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 in order 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 7 Note: if the 3D notification cannot be processed, the medical practitioner will need to apply via the HW077 application form.
2	Check the Provider Directory System (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 % 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 7
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 1 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 10 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 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 7
5	Medical registration + Read more ... Check the 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 7
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 Step 1, Table 2 Go to Step 7 No, go to Step 7
7	Dual recognition + Read more ... Check the stem for specialty code 104, 180, 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 health practitioners for Medicare No, the medical practitioner is not eligible for dual recognition
8	Vocational Recognition + Read more ... Check for VR specialty code 104, 180, 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 Step 1, Table 2 for date of effect See - Mental Health Skills Training (MHST) for health professionals See - Non-Directive Pregnancy Support Counselling (PSC) – medical practitioners See - Focussed psychological strategies (FPS) for health professionals 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 information 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.
2	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 health 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 180 or 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 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 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 Table 2 in Resources for appropriate letter options. Send letter template Z2264 Recognition as a specialist and consultant physician is approved Complete relevant fields Print letter Save letter as a PDF Upload 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 your processing Select Complete Select Save Send letter via post to the medical practitioner

Assess an application for Specialist Recognition 3DB

Table 3: 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 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 7
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’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 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 and, or prescriber number for a medical practitioner form (HW019) 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 for an initial provider number. 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 notes “Awaiting application – application to be sent by (DD/MM/YYYY)” Also include the sender email address where applicable to assist in 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 you cannot locate the HW019 request an inbox search If the medical practitioner cannot be contacted or has not provided the HW019 application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without an established provider stem.
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. (Note: medical practitioners may have more than one specialty) If the requested specialty is not listed, go to Step 4. Note: if the specialty code is listed, check if the medical practitioner has indicated their residency status has changed or, if 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 application is a duplicate, the file can be completed. Check PaNDA to cross-reference when the original application was processed. If notification is confirmed a duplicate, add a note to PANDA stating duplicate application received NFA 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
4	Check the medical practitioner’s residency status on both application and PDS + Read more ... If the medical practitioner ticked temporary resident on the form, assess the application under 3E of the Act. See Table 5 for 3E assessment. If the medical practitioner ticked permanent resident or Australian citizen on the form, are they a permanent resident or Australian Citizen on PDS? Yes, go to Step 6 and continue to assess under 3DB No, go to Step 5
5	Updating residency status + Read more ... If the medical practitioner ticked 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. 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 information 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 ticked, 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 and their Ahpra registration support the additional specialty/ies? Yes, all specialties can be processed, go to Step 7 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 7.
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 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 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 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 Step 11, Table 4 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 Step 10, Table 4 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 Yes, and the medical practitioner 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 Step 10, Table 4 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 4 No, Return the application Do not process

Process specialist recognition 3DB application

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 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 your 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 ... Does the medical practitioner have provisional or limited registration on Ahpra? Yes, go to Step 8 for limited registration go to Step 9 for provisional registration 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 to confirm the date needed for Medicare claiming: If no date has been requested, key the date on the Schedule 1 college fellowship certificate or letter if supplied. The date of effect must not be earlier than the date fellowship was awarded If no date is listed and no fellowship document was supplied, key as date of lodgement of the application 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 Aphra, recognition can only be granted for a period of 2 years. 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) 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 ... 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 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 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 10
9	Provisional 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 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 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, 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 health 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 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 No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... A Provider Service Rule (PSR) is needed on any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Is there a valid section 19AB exemption or section 19AB class exemptions? 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. Add the following specialist recognition comments at the end of the registration line: Specialist recognition subject to 19AB. See notes Granted specialist recognition subject to s19AB. 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 14 No, Where a 519 19AB exemption or class exemption flag recorded on all locations add a note to the PDS stem 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 specialist recognition comments at the end of the registration line: Specialist recognition subject to 19AB. See notes Go to Step 13
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 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 that training equivalent to Level 1 Adult Sleep Medicine Training 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 is needed in writing along with evidence that training equivalent to Level 1 Adult Sleep Medicine Training 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 Table 2 in Resources for appropriate letter options. Prepare confirmation letter using template Z2264 Recognition as a specialist and consultant physician is approved: 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 letter as a PDF Upload 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 Note: where specialist recognition is updated as a result of 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 an application for Specialist Recognition 3E

