Complete a manual assignment of benefit

Claiming if you do not have immediate access to the internet or a printer

If you intend to claim from a site without access to the internet you can print a manual Assignment of benefit form (DB020) prior to the visit. This Assignment of benefit form allows you to record the claim and patient details, obtain the patients signature and give a copy to the patient. When you have access to the internet you can transfer the information into Medicare Bulk Bill Webclaim in Health Professional Online Services (HPOS).

You can also fill out a Bulk bill voucher - electronically transmitted claims form (DB4E).

Completing a manual Assignment of benefit form

Steps to complete a manual Assignment of benefit form:

1. Only one patient is allowed per form.
2. Check date of service is before Medicare card expiry date – indicate with an X in the Expiry date checked box.
3. Complete patient details and all other fields that relate to the service provided.
4. The Practitioner use box must indicate where required name of hospital, emergency, lost referral, time of service, information about anaesthetists or service duration.
5. Patient must sign the Assignment of benefit form after the service has taken place and the form has been completed (a legislative requirement).
6. If the patient is unable to assign their right to benefit to the servicing provider, tick the box beside Patient is unable to sign. An explanation should be given as to why the patient was unable to sign in the relevant box.
7. A copy of the Assignment of benefit form must be provided to the patient (a legislative requirement).
8. When an internet connection is available, access HPOS and Submit a Medicare Bulk Bill Webclaim.