Medicare Provider and Prescriber Numbers

19/02/2025

Medicare provider and prescriber numbers are essential components for healthcare professionals working in Australia, including those in locum positions. These numbers are crucial for accessing the Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS), allowing healthcare providers to offer subsidized services and medications to patients.

What Exactly Are Medicare Provider and Prescriber Numbers?

These numbers are issued by Medicare to eligible health professionals, allowing you to access the Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS). Think of it this way: they enable the government to subsidize the cost of healthcare for patients. This means patients can claim rebates for your services and medications you prescribe.

• Medicare Provider Number: This number is linked to your location of practice. Each time you work at a new location, you will need to obtain a new provider number specific to that location.
• Medicare Prescriber Number: This number stays with you throughout your entire career, regardless of where you work.

Example Usage

What Is An Example Of Using A Medicare Prescriber Number?

In the image above on the left hand side, you can see a field for "Prescriber No." on a PBS medication prescription form. This is an example of when you would need to use your universal prescriber number.

What Is An Example Of Using A Medicare Provider Number?

In the image above on the right hand side, you can see a field for "Provider No." on a radiology imaging request/referral form. This is an example of when you would need to use your location-specific provider number.

Why Do You Need These Numbers?

• Prescribing Medications: Your prescriber number is essential for writing prescriptions that patients can have subsidized through the PBS, particularly for discharge scripts or when working in outpatient clinics or the emergency department.
• Referring Patients and Ordering Investigations: Your provider number allows you to initiate referrals to specialists and request pathology or radiology investigations for patients.

Provider Numbers and Auditing

Medicare uses these numbers to monitor the services you provide and the medications you prescribe. This is primarily for auditing and clinical governance purposes. While it's less of a concern for junior doctors, Medicare tracks the tests you order and the item numbers billed to Medicare, comparing them against your peers in the same area. Live prescription monitoring systems also exist to prevent over-prescription and misuse of certain medications.

How to Get Your Numbers

1. Apply Online: The easiest and fastest method is to apply through the PRODA website. This process is almost instantly through this method.
2. AHPRA Registration First: Ensure you have your AHPRA registration sorted before applying for Medicare numbers. Your AHPRA registration is the most important thing to have ready before starting your internship.

What if You Don't Have Your Numbers Right Away?

Don't panic! It's common for new interns and locums to not have their numbers immediately. Here's what you can do:

• Ask a Colleague: In the meantime, ask a colleague to write referrals or prescriptions for your patients.
• Inform Patients: Be transparent with patients that they may have to pay the full private fee for their tests, specialist appointments, or medications until you get your numbers.

Important Notes for Junior Doctors

As a junior doctor in a public hospital, you primarily need your numbers for outpatient services:

• Inpatient care in public hospitals is funded by the state government, so Medicare numbers aren't typically required for charting medications for admitted patients.
• Focus on using your provider and prescriber numbers for prescriptions, referrals, and investigations when discharging patients or seeing them in outpatient settings.

Also, remember that some medications require an Authority Script with an approval code from the PBS hotline. When in doubt, always consult with a senior colleague.

How Can I Upload My Medicare Provider and Prescriber Numbers to Medlo?

Medlo makes the process of uploading your Medicare provider and prescriber numbers easy. Once you've signed up, you can upload your numbers under the "Documents" section.

Example Scenario: Different Numbers

1. First upload your Medicare prescriber number (universal and kept across your career)

2. Let's say you're working at Yass District Hospital, Manning Base Hospital, and Blacktown Hospital.

3. You'll need to upload a new provider number for each of these NSW hospitals.

What Format Are Provider Numbers In?

Medicare provider numbers follow a specific 8-character format:

• First 6 characters: Digits (0-9), zero-filled if needed
• 7th character: One Practice Location Value (PLV) - can be alphanumeric but excludes I, O, S, Z, and 0
• 8th character: Check digit - must be one of: Y, X, W, T, L, K, J, H, F, B, or A

For example: 12345678 where:

• 123456 - First 6 digits
• 7 - PLV character
• 8 - Check digit from allowed set

What Format Are Prescriber Numbers In?

Medicare prescriber numbers are 7 characters long and only consist of digits.

Sources

For the most up-to-date information about provider and prescriber numbers, visit the Services Australia website.

For a video version of this explainer, visit our Tiktok here