Dual recognition of medical practitioners for Medicare 012-42020040

Dual recognition may be processed when Services Australia receive one of the following:

• Telephone call from the medical practitioner, go to Step 3
• Signed written request from the medical practitioner, go to Step 3
• Email from the medical practitioner, sent from the email address listed on the medical practitioner’s stem, go to Step 3
• Application for recognition as a specialist or consultant physician form (HW077), go to Step 2

See Perform telephone security check for Medicare health professionals for steps to perform a security check.

When taking information over the telephone, a note is required to be added to the provider’s stem confirming:

• date and time of telephone call
• whom the Service Officer spoke with, and
• describes the information obtained over the telephone

• To process an application see Recognition as a specialist or consultant physician for Medicare

Once the application is processed, go to Step 3.

Open PDS:

• select Provider
• select View
• select Detailed Search
• in the Family name field key the first 3 letters of the last name followed by a %
• in the Given name field key the first 3 letters of the first name followed by a %
• key date of birth in Date of Birth field
• select Search

A list of health professionals with a matching name will display.

Select View for the matching medical practitioner.

Scroll to the bottom of the provider stem record to view the specialty codes for the medical practitioner.

Check if the PDS stem has any of the following codes registered:

• Specialist and consultant physician specialty codes - 001-099 and 801-899, and
• General practitioner specialty codes - 130, 132,530, 532 or 540

Medical practitioner has a specialist or consultant physician specialty code and a general practitioner specialty code:

• Yes, eligible for dual recognition, go to Step 5
• No, does the medical practitioner have a specialist and/or consultant physician specialty code with a 104 or 180 specialty code, or a registered approved 3GA placement in general practice at any open location?
• Yes, eligible for dual recognition, go to Step 5
• No, not eligible for dual recognition, go to Step 6

Request received for dual recognition via:

• Telephone call, see Table 2
• Signed written request, see Table 2
• Email from the medical practitioner, sent from the email address as listed on the stem, see Table 2
• Application for recognition as a specialist or consultant physician form (HW077), see Table 3

Where the request for dual recognition is received via a telephone call, advise the medical practitioner they do not meet the eligibility criteria and dual recognition will not be applied to their provider record.

A security check is required to be performed. See Perform telephone security check for Medicare health professionals for steps to perform a security check

When taking information over the telephone, a note is required to be added to the provider stem with the following:

• confirming date and time of telephone call,
• whom the Service Officer spoke with, and
• describing the information obtained over the telephone

Where the request for dual recognition is received via a written request or email, select letter template Z2305 Provider Registration - Reject, and:

• Complete appropriate fields of letter template
• Print letter
• Save letter as a PDF
• Upload letter to PaNDA
• In PaNDA, ensure the Surname First Name, Provider Number and Case ID fields are completed and correct
• Add any appropriate notes to the PaNDA file
• Select Complete
• Select Save
• Send letter

Where the Application for recognition as a specialist or consultant form (HW007) is received, the respective team processes the application. As the medical practitioner is not eligible for dual recognition, no further action is required.

Open PDS:

• select Provider
• select View
• select Detailed Search
• in the Family name field key the first 3 letters of the last name followed by a %
• in the Given name field key the first 3 letters of the first name followed by a %
• select Medical Practitioner from the Profession drop down menu
• select Search

A list of health professionals with a matching name will display.

• Select View for the matching medical practitioner
• Select Edit
• Select Specialty tab
• Select Add Specialty Code
• Key 165 in Specialty Code Description
• Key date of telephone call or date of lodgement of the written request in Start Date
• End Date:
• General practitioner and specialist/consultant physician specialty codes are open ended, no end date is keyed
• Medical practitioner with 180 specialty code or approved 3GA placement in general practice at any open location, no end date is keyed
• Specialist/consultant physician specialty code/s has a future end date, key specialist/consultant physician specialty code end date
• Select Add New
• Select Cancel
• Select Save

Select and complete the appropriate letter template from the letters template index. See the Resources page for a link

• Complete appropriate fields of letter template
• Save letter as a PDF
• Upload letter to PaNDA
• In PaNDA ensure that the Surname First Name, Provider Number and Case ID fields are completed and correct
• Print the letter and send to the provider
• Add any appropriate notes to the PaNDA file
• Select Complete
• Select Save

Open PDS:

• select Provider
• select View
• select Detailed Search
• in the Family name field key the first 3 letters of the last name followed by a %
• in the Given name field key the first 3 letters of the first name followed by a %
• key date of birth in Date of Birth field
• select Search

A list of health professionals with a matching name will display.

Select View for the matching medical practitioner.

