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 - Go To 4
3.  Leave blank 
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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