New Doctor Guide

Starting Private Practice

One setup. Years of smooth billing.

Done correctly, the registrations you set up now will support every claim you submit for the rest of your career. Done poorly, they will create errors, delays, and rejected claims at the worst possible times.

The steps are not difficult, but they have a specific order, and each one depends on the last. Here is how to go through them properly.

Register with PRODA to access Medicare's online services
Add your bank account so Medicare knows where to send payments
Register every location where you will see private patients
Obtain a provider number for each location
Register with the major health funds as a recognised provider

Step 1: PRODA Registration

Everything else depends on this. Do it first.

PRODA stands for Provider Digital Access. It is the Australian Government's identity verification system, and it is your key to Medicare's online provider portal (HPOS, Health Professional Online Services). You cannot register bank details, manage provider numbers, or process ECLIPSE claims without it.

What PRODA gives you

PRODA is a single secure login that connects to multiple government services including HPOS, myGov, and eventually PBS Online. Think of it as your government-issued digital identity as a health professional.

How to register

Create your PRODA account

Go to proda.humanservices.gov.au and register with your personal details. You will need a valid Australian mobile number for two-factor authentication.

Verify your identity (3 documents)

PRODA uses the Document Verification Service. You will need to verify using three documents: typically Medicare card, driver's licence, and passport. All three must match the name on your Medicare provider record.

Link to HPOS

Once your PRODA account is active, navigate to "Link your online accounts" and connect to HPOS (Health Professional Online Services). This is the Medicare portal where you will manage everything from banking to provider numbers.

Locate your Individual Healthcare Identifier (IHI)

Inside HPOS you can view your HPI-I (Healthcare Provider Identifier – Individual). You will need this number for health fund registrations. Keep it handy.

Name matching matters

The name on your PRODA account must exactly match your Medicare provider enrolment. If you have recently changed your name (e.g. marriage), update your Medicare provider record first before attempting PRODA verification, otherwise it will fail.

Step 2: Banking Details

Medicare pays you directly. You need to tell them where.

Once you have HPOS access, registering your banking details is straightforward, but it is a step that catches people off guard if they have never billed Medicare before. Your bank details are stored at the individual provider level, not at the practice level. This means each doctor has their own banking record in Medicare's system, regardless of where they work.

What you will need

BSB number, account number, and the exact account name as it appears on your bank statements. Joint accounts are acceptable provided your name appears on the account.

Where to do it

Log in to HPOS via PRODA. Navigate to My Details → Bank Account Details and add your account. Changes take effect within 1–2 business days.

Using a business bank account?

Many specialists have payments directed to a practice entity or company account. This is fine. Just ensure the account name reflects the entity name exactly as registered, and that you have the appropriate arrangement in place for your tax structure. Speak to your accountant about this before you start billing.

Changing bank details later

You can update your bank details in HPOS at any time. There is a brief processing delay, so if you change accounts, make sure existing outstanding payments have cleared first. You cannot maintain two active bank accounts in the system simultaneously.

Step 3: Practice Locations

In Medicare's system, provider numbers are location-specific. Every site needs its own registration.

This surprises most doctors the first time they encounter it. In Australia, your Medicare provider number is unique to each practice location. If you consult at three different rooms (say, a public hospital, a private hospital consulting suite, and your own rooms), you will have three different provider numbers. Each one is tied to a registered practice location in Medicare's system.

You cannot bill without a location-specific provider number

Submitting a claim with the wrong provider number, or a provider number from a different location, is an incorrect claim. Always match the provider number to the location where the service was delivered.

What counts as a practice location?

Any address where you regularly see private patients. Common examples include:

Requires registration

Consulting rooms (owned or rented), private hospital rooms, day surgery suites, telehealth-primary locations, and any recurring sessional consulting address.

Special cases

If you provide services across multiple hospital sites, each hospital address is a separate location. Public hospitals have their own provider numbers; confirm with the billing office.

How to register a practice location

Confirm the address

Use the physical street address of the rooms. If you are in a shared medical centre, confirm the exact address format with the practice manager, as variations in address format can create issues later.

Submit via HPOS or paper form

In HPOS, navigate to Provider → Manage Locations. Alternatively, submit a paper HW001 form (Application for a Medicare Provider Number) to Services Australia. HPOS is faster; processing typically takes 5–10 business days.

Receive your provider number

Once approved, you will receive a provider number for that location. It will appear in your HPOS portal. Store these carefully; you will need them for every claim you submit at that location.

