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

Open PDS and Select:

• Provider
• View
• Key the practitioner’s surname in the appropriate field with a % sign either side (this is a wild card function)
• Key the practitioner’s first name in the applicable field with a % sign at the end of the name
• Select Profession
• Select Search, if the search returns multiple results add the providers date of birth to the search function

Assess the search results returned:

• Select View, this will open the provider’s stem page
• Assess the search results returned:
• select view to open the provider’s file

Has the medical practitioner provided or quoted a provider number?

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

Note: to check for issued locations see the top of the PDS page. Select the provider stem hyperlink to open a list of provider numbers issued to the practitioner.

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

• Key the suburb as quoted on the application form
• Select from the dropdown box
• Address line key as per application and select as per RAET
• Procedure ends here

If the locality still does not appear, go to Step 3.

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

if no match:

• select Manual entry
• key details from the application

If the health professional submit the application via:

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

Return using incomplete letter Z2306 or rejection letter Z2305 and where appropriate include a copy of the submitted documents.

• Complete appropriate fields of letter template
• Save letter as a PDF
• Upload letter to PaNDA
• Issue the letter to the provider via:
• Post and
• HPOS if the provider has an active HPOS account. See Table 5
• In PaNDA, make sure the Surname First Name, Provider Number and Case ID fields are complete and correct
• Add appropriate notes to the PaNDA file
• Select Complete
• Select Request Rejected in the Complete Reason field
• Select Save

Note: there may be more than one reason the application cannot be processed. It is important that all the reasons are communicated to the provider.

If more details or supporting documents are needed:

In PDS

• Select Reject
• Select the reason for rejecting from the dropdown list
• A letter will create and send to the provider’s HPOS mailbox

In PaNDA

• Make sure the following are complete and correct:
• Surname First Name
• Provider Number, and
• Case ID fields
• Add any appropriate notes to the PaNDA file
• Select Complete > Request Rejected in the Complete Reason field > Save

• Complete appropriate fields of the required letter template
• Save the letter as a PDF in the Customer Information folder on your teams secure drive with the naming convention <INITIALS>.<SURNAMEFIRSTNAME>.LETTER
• In cases where multiple documents need to be saved for the one application, further detail should be added to the file name to differentiate each document’. For example:
• <INITIALS>.<SURNAMEFIRSTNAME>.LETTER
• <INITIALS>.<SURNAMEFIRSTNAME>.DHAC DECISION
• <INITIALS>.<SURNAMEFIRSTNAME>.AHPRA
• Upload letter to PaNDA
• Issue the letter to the provider via:
• Post, and
• HPOS if the provider has an active HPOS account. See Table 5
• Once the letter has been uploaded to PaNDA, delete the PDF from the Customer Information folder.

• Screenshots may be required to be saved and uploaded to PaNDA when assessing applications. For example, AHPRA registration and/or confirmation of address
• When saving a screen shot and/or an attachment for uploading to PaNDA:
• save the screen shot and/or attachment as a PDF in the Customer Information folder on the teams secure drive
• name the screen shot and/or attachment with the following convention, <INITIALS>.<SURNAMEFIRSTNAME>.<DOCUMENT TYPE>
• In cases where multiple documents need to be saved for the one application, add further detail to the file name to differentiate each document. For example:
• <INITIALS>.<SURNAMEFIRSTNAME>.LETTER
• <INITIALS>.<SURNAMEFIRSTNAME>.DHAC DECISION
• <INITIALS>.<SURNAMEFIRSTNAME>.AHPRA
• Upload to PaNDA. Once the screen shot has been uploaded to PaNDA, delete the PDF from the Customer Information folder.

Create the manual letter and save as a PDF.

Confirm if application type and letter type are in scope for send as a HPOS message - See Resources page Tables 3 and 4.

The HPOS Registration field in PDS shows the provider's status:

• Active - the provider has logged into HPOS in the last 6 months
• Inactive - the provider has not logged into HPOS in the last 6 months
• None - the provider does not have a HPOS account linked to their provider number/s

Only providers with an active HPOS status can have a message sent via HPOS.

To locate a providers PRODA RA number:

• log into PRODA - Provider Digital Access in the Medicare Portal/eBusiness system using the local source office
• enter the provider's first name, surname and date of birth in the Demographic Search field
• select Search

The PRODA RA number will appear under the Account details.

To send an HPOS message access the HPOS support function via the Medicare portal/eBusiness system. Use the usual source office.

• from Mail Centre select Medicare > Compose New Email
• enter the Provider's PRODA RA number in the To field
• copy the text for the subject line and text boxes from the Z3014 template. See the Provider Registration page.
• Subject line: Your Medicare provider registration application has been processed
• Text box: This message is from Services Australia. Please read the attached letter about the outcome of your Medicare provider registration application
• select Choose File
• attach a copy of the required PDF letter
• select Add file
• repeat this process if any additional attachments are needed
• select Send

Note: providers can see the attached file name.

If sending multiple documents, where possible merge all documents into one file using the naming conventions outlined in Table 4.

