Provider Number Information
Since the Commonwealth Government provided our profession (dental hygienist, dental therapist and oral health therapist) access to Medicare provider numbers from 1 July 2022, the DHAA has received many queries from members seeking advice and clarification.
Below are some common topics that were frequently discussed:
Provider Numbers:
Provider numbers and item codes are purely commercial arrangements among the providers, patients and insurance companies/payers for health services.
The provider numbers are issued by Medicare (Commonwealth Government) for access to the Child Dental Benefit Scheme (CDBS), and the Government decided that it is optional for providers to apply for them. They are happy to allow dentists to claim services provided by hygienists and therapists if they do not have their own provider numbers. However, if a provider obtained a provider number they must use it for the CDBS.
Health Funds:
Various health funds decided to recognise the Medicare provider numbers for claiming their dental benefits while others are not recognising them. It's important to understand that each fund sets its own rules for their individual fund. For example, NIB offered a transition period of 6 months to get a provider number (by 1 Jan 2023) while Medibank Private offers 12 months (by 1 July 2023) before they are made mandatory under their funding agreements with dental practices.
Unfortunately, there is no consistency across the various health funds regarding provider numbers.
Once you have been issued with a Medicare provider number by Services Australia, there is an automatic (but with lag time) update to online claiming software such as HICAPS.
In some cases, health funds have a ‘preferred provider’ arrangement with dental practices.
Some funds (e.g. Medibank’s Members Choice) require extra manual steps to add your provider number to their system and these will be individual to the fund itself so you or your practice will need to contact them to determine the steps required.
Applying for a Provider Number:
To apply for an initial Medicare provider number, please complete the HW093 form (https://www.servicesaustralia.gov.au/hw093) and return the form to Services Australia.
Provider numbers are location specific so you may need to apply for multiple numbers if you practise at multiple practices. Services Australia will send you a letter with your provider numbers for each of your new practice locations. And remember, if you have a provider number you must use it for CDBS claims.
Locum Work and Provider Numbers:
Locums can use the principal provider’s number for a short period (2 weeks) when they are providing care on behalf of that provider. Clinical notes must include a reference to the practitioner who conducted the treatment.
More Information:
DHAA members have access to the provider number information, training and resources via the DHAA member portal (login required).
Provider Number Info
If you have specific questions about provider number after viewing the online resources, please email [email protected]