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Aged and Community Care

Payment Statement

Payment for Commonwealth Subsidy (Flexible Care) for Care Recipients receiving Transition Care

Forms

PDF version of the Attachment C - Payment Statement (PDF 79 KB)

Text Version

Below is the text from Attachment C – Payment Statement form.

Page 1

Australian Government Payment Statement
Medicare Australia ABN 75 174 030 967
Explanation of Payment for Commonwealth Subsidy (Flexible Care) for Care Recipients receiving Transition Care

In accordance with subsection 50-1(1) of the Aged Care Act 1997 and the Payment Agreement between the Commonwealth and the Approved Provider, for the month ending ...............

Provider ID :
Provider name :

ABN :
GST Branch :

Transition Care
Service ID :
Service Name :

Postal address :

Advice:

The following payment information is in respect of care recipients receiving transition care for the above month.

Page 2

Transition Care Service ID:
Transition Care Service Name:
Payment Statement for the month ending:

Approved Place capacity:
Column 1: Care Recipient Surname
Column 2: Initial
Column 3: Recipient ID
Column 4: Admission Detail: Commencement/Departure
Column 5: Paid Care Days
Column 6: Non claimable Days
Column 7: Rate Per Day
Column 8: Total Amount Due

Page 3

Transition Care Service ID:
Transition Care Service Name:
Payment Statement for the month ending:

Approved Place capacity:

Daily Subsidy Rates
Column 1: Date of Determination
Column 2: Subsidy rate per day
Column 3: Service Days

Total Subsidy Paid
Subsidy as Calculated
Adjustments for previous claim periods
Outstanding balance from August
Less Advance
2nd Payment Due/Heldover
Other Adjustments
Total Amount Paid to Provider

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