This circular is to remind all hospitals and insurers of their reporting requirements under the following legislation:
- Private Health Insurance Act 2007
- Private Health Insurance (Health Insurance Business) Rules 2018
- Private Health Insurance (Data Provision) Rules 2018
All declared hospitals are required to submit Hospital Casemix Protocol (HCP) data for privately insured episodes of admitted hospital treatment, to private health insurers. In addition, private hospitals are required to submit Private Hospital Data Bureau (PHDB) data to the Australian Government Department of Health.
It is a requirement for second-tier approved hospitals, to submit HCP data to health insurers electronically with every claim for second-tier default benefits. It is important for both hospitals and insurers to enter the data correctly, as this can affect hospital categorisation.
Data specifications can be found at:
The department expects all public and private hospitals to provide a complete set of HCP data (including clinical information) to private health insurers, as per the data specifications.
If you require further information about uploading PHDB data to the department’s Data Submission Portal call (02) 6289 8058 or email your enquiry to email@example.com
Any questions relating to second-tier defaults eligibility should be sent to firstname.lastname@example.org.