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

Current form number and version

Form name

Old form version cut-off date

IP001.2412

Practice Incentives application form

IP001.2211 - 31 January 2025

Earlier versions are no longer accepted.

IP002.2404

Practice Incentives Program eHealth application

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

IP003.2412

IP003.2410

Practice Incentives Individual general practitioner or nurse practitioner details form

IP003.2107 - 31 January 2025

Form titled:

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

Earlier versions are no longer accepted

IP004.2412

IP004.2410

Practice Incentives Program Procedural General Practitioner Payment application form

IP004.2107 - 31 January 2025

Earlier versions are no longer accepted

IP005.2412

IP005.2410

Practice Incentives Change of practice details form

IP005.2205 - 31 January 2025

Earlier versions are no longer accepted

IP006.2412

IP006.2410

Practice Incentives Program Teaching Payment claim form

IP006.2305 - 31 January 2025

RTF (Word) versions are no longer accepted unless they meet the university certification criteria below.

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

Eligible university certification dates for previous versions:

IP006.2305 - 1 May 2023 to 31 January 2025

IP006.2011 - 1 November 2020 to 31 December 2023

IP006.1808 - 1 August 2018 to 31 January 2021

Earlier versions are no longer accepted.

Exceptions are in place for the University of Melbourne and Flinders University, see Teaching Payment Claims for Practice Incentives Program (PIP) for more details.

IP007.2412

IP007.2410

Practice Incentives Practice closure or withdrawal form

IP007.2107 - 31 January 2025

Earlier versions are no longer accepted

IP008.2412

Practice Incentives Practice ownership details and declaration form

IP008.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP010.2501

IP010.2411

IP010.2412

Practice Incentives Change of practice ownership form

IP010.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP017.2410

Practice Incentives Program Indigenous Health Incentive patient registration and consent form

IP017.2311 - 31 January 2025

Earlier versions are no longer accepted.

RTF (Word) versions are no longer accepted

IP025.2412

Practice Incentives Additional practice branch

IP025.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP026.2412

IP026.2410

Practice Incentives Program Indigenous Health Incentive practice application form

IP026.2211 - 31 January 2025

Earlier versions are no longer accepted.

IP027.2412

IP027.2410

Practice Incentives Review of decision form

IP027.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP029.2412

IP029.2410

Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent form

IP029.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP030.2412

IP030.2410

Practice Incentives Program After Hours Incentive application

IP030.2107 - 31 January 2025

Earlier versions are no longer accepted.

IP032.2107

Practice Incentives Overpayment information and summary sheet

Note: this form is for internal use only.

IP033.2410

Practice Incentives Program Quality Improvement application

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

Form name and number

Completed by

• Practice Incentives application (IP001) form
• Practice Incentives Practice ownership details and declaration (IP008)
• 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

Company

• At least one director must sign the declaration

Trust

• At least one trustee must sign the declaration. If trustee is a company at least one director 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

Note: if the practice has submitted an older acceptable form and selected Associateship, determine the correct ownership structure. Assess the signature requirements based on that.

• The owners signing an IP007 must be listed on the practice profile as practice owners

Practice Incentives Change of practice details (IP005)

One owner on the practice profile must sign the declaration if the request is for or includes:

• Changes to authorised contact persons
• Relocation
• Amalgamation

One owner or authorised contact person can sign the declaration if the request is for any of the following:

• Bank account details
• Ceasing general practitioners or nurse practitioner
• Updating health professional details only

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

For most notifications:

• the general practitioner or nurse practitioner must sign the practitioner declaration
• an authorised contact person must sign the practice declaration

See Practitioners in PIP and WIP - Practice Stream for signature requirements for specific notifications.

All other forms

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

Forms signed by a contact person who has since been removed are acceptable if it was signed and dated before the contact was removed from the profile. See Table 2 on the Process page.

