Online Provider Agreement Form

Online Provider Agreement Form

Medicare/Bulk Bill and DVA claims will not be processed online if the Online Provider Agreement Form ( HW-027) has not been completed.  This allows for one provider number. 

If the provider has multiple provider numbers, these need to be added to the Online Claiming Banking Details Form ( HW- 052)

Please forward completed forms to support@cesoft.com.au 

To complete the HW-027 form:

1. Provider details
2. Provider Number 
3.  RA number - LEAVE BLANK 
12.  Minor ID is:  CUT
13 - 17 Complete your contact details
18-22 - leave blank
23.  Your Bank Details
24. Tick:  only Medicare Bulk Bill and DVA
25-26 Tick: NO
28:  Sign and date.

To complete the HW-052 form:

1.  Minor ID is: CUT 
2.  Tick No
3.  Tick No
4.  Practice or Doctors name
5.  Address that one of the provider numbers is registered to
6. Post address for correspondence
7.  Telephone number
8//9/110/11/12  Leave blank
13.  Bank details and date effective from
14.  Leave blank
15.  Just ticks Medicare/Bulk Bill and DVA
17.  Add the relevant provider numbers and get doctor to sign each one.










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