Health Funds

How do I get on the health fund list?

How do I get my provider numbers?

My client/patient had a claim rejected. What should I do?

How do I set up an electronic claiming terminal (eg: HICAPS) in my clinic?

Do I need to put a provider number on receipts that I issue to my clients?

How do I get on the health fund list?
In order to be included on the AACMA health fund list you must be in a practising member category, for example, Member, Provisional Member or Fellow. In addition, your annual compliance must be up-to-date. This means that you have paid your annual membership fee, have provided proof of your current first aid certificate and professional indemnity insurance policy and have submitted your annual Continuing Professional Development(CPD) card. Lastly, you must also provide AACMA with your current practice address(es).

Please note that the AACMA health fund list is completed and sent to the health funds once per month on the first of each month (or closest business day). All necessary compliance items (as listed above) must be received by AACMA no later than the 19th of the month in order to include you on the next list.

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How do I get my provider numbers?
It is important to note that not all health funds use provider numbers or require a provider number to be included on receipts for services. The health funds that do require you to use a provider number are Australian Regional Health Group (ARHG), Medibank Private and BUPA.

ARHG: Please refer to the Health Funds Paying a Benefit for Services information sheet for your ARHG provider number.

Medibank Private: You will be sent a letter to your clinic from Medibank Private to notify you of your provider number(s) approximately 4-6 weeks after you have been included on the AACMA health fund list.

BUPA: The BUPA group includes HBA, MBF, Mutual Community and MBF Alliances. BUPA sends your provider number(s) directly to AACMA. We receive this data approximately 3-4 weeks after you have been included on the AACMA health fund list. We will notify you via email of your provider number when we receive it.

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My client/patient had a claim rejected. What should I do?
Please ring the Membership Administrator at the AACMA national office on (07) 3457 1800. You will need to know which health fund the claim was rejected by and if the claim was manual (i.e. your client took the receipt into a branch or posted it to their health fund) or if it was electronic (i.e. their health fund card was swiped through an electronic claims terminal such as HICAPS).

The Membership Administrator will then check and confirm your details in the AACMA membership database to ensure that our records are correct and current and to identify any possible reason(s) the claim may have been rejected. In many cases, there is no identifiable reason for the claim being rejected and in which case, the Membership Administrator will contact the health fund to investigate further and have the problem rectified. You will then be notified by phone or email when the problem has been resolved.

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How do I set up an electronic claiming terminal (eg: HICAPS) in my clinic?
There are two major providers of electronic claiming for the purpose of health fund rebates. They are HICAPS and iSoft (IBA). You will need to contact these organisations directly for further information and to identify which facility (if any) will best suit your business. The contact phone numbers are listed below:
HICAPS – 1800 805 780
iSoft – 1300 301 692

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Do I need to put a provider number on receipts that I issue to my clients?
Yes, if you have been issued with a provider number by AACMA or a specific health fund you should include it on receipts. If you do not know your provider numbers, please refer to ‘How do I get my provider numbers'?

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