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

Notification type

Verbally accepted details

Extra actions

Practice Details

Applies to:

• the Practice Details section on all forms
• general correspondence

Practice ID

• practice ID is invalid or incorrect
• practice ID is missing

Practice Name

• practice name is missing
• practice name does not match the practice profile

Practice ID

• If only one is missing or incorrect, only accept details verbally if all other details are complete
• If more than one is missing or incorrect, return the form
• Authorised Contact Person (ACP) must be advised to use the correct information

Practice Name

• If the practice name has changed tell them how to update. See Enquiry management for PIP and WIP - Practice Stream

IP001 Practice Incentives application form

Public liability

• correct expiry date when public liability is showing as expired at the date of lodgement

Professional indemnity

• the question has not been answered

Practice type

• the practice type has not been selected
• more than one type has been selected

Practice phone number

• not provided - phone number is a mandatory field

PIP Practice ID

• not provided and the practice has selected ‘yes’ to PIP registration and ‘yes’ to PIP consenting

Health professional indemnity insurance

• the question has not been answered

Practitioner professional indemnity

• not answered

Provider number is not correct

• digits missing or reversed
• additional digit
• location identifier missing or incorrect

Start date at practice

• date missing or invalid

Incorrect provider location:

• If the incorrect provider location has been indicated, staff must use PDS to confirm the practitioner has a provider number for the location before calling
• If there is no linked provider number, staff must reject the form

IP003 Practice Incentives individual general practitioner or nurse practitioner details form

Adding a practitioner

• Professional indemnity not answered
• Provider number is not correct
• Digits missing or reversed
• Additional digits
• Location identifier missing or incorrect
• Start date is missing or invalid

Ceasing a practitioner

• Provider number is not correct
• Digits missing or reversed
• Additional digits
• Location identifier missing or incorrect
• End date at practice is missing or invalid

Incorrect provider location:

• If the incorrect provider location has been indicated, staff must use PDS to confirm the practitioner has a provider number for the location before calling
• If there is no linked provider number, staff must reject the form

Ceased practitioner

• If staff can identify the ceased practitioner from the Current GPs list they do not need to confirm the provider number

IP005 Practice Incentives Change of practice details form

Ownership question

• Not answered

Old location operating as a medical practice

• Not answered

Public liability

• If policy expiry date is before the date of lodgement

Professional indemnity for practitioners and health professionals

• Not answered

Authorised contact persons

• Add/remove not indicated

Ceasing a practitioner

• Provider number is not correct
• Digits missing or reversed
• Additional digits
• Location identifier missing or incorrect
• End date at practice is missing or invalid

Practice ownership question

• If the ACP indicates the ownership has changed, return the form and ask for completion of IP010

Old location operating as a medical practice question

• If the answer is ‘yes’ staff must ask for further information
• Return the form to the practice

IP008 Practice Incentives Practice ownership details and declaration form

Application number

• missing or invalid

PIP ID for WIPPS

• missing and PIP consenting indicated

IP010 Practice Incentives Change of practice ownership form

Partial change of ownership

• add/remove has not been checked

Return the form to the practice if new owners:

• are being added, and
• have not signed the declaration

IP010 Practice Incentives Change of practice ownership form

Public liability

• policy expiry date is before the date of lodgement

Professional indemnity for practitioners and health professionals

• not answered

Ceasing a practitioner

• provider number is not correct
• digits missing or reversed
• additional digits
• location identifier missing or incorrect
• end date at practice is missing or invalid

Authorised contact persons

• If add/remove not indicated

IP025 Practice Incentives Additional practice branch form

Professional indemnity for practitioners and health professionals

• not answered

Practitioner details

• professional indemnity insurance not answered
• Provider number is not correct
• digits missing or reversed
• additional digits
• location identifier missing or incorrect
• start date at branch location is missing or invalid

Incorrect provider location:

• If the incorrect location has been indicated, staff must use PDS to confirm the practitioner has a provider number for the location before calling
• If there is no linked provider number, staff must reject the form

Practice update

Form required

Online application

Practice Incentives Practice ownership details and declaration (IP008) and supporting documents

Relocation

Practice Incentives Change of practice details (IP005) and supporting documents

Change of ownership

Practice Incentives Change of practice ownership form (IP010) and supporting documents

Accreditation

Current accreditation or registered for accreditation certificate. External users cannot update or amend accreditation details online

Closure/withdrawal

Practice Incentives Practice closure or withdrawal form (IP007) - external users cannot close or withdraw a practice online

Procedural GP

Practices cannot register a GP for procedural payments. The GP must submit a Practice Incentives Individual general practitioner or nurse practitioner details form (IP003)