of decision form

Earlier versions are no longer accepted.

IP029.2107

Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent form

Earlier versions are no longer accepted.

IP030.2107

Practice Incentives Program After Hours Incentive application

Earlier versions are no longer accepted.

IP032.2107

Practice Incentives Overpayment information and summary sheet

Note: this form is for internal use only.

IP033.1908

Practice Incentives Program Quality Improvement application

Note: Program Management will issue this form in exceptional circumstances.

Letter category

Letter name and action

PIP or combined PIP/WIP – Practice Stream Amendments

Z1736 Request for more information for PIP and the WIP – Practice Stream

Use this letter to return any form to the practice that needs more information

Z1844 Recovery of PIP payments

Use this letter to recover a PIP overpayment

Z2092 We need more information to update GP/NP and HP details

Use this letter to return an IP003 form to the practice that needs more information

Z2188 PIP WIP Practice closure or withdrawal from the PIP and WIP – Practice Stream

Use this letter to confirm the practice/additional practice branch is closed or withdrawn

PIP Annual Confirmation Statements

Z2121 Request for more information for your Practice Incentives Program Annual Confirmation Statement

Use this letter to return an Annual Confirmation Statement to the practice that needs more information

The Annual Confirmation Statement may be processed

PIP or combined PIP/WIP – Practice Stream Applications

Z2592 We need more information to process your application

Use this letter to reject an application that needs more information

Z1597 Your practice has been approved for the Practice Incentives Program

Use this letter to confirm the practice’s PIP application is approved

Z2187 Your application is not approved

Use this letter to reject a PIP/WIP – Practice Stream application when the practice is not meeting the program’s eligibility requirements

PIP and WIP – Practice Stream Compliance

Program Management use the below letters after a Health Audit finding of non-compliance:

• Z2433 Your PIP and WIP – Practice Stream payments are on hold
• Z2435 Your practice has been withdrawn from the PIP and the WIP – Practice Stream
• Z2436 Your withheld payments will be paid to your practice

PIP eHealth Incentive and Quality Improvement Incentive

Z2320 Your eHealth Incentive and Quality Improvement Incentive request needs to be completed online

• Use this letter to tell the practice to apply for the eHealth Incentive or Quality Improvement through HPOS
• Use this letter to tell the practice to update their eHealth Incentive information through HPOS

PIP Indigenous Health Incentive

Z1661 Your application for PIP IHI has been approved

Use this letter to confirm the IHI practice application is approved

Z1704 PIP IHI and PBS Co-payment Measure – more information is needed

Use this letter to return an IHI Patient registration form that needs more information

Z1874 PIP IHI patient registration – patient/s not registered

Use this letter to reject an IHI patient registration for not meeting the incentive’s eligibility requirements

Z2411 PIP IHI practice registration - IHI patient withdrawal – more information is needed

• Use this letter to return an IHI practice application that needs more information
• Use this letter to return an IHI patient withdrawal that needs more information

PIP Teaching payments

Z1656 PIP Teaching payment claim – request for more information

Use this letter to return a teaching claim that needs more information

Z1657 PIP Teaching session/s not payable

Use this letter to reject a teaching claim that is:

• Not payable as the claim is a duplicate, or
• Does not meet the incentive’s eligibility requirements

WIP – Practice Stream Only letters

Z1669 Recovery of WIP – Practice Stream

Use this letter to recover a WIP – Practice Stream overpayment

Z1758 We have not made a payment for you <first-second> quarter

Program Management use this letter to tell a practice:

• They have not received WIP – Practice Stream payment/s for one or 2 quarters, and
• If payments are zero or withheld for 3 quarters, they will be withdrawn

Z2190 Your payments remain zero or withheld for the <second><third> quarter

Program Management use this letter to tell a practice:

• Their payments are on hold for 2 or 3 quarters, and
• They will be withdrawn from the program on a particular date

Provides practices the opportunity to address the held payment reasons before being withdrawn

WIP – Practice Stream Quarterly Confirmation Statements

Z2189 We need more information for your QCS

Use this letter to return a QCS that needs more information

The QCS may be processed

Form field

Action

Practice ID

If the practice does not provide the practice ID, or the practice ID is incorrect:

• Return the form to the practice using the addressee details on the form
• Check the rest of the form for incomplete questions only
• Do not check the practice details (including address and contact information) on PIP/WIP – Practice Stream Online or other search options
• Upload the documents to Processing and National Demand Allocation (PaNDA)
• Finalise the Work Item as Complete, Request rejected in PaNDA

Practice details:

• Practice name
• Main practice address

The practice must provide these details.

If these details are missing or incorrect, return the form to the practice

Declaration details

• Owner/authorised contact person’s name
• Owner/authorised contact person’s signature
• Declaration date

There must be the signature of at least one registered owner or authorised contact person.

If there are no name details, check the signature. Accept the form if the name can be identified from the signature.

If the name is not identifiable and/or the declaration does not have a valid date, return the form to the practice.

