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Private Healthcare Australia - Provider number information

18 Jun 2020 5:24 PM | Anonymous

ADOHTA has had recent communication with Private Healthcare Australia in effort to progress Medicare and PHI provider numbers for our members.

The below information explains that despite the DBA SOP changes on 1st July 2020,  DTs, DHs and OHTs will NOT be allocated provider numbers and will need to continue to bill for services under a dentist’s provider number.

Please take the time to read these statements issued by the PHA.

Billing requirements with private health insurers

Given the changes to the scope of practice changes announced by Dental Board effective from 1 July 2020, Private Healthcare Australia advises that most funds will not be able to provide rebates for independent dental hygienists, dental therapists and oral health therapists due to technical requirements around provider numbers. It is recommended that a formal relationship (or other appropriate structure) be established with a dentist (if one currently does not exists), so as to facilitate the continuation of your services being billed under a dentists provider number for the purposes of claiming a rebate from a private health fund. Please ensure that this relationship exists to ensure no disruption occurs to manner in which your patients (health fund customers) obtain a reimbursement from their individual insurer.

Should any of the three professional categories “dental hygienist, dental therapists and oral health therapists”, issue an account under their own details to a patient with private health insurance, most private health funds are unlikely to be able to pay a rebate at this point in time. As noted above the historical structure of billing under a dentists provider number is still available.

Ongoing discussions around future requirements

While the curtailed consultation on this change has likely impacted some operational requirements, Private Healthcare Australia will continue to work with all professional associations and the Dental Board on investigating any future arrangements where rebates may be payable for independent practice under a more formal structure.


  • 29 Jun 2020 8:36 AM | Deleted user
    I believe the decision by Medicare and PHI not to provide OHT's with a provided number could be considered as restricting the practice of an independent practitioner.
    Is the association going to pursue any legal opinions ?
    Link  •  Reply


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