• Select View for the matching medical practitioner
• Select Edit
• Select Specialty tab
• Select Add Specialty Code
• Key 165 in Specialty Code Description
• Start Date is the date the medical practitioner became a specialist and/or consultant physician and a general practitioner/vocationally registered. For example, 055 specialty code granted from 01/09/2021, Ahpra registration as a Specialist GP effective from 18/07/2021, dual recognition specialty code granted from 01/09/2021
• End Date:
• General practitioner and specialist/consultant physician specialty codes are open ended, no end date is keyed
• Medical practitioner with 180 specialty code, or approved 3GA placement in general practice at any open location, no end date is keyed
• Specialist/consultant physician specialty code/s has a future end date, key specialist/consultant physician specialty code end date
• Select Add New
• Select Cancel
• Select Save

Select and complete the appropriate letter template from the letters template index. See the Resources page for a link

• Complete appropriate fields of letter template
• Save letter as a PDF
• Upload letter to PaNDA
• In PaNDA ensure that the Surname First Name, Provider Number and Case ID fields are completed and correct
• Print the letter and send to the provider
• Add any appropriate notes to the PaNDA file
• Select Complete
• Select Save

Removal of dual recognition may be processed when one of the following is received:

• Telephone call from the medical practitioner, go to Step 3
• Signed written request from the medical practitioner, go to Step 3
• Email from the medical practitioner, sent from the email address listed on the medical practitioner’s stem, go to Step 3
• Removal of specialist or consultant physician recognition under sections 3DA, 3DC or 3E of the Health Insurance Act 1973, go to Step 2
• Change of residency status from temporary to permanent resident of Australia which has a 180 specialty code only, see Processing a change in residency status for a medical practitioner

See Perform telephone security check for Medicare health professionals for steps to perform a security check.

When taking information over the telephone, a note is required to be added to PaNDA confirming:

• date and time of telephone call
• whom the Service Officer spoke with, and
• describes the information obtained over the telephone

To process an application, see Recognition as a specialist or consultant physician for Medicare.

Once the application is processed, go to Step 3.

Open PDS:

• select Provider
• select View
• select Detailed Search
• in the Family name field key the first 3 letters of the last name followed by a %
• in the Given name field key the first 3 letters of the first name followed by a %
• key date of birth in Date of Birth field
• select Search

A list of health professionals with a matching name will display.

Select View for the matching medical practitioner.

Scroll to the bottom of the provider stem record to view the specialty codes for the medical practitioner.

Is the 165 specialty code present?

• Yes, continue
• No, procedure ends here

Determine if the medical practitioner has continued to meet the eligibility criteria to have the dual recognition specialty code on the provider record:

• Specialist and consultant physician specialty codes - 001-099 and 801-899, and
• General practitioner specialty codes - 130, 132,530, 532 and/or 540, or
• With 180 specialty code only, or a registered approved 3GA placement in general practice at any open location, or
• Other Medical practitioner (specialty code 104), or
• MedicarePlus OMPs Ongoing (specialty code 189)

Medical practitioner has a specialist or consultant physician specialty code and working in a general practitioner capacity:

• Yes, remains eligible for dual recognition, procedure ends here
• No, medical practitioner is not eligible for dual recognition, go to Step 5

The end date used depends on how the removal request is received.

If Services Australia receive the removal request via:

• Telephone call from the medical practitioner:
• dual recognition removal is the date of the telephone call
• Signed written request from the medical practitioner:
• dual recognition end date is the date requested in the letter or the date of lodgement of the letter
• Email from the medical practitioner:
• dual recognition end date is the date requested in the email or the date of lodgement of the email
• Removal of specialist or consultant physician recognition under sections 3DA, 3DC or 3E of the Health Insurance Act 1973. Does the medical practitioner have an additional specialist or consultant physician recognition on PDS:
• Where they have additional open specialty codes as a specialist or consultant physician, no requirement to close the 165 specialty code
• Where they are being end dated and there is no additional open specialist or consultant physician specialty codes, end date the 165 specialty code
• Change of residency status from temporary resident to permanent resident of Australia, see Processing a change in residency status for a medical practitioner

Open PDS:

• select Provider
• select View
• select Detailed Search
• in the Family name field key the first 3 letters of the last name followed by a %
• in the Given name field key the first 3 letters of the first name followed by a %
• key date of birth in Date of Birth field
• select Search

A list of health professionals with a matching name will display.

Select View for the matching medical practitioner

• Select View for the matching medical practitioner
• Select Edit
• Select Specialty tab
• Select Amend against the 165 specialty code
• Key End Date as determined in Table 4 Step 5
• Select Update
• Select Save

Select and complete the appropriate letter template from the letters template index. See the Resources page for a link

• Complete appropriate fields of letter template
• Save letter as a PDF
• Upload letter to PaNDA
• In PaNDA ensure that the Surname First Name, Provider Number and Case ID fields are completed and correct
• Print the letter and send to the provider
• Add any appropriate notes to the PaNDA file
• Select Complete
• Select Save