Signature block

Completed by

Individual/Partner/Associate/Representative on the:

• Practice Incentives application (IP001) form
• Practice Incentives Change of practice ownership (IP010) form
• Practice Incentives Practice closure or withdrawal (IP007) form

Individual Proprietor

• The individual owner must sign the declaration

Partnership

• At least 2 partners must sign the declaration

Associateship

• At least one associate must sign the declaration

Body Corporate

• At least 2 representatives must sign the declaration

State or territory government or other public body

• At least 2 officers must sign the declaration

Individual/Partner/Associate/Representative on:

• All other forms

One owner on the practice profile must sign the declaration

Authorised Contact Person

An authorised contact person on the practice profile must sign the declaration.

Note: an owner on the practice profile can sign the declaration in place of an authorised contact person.

General Practitioner

The general practitioner must sign the declaration.

Nurse Practitioner

The nurse practitioner must sign the declaration.

Form

Addressee details on letter

Practice Incentives Service incentive payment banking details (IP011) form

Send to the general practitioner wanting to change their bank account details

Practice Incentives Individual general practitioner, nurse practitioner or health professional details (IP003) form

• Send to the primary authorised contact on the practice profile, or
• Send to the general practitioner or nurse practitioner on the form, if there is no Practice ID or the practice ID is incorrect

Practice Incentives Change of practice ownership (IP010) form

• Send to the new primary authorised contact person on the form, or
• Send to the primary authorised contact person on the practice profile
• If the primary authorised contact person is a previous owner or no authorised contacts from the previous ownership remain at the practice, send to the new owner on the form

All other forms

Primary authorised contact registered against the PIP and/or WIP – Practice Stream practice profile

Forms where the practice ID is missing, incorrect or the practice cannot be identified

Send to the name on the form

If there is no name on the form, use ‘Practice Manager’

Form

Postal address to use on letter

Practice Incentives Application (IP001) form

Send to the postal address on the form.

If the postal address is not available, send to the main practice address on the form.

Online applications

Send to the postal address on the application.

If the postal address is not available, send to the main practice address on the application.

Practice Incentives Practice closure or withdrawal (IP007) form

Practice closure

Send to the forwarding address on the form.

If the forwarding address is not available, send to the postal address on the practice profile.

Practice branch closure

Send to the postal address on the practice profile.

Practice Incentives Practice ownership details and declaration (IP008) form

Send to the postal address on the online application.

If the postal address is not available, send to the main practice address on the form.

Practice Incentives Service incentive payment banking details (IP011) form

Send to the postal address on the form

If the postal address is not available, send to the:

• address on the form, or
• the provider’s preferred mailing address on the Provider Directory System (PDS)

Practice Incentives Change of practice ownership (IP010) form

Send to the main practice address on the practice profile.

Practice Incentives Change of practice details (IP005) form

For practice relocations only:

• Send to the new postal address on the form
• If the postal address is not available, send to the new main practice address on the form

All other notifications, send to the postal address on the practice profile.

All other forms

Send to the postal address on the practice profile.

Forms where the practice ID is missing, incorrect or the practice cannot be identified

Send to the postal address on the form.

Word

Abbreviation

Adelaide

Adl

Alice Springs

Asp

Association/Associates

Assoc

Avenue

Ave

Boulevard

Bvd

Brisbane

Bris

Building

Bldg

Canberra

Cbr

Centre

Ctr.

Circuit

Cc

Controlled

Cont

Cooperative

Coop

Corner

Cnr

Corporate or Corporation

Corp

Court

Ct

Crescent

Cres

Darwin

Drw

Doctor/Doctors

Dr/Drs

Drive

Dr

Esplanade

Esp

Health

Hlth

Highway

Hwy

Hobart

Hba

Hospital

Hosp

Incorporated

Inc

Medical

Med

Melbourne

Mel

Parade

Pde

Perth

Per

Place

Pl

Plaza

Plz

Practice

Prac

Proprietary Limited

Pty Ltd

or

P/L

Region/Regional

Reg

Ridge

Rdge

Road

Rd

Service/s

Srv/s

Square

Sq

Street

St

Sydney

Syd

Terrace

Tce

University

Uni

Work Type

Code

FREE TEXT LETTER

FTL [CODE]

EMAIL

EMAIL [CODE]

Accreditation

ACCRED

Additional Practice Branch

ADD BRANCH

Amendments

AMEND

Bank Details SIP ACAI PIP

BANK ACAI

Bank Details WIP-DS

BANK WIP DS

Change of Details - Cease GP/NP

CoD CEASE

Change of Details - Authorised Contact

CoD CONTACT

Change of Details - Bank details

CoD BANK

Change of Details - Amalgamation

CoD AMALG

Change of Details - Relocation

CoD RELOC

Change of Ownership

OWNERSHIP

Confirmation Statement PIP

ACS

Confirmation Statement WIPPS

QCS

COVID

COVID

IHI Multi Patient Registration PIP

IHI MULTI

IHI Patient Registration

IHI

IHI Patient Withdrawal

IHI WITHDRAW

IHI Practice Authority Registration

IHI PRAC AUTH

Individual Practitioner Details

INDIV DET

Practice & Branch Closure or Withdrawal

CLOSURE

Practice Ownership Details

HPOS APP

Program Application

PROG APP [SPLIT]

Recovery/Voluntary Reimbursement

RECOVERY

Review of Decision

RoD

Teaching Claim

TEACH

Incentive Application

INC APP