Medicare Provider Numbers: Quick Guide

A Medicare provider number is a unique identifier issued by Services Australia to eligible health professionals. It allows practitioners to bill, refer, and request services eligible for Medicare benefits. Understanding when you need a new provider number, and when your existing one continues to apply, helps ensure your claiming setup in MediRecords is correct from the start.

Contents:

1. What is a Medicare Provider Number?
2. When You Need a New Provider Number
   • Working at a New Practice Location
   • Providing a New Service at the Same Location
   • Practising in a New Health Profession or Discipline
3. When You Do Not Need a New Provider Number
4. How to Apply for a Provider Number
   • Applying Online via HPOS
   • Applying Without Australian Government Identity Documents
   • Processing Times
5. PBS Prescriber Numbers
6. Adding Your Provider Number in MediRecords

What is a Medicare Provider Number?

A Medicare provider number is issued by Services Australia to eligible health professionals and is required to bill, refer, and request services under Medicare. Provider numbers are location and profession specific, meaning you must hold a unique provider number for each place of practice and each profession you practise in.

When You Need a New Provider Number

You must apply for an additional provider number in the following circumstances:
 

Working at a New Practice Location

Each physical location where you practise requires its own provider number. If you take up a position at a new practice, move to a different site, or begin working as a locum at an additional location, you will need to apply for a new provider number specific to that address.
 

Providing a New Service at the Same Location

If you begin offering a new type of service at a location where you already hold a provider number, a separate provider number is required for that service. This applies even if the physical address has not changed.
 

Practising in a New Health Profession or Discipline

If you become registered in an additional health profession or discipline, you must obtain a provider number for that profession. Your existing provider number is tied to your current profession and cannot be used across different disciplines.

When You Do Not Need a New Provider Number

Your existing provider number remains valid when:

• You change practice management software (including migrating to MediRecords). Your provider number stays the same; only your Minor Site ID changes.
   
• Your practice moves to a new address but you continue practising in the same role at the same location. You can update the address in MediRecords without applying for a new number.
   
• Your practice name changes but the physical location and your role remain the same.

How to Apply for a Provider Number

Applications are managed through Services Australia. The fastest way to apply is online using Health Professional Online Services (HPOS), accessed via your Provider Digital Access (PRODA) account.
 

Applying Online via HPOS

To apply online, you will need an active PRODA account and your AHPRA registration number. If you do not yet have a PRODA account, you can register online. Setup typically takes 10 to 15 minutes.

1. Log in to your PRODA account and access HPOS.
2. Select My Details.
3. Select My Digital Provider Number Registration.
4. Select Apply.
5. Complete the questions in the application and select Submit.

Applying via HPOS grants your provider number instantly upon approval.

Applying Without Australian Government Identity Documents

If you do not have Australian Government issued identity documents, you will need to complete the Manual Identity Verification Provider Digital Access form to register a PRODA account before proceeding with an online application. Alternatively, you can submit a paper application form by post or email to Services Australia.

Processing Times

Online applications via HPOS are processed instantly. Postal and email applications can take up to 28 days to process from the date of submission. Where possible, apply online to avoid delays to your claiming setup.

PBS Prescriber Numbers

If you prescribe medications under the Pharmaceutical Benefits Scheme (PBS), you will also need a PBS prescriber number in addition to your Medicare provider number. You can request this during your HPOS application by selecting Yes to the prescriber number question in the Location Details section of the Practice Address tab. A prescriber number can also be requested by completing the relevant Services Australia form.

Adding Your Provider Number in MediRecords

Once you have obtained your provider number from Services Australia, it needs to be recorded in MediRecords before you can submit claims. Provider numbers are added as part of the provider configuration process.

For instructions on configuring providers for online claiming, including where to enter your provider number and how to set your Medicare provider type, refer to Medicare Online Claiming: Configuration & Preferences.

Further Reading

• Medicare Online Claiming: Configuration & Preferences
• Online Claiming: Applying for Minor Site IDs
• Checklist: Creating & Configuring New Providers