Starting a new role?

Do not wait until your first private patient to register the location. Processing takes up to two weeks. Register as soon as you know the address where you will be working.

Step 4: Provider Numbers

Your provider number is the unique identifier that links a claim to you, at a specific location.

Once a practice location is registered, Medicare issues a provider number for that site. This 8-character alphanumeric code (e.g. 2354781B) appears on every Medicare and health fund claim you submit from that location. It is how Medicare knows who performed the service, where, and under what speciality.

Vocational registration matters

Your provider number and the MBS items you can claim depend on your vocational registration. Fellows of specialist colleges (FRACP, FRACS, FANZCA, etc.) access specialist MBS items. If your Fellowship is pending, confirm with Services Australia what you are entitled to claim in the interim.

Managing multiple provider numbers

Most specialists accumulate several provider numbers over their career. Keep a record that clearly maps each provider number to its corresponding address. This is not just an administrative convenience. Submitting a claim under the wrong provider number is a billing error, and patterns of such errors can attract a compliance review.

Active locations

Provider numbers for current consulting locations. These should be updated in your billing software and shared with any billing service you use.

Ceased locations

When you leave a practice location, notify Medicare via HPOS to cease that provider number. Old numbers on claims will reject.

When your provider number is delayed

There is no workaround for a missing provider number. You simply cannot submit a valid Medicare or ECLIPSE claim without one. If you are waiting on a new number, you have a few options:

Call Services Australia's Provider Registration line – Direct escalation via phone often resolves pending applications faster than waiting for the standard processing cycle.
Issue a fee invoice with a delayed claim – You can give the patient an itemised invoice and submit the claim retrospectively once your provider number is issued. Most health funds allow backdating within a reasonable window.

Step 5: Health Fund Registration

Medicare registration is automatic with your provider number. Health funds are a separate process, and each fund is different.

Once you have your provider number(s), you will want to register with Australia's major health funds so your patients can claim their extras and hospital cover directly through ECLIPSE. Without fund registration, you can still bill patients directly, but they will need to claim manually, which creates friction and affects your perceived service quality.

Fund registration overview

Health Fund	How to Apply	Notes
Medibank Private	Online via Medibank's provider portal	Largest fund by membership. Priority to register first.
BUPA	BUPA Provider Registration online form	Second largest. Often requires copy of Fellowship certificate.
HCF	HCF Provider Services (phone or online)	Strong in NSW/ACT. Separate process from Medibank/BUPA.
NIB	NIB Provider portal	Growing membership base. Online application available.
HBF	HBF Provider Relations, WA focused	Essential if you practise in Western Australia.
AHM	Via Medibank (AHM is a Medibank subsidiary)	Registration through Medibank usually covers AHM.
CBHS / TUH / others	Contact each fund directly	Smaller funds: register as your patient base warrants.

What funds typically ask for

Medicare provider number(s) – Your current provider number for each location where you intend to submit fund claims.
Specialist Fellowship certificate – Confirmation of your vocational registration: FRACGP, FRACP, FRACS, FANZCA, etc.
AHPRA registration number – Your current AHPRA number and registration status. Funds will verify this independently but require it on the application.
Professional indemnity insurance – Certificate of currency from your insurer (MDA National, Avant, MPS, etc.). Most funds require a minimum coverage level; check each fund's requirements.
Bank account details – Each fund makes its own direct payments, so you will provide banking details separately to each fund during their registration process.

Health fund banking ≠ Medicare banking

Your bank details registered with Medicare (in HPOS) are separate from the bank details you register with each health fund. If you change bank accounts, you need to update both: Medicare in HPOS, and each fund individually. Forgetting even one fund means those payments go astray.

Timeline Summary

Roughly how long each step takes, and when to start.

8–10 weeks before your first private patient

6–8 weeks before

4–6 weeks before

Confirm provider numbers have been issued. Follow up on any health fund applications. Add banking details to HPOS.

2 weeks before

Set up your billing software (or billing service). Enter provider numbers, confirm ECLIPSE connectivity. Do a test claim if possible.

Day one: you are ready

Confirm all registrations are active. Brief your front-desk team on patient claiming procedures. Start seeing patients.

Ready to start billing and do it right?

FreshClaim is built for specialist doctors. We manage your ECLIPSE claims with sub-0.3% error rates, and we can help new-to-billing doctors get set up correctly from day one.

Talk to FreshClaim

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