Assignment of benefit Medicare bulk bill Webclaim form (DB020)

Use this form in conjunction with HPOS Medicare Bulk Bill Webclaims only. It cannot be submitted to us for manual processing.

You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

Download and complete the Assignment of benefit Medicare bulk bill Webclaim form.

This form is interactive. It has 2 copies, one for the health professional and one for the patient.

Page last updated: 21 September 2023.
QC 21151