Table 5: 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 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. Note: 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 Incomplete, inconsistent, or rejected applications table Process ends
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 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 be assessed together If an Application for a Medicare provider number and, or prescriber number for a medical practitioner form (HW019) 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 for an initial provider number. If contact is made: Request the email address sender will use Request that the sender quotes the doctor’s name in the subject line Leave notes “Awaiting application - application to be sent by (DD/MM/YYYY)”. Also include the sender email address where applicable to assist in 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 HW019application, return the HW077 application to the medical practitioner using the address on the application. HW077 cannot be actioned without an established provider stem. See Step 1, Table 7 to return the application.
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 on the previously approved specialist recognition period or their residency status may have changed. Is an end date recorded? Yes, go to Step 4 No, If the application is a duplicate, the file can be completed. Check PaNDA to cross-reference when the original application was processed. If notification is confirmed a duplicate, add a note to PANDA stating duplicate application received NFA 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
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 ticked temporary resident at question 8 on the HW077 form? Yes, go to Step 5 and continue to assess under 3E No, the medical practitioner may be eligible for specialist recognition under section 3DB. See Step 1, Table 3
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 ticked, 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, all specialties can be processed 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 Medical practitioners with Schedule 1 college 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 ticked the appropriate checklist box and/or supplied evidence of Schedule 1 college fellowship, go to Step 6. If schedule 1 college fellowship was supplied go to Step 9.
6	Check list box not ticked and/or no schedule 1 college fellowship supplied + Read more ... If the medical practitioner has not ticked 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 9 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	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 9 No, go to Step 8 Note: specialist recognition cannot be processed if limited registration reflects registration subtype Postgraduate training or supervised practice.
8	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 9 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
9	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 Step 13, Table 6 Go to Step 10 No, Go to Step 10
10	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 6, Step 10 Go to Step 11 No, the medical practitioner is not eligible for dual recognition Go to Step 11
11	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 12 Yes, and the medical practitioner 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 Step 11, Table 6 Go to Step 12 No, Go to Step 12
12	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 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 3E application

Table 6: 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 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 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 ... 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 assistance is needed, contact Local Peer Support (LPS).
6	Specialty Code tab + Read more ... Does the medical practitioner have provisional or limited registration? Yes, go to Step 8 for limited registration go to Step 9 for provisional registration 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 to confirm the date needed for Medicare claiming. If no date has been requested, key the date on the schedule 1 college fellowship certificate or letter if supplied. The date of effect must not be earlier than the date fellowship was awarded. If no date is listed and no fellowship document was supplied, key as date of lodgement of the application. 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 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) 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 ... 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 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 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 ... 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 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) 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 health 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 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 No, go to Step 12
12	Medical practitioner subject to 19AB + Read more ... A Provider Service Rule (PSR) is needed on any open location where there is not a valid section 19AB exemption or section 19AB class exemption. Is there a valid section 19AB exemption or section 19AB class exemptions? 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 specialist recognition comments at the end of the registration line: Specialist recognition subject to 19AB. See notes Go to Step 14 No, Where a 519 19AB exemption or class exemption flag recorded on all locations add a note to the PDS stem 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 Add the following specialist recognition comments at the end of the registration line: Specialist recognition subject to 19AB. See notes Granted specialist recognition subject to s19AB. 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
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 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 that training equivalent to Level 1 Adult Sleep Medicine Training 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 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 1 Adult Sleep Medicine Training 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 Table 2 in Resources for appropriate letter options. Send letter template Z2264 Recognition as a specialist and consultant physician is approved: 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 letter as a PDF Upload 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 your 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 via post to the medical practitioner On the PaNDA file, select: Complete Save

Returning an incomplete specialist recognition application

Table 7: 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 ...

Where 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
Where 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

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

For 3D notification:

return using letter Z2266 if provider is a temporary resident
return using letter Z2270 if a provider has no stem
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 PO will arrange an appropriate letter

Finalising the application + Read more ...

Convert the letter to PDF format and upload to the original file
Upload letter to PaNDA
Make sure that the Surname, First Name, Provider Number and Case ID fields are completed and correct
Mark the work item as Complete in PaNDA

Assess a request to revoke specialist recognition

Table 8: 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 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 profession in Profession field Select Search. A list of health professionals with a matching details will shows 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, go to Table 9, Step 2. Does the applicant appear in the list of health professionals? Yes, see Table 9 No, escalate to Local Peer Support (LPS) for help

Process a request to revoke specialist recognition

Table 9: 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 If the request was submitted by 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 prior to date of lodgement, whichever is later If the existing specialist or consultant physician specialty code has an end date in the future, see Table 3, 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: Complete relevant fields Print letter Save letter as a PDF Upload letter to PaNDA Make sure 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
4	Finalise + Read more ... Once the application has been approved by the delegate they will add a note in PaNDA Approved. Print only the approved confirmation letter and send via post to the medical practitioner. On the PaNDA file, select: Complete Save

Assess backdating specialist recognition assessment and escalation

Table 10: this table 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 needs: To 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 Requested date for backdating is 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 seek approval from a PO to determine eligibility to backdate The application should be re-categorised to the National Office Escalation folder in PaNDA until advice received No, see Table 11 Note: if granted under 3D- no determination is needed. Escalate requests to backdate a 3D notification to LPS.

Process backdating specialist recognition

Table 11: this table 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: Complete relevant fields Print letter Save letter as a PDF Upload 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 application has been approved by the Delegate they will add a note in PaNDA Approved. Print only the approved confirmation letter and send via post to the medical practitioner. On the PaNDA file, select: Complete Save

Operational Information