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

Open PDS:

• Select Provider > View > Detailed Search
• In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
• In the Given name key the practitioner’s first name with a % sign at the end of the name
• Select Profession > Search
• A list of health professionals with a matching name displays. If the search returns multiple results, add the providers date of birth to the search function

Is there a PDS match for the medical practitioner?

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

The Resources page contains a link to the Ahpra website.

Use the look up a health practitioner function by searching either the Ahpra registration number or by the health practitioner’s name.

In PDS:

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

Open PDS:

• Select Provider > View > Detailed Search
• In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
• In the Given name key the practitioner’s first name with a % sign at the end of the name
• Select Profession > Search
• A list of health professionals with a matching name displays. If the search returns multiple results add the providers date of birth to the search function
• Select the relevant match

• Select Edit > Speciality Tab
• Select Amend on Specialty Code
• Enter the Start Date of the specialty code into the End Date for all specialty codes
• Select Notes Tab > New Note
• In the Notes Subject field key Provider Stem Issued in error for <insert provider name>
• In the Notes Description key Provider Stem Issued in error, reuse for <insert provider name> when provider submits a completed and eligible provider number request
• Select Save

All other fields do not require any amendments. The providers full name, date of birth and registration details to be keyed accurately from the Ahpra window or application and supporting documents for non-Ahpra registered health professionals.

If a prescriber number was issued in error, contact Local Peer Support (LPS). They will escalate to a Program Officer to remove the prescriber number from the provider stem.

Was there a provider number(s) created in error?

• Yes, see Table 8
• No, procedure ends here

Open PDS:

• Select Provider > View > Detailed Search
• In the Family name key the practitioner’s surname with a % sign either side (this is a wild card function)
• In the Given name key the practitioner’s first name with a % sign at the end of the name
• Select Profession > Search
• A list of health professionals with a matching name displays. If the search returns multiple results add the providers date of birth to the search function
• Select the relevant match
• Select the orange hyperlink at the top of the stem page

• Select Edit > Clear
• Locality or post code key the states capital city for the provider number that was issued. For example, 6000 Perth 3000 Melbourne
• Address line - key issued in error
• Building or department - key issued in error
• Select contact tab
• Remove phone fax and email address if present
• Location end - date key same as location start date
• Select Loc-Spec Codes tab> Add Service Rule
• In Service Rule Number field, key 618
• In the Activity Code field, select Yes
• Enter the Start Date of the location
• In End Date, leave blank
• Select Add New > Cancel > Save

If business structure and/or bank account details were saved to the location, contact Local Peer Support (LPS) who will raise the location to a Program Officer to remove the business structure and/or bank account details from the location.

If a health professional or third party calls and asks for their application to be prioritised, staff must find out the reasons. Applications can be prioritised if an exceptional circumstance applies.

An exceptional circumstance applies if the provider is ineligible or unable to apply online and one or more of the following applies:

• the only health professional in a community or rural/remote practice leaves, and an urgent replacement health professional is required
• a disaster has occurred, and:
• caused damage to a practice, and the affected health professional(s) need to relocate, or
• the community needs urgent health care near the disaster
• a medical practitioner has reached their scaling end-date but is unable to create locations via HPOS due to a future moratorium end-date
• a foreign graduate of an Australian medical school (with post-graduate qualifications) is unable to create provider numbers with access to Medicare benefits via HPOS, at locations which are eligible for the following:
• Northern Territory class exemption
• Specialist class exemption
• Distribution Priority Area class exemption
• District of Workforce Shortage class exemption
• a health professional is unable to use HPOS to create a location which returns an MM classification of 6 or 7 on the Health Workforce Locator map. To determine this:
• go to the Health Workforce Locator
• select Modified Monash Model 2019
• key the practice address
• select Search
• the map will display an MM classification from 1 to 7
• a health professional working in an Urgent Care Clinic (UCC) approved by a Primary Health Network, state government or territory government if:
• application form states the practice is a UCC, and
• the location is listed within the Medicare Urgent Care Clinics (UCC) Directions under Subsection 19(2)
• a health professional gets the following error message when applying through HPOS
  ‘Locality limit exceeded (no more than 24 characters exceeded)’

Note: Medicare UCCs complement existing state-run emergency diversion initiatives.

If the reason is:

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

When the reason is due to an exceptional circumstance, staff must:

• add a note to the relevant PaNDA file with details of the request to process an application quicker, and the reason for approving
• process the application, if scheduled on processing, or
• contact the Team Leader via email and ask for the application to be processed by an available operator, if not scheduled on processing

When the reason is not due to an exceptional circumstance, staff must:

• tell the caller, 'For procedural fairness, applications are assessed in the order we receive them.
• add a note to the relevant PaNDA file with details of the request to process an application quicker, and the reason for not approving

A caller may say they want to make a complaint about an unfavourable decision and/or the time taken to process an application. If they do, tell them to contact Medicare Complaints by submitting an online or written complaint. The caller can do this by searching ‘complaint’ on the agency website for details.