Resources
Update to Assignment of Medicare Benefit requirements – Private health insurers
Explains updated simplified billing requirements for private health insurers, including how assignment works, when consent is required, and responsibilities for processing and record-keeping.
Update to Assignment of Medicare Benefit requirements
Outlines updated simplified billing requirements for approved billing agents from 1 July 2026, including assignment pathways, compliance requirements, and what providers and patients need to do.
Why we need your agreement to bill Medicare
This resource provides detailed information for privately insured patients on how assigning Medicare benefits works, what options are available, and what happens after the benefit is processed.
Say yes to Medicare payment
This resource explains how Medicare benefits can be assigned to a private health insurer, what patients may need to do, and how they will be notified once their benefit is processed.
List of declared hospitals
The Minister for Health and Ageing must declare a facility to be a hospital under section 121–5(6) of the Private Health Insurance Act 2007. View the current list of declared hospitals.
Changes in HCP and PHDB data specifications – 2026–27
This fact sheet outlines changes in the data specifications for Hospital Casemix Protocol (HCP) and Private Hospital Data Bureau (PHDB) data for the 2025–26 financial year. They take effect on 1 July 2026.
HCP and PHDB data submission user guide
This user guide for hospitals and private health insurers explains how to submit Hospital Casemix Protocol (HCP) and Private Hospital Data Bureau (PHDB) data.
HCP data specifications – Hospital to insurer – 2026–27
The Hospital Casemix Protocol (HCP) data specifications for HCP files details the financial, clinical and demographic data that hospitals must provide to private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2026.
HCP data specifications – HCP2 – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for HCP2 files for 2026–27 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2026.
HCP and PHDB reporting requirements for hospitals and insurers
This fact sheet outlines the Hospital Casemix Protocol (HCP) and Private Hospital Data Bureau (PHDB) reporting requirements for declared hospitals and registered private health insurers.
HCP data specifications – HCP1 – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for HCP1 files for 2026–27 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2026.
GT-Dental data specification – Insurer to department – 2026–27
The Hospital Casemix Protocol (HCP) data specification for General Treatment-Dental files for 2026–27 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2026.
PHDB data specification – Hospital to department – 2026–27
The Private Health Data Bureau (PHDB) data specifications for 2024–25 details the financial, clinical and demographic data that hospitals must provide to us. Effective from 1 July 2026.
Roadmap Implementation Governance Group (RIGG) – Meeting Summary 4 December 2025
This document summarises the discussion and outcomes of the fourteenth Roadmap Implementation Governance Group (RIGG) meeting held on 4 December 2025.
PHDB annual report 2024-25 – Preliminary
This preliminary annual report of Private Hospital Data Bureau (PHDB) data outlines health statistics received from private hospitals detailing information relating to patient data for the financial years 2020-21 to 2024-25.
HCP annual report 2024-25 – Preliminary
This preliminary annual report of Hospital Casemix Protocol (HCP) data outlines health statistics received from private health insurers detailing information relating to patient, medical and financial data for the financial years 2020-21 to 2024-25.
Roadmap Implementation Governance Group (RIGG) – Meeting Summary 5 March 2025
This document summarises the discussion and outcomes of the twelfth Roadmap Implementation Governance Group (RIGG) meeting held on 5 March 2025.
Roadmap Implementation Governance Group (RIGG) – Meeting Summary 29 July 2025
This document summarises the discussion and outcomes of the thirteenth Roadmap Implementation Governance Group (RIGG) meeting held on 29 July 2025.
Hospital declaration form – Public hospital
Facilities applying to be declared as a public hospital must use this form to provide information.
Hospital declaration form – Private hospital
Facilities applying to be declared as a private hospital must use this form to provide information.
Private Health Chief Executive Officer Forum – Terms of reference
The terms of reference outline the scope of the Private Health Chief Executive Officer Forum.
Medicare annual statistics – Modified Monash Model locations (2009–10 to 2024-25)
This document contains annual statistics about the use of Medicare by Modified Monash Model locations, from 2009–10 to 2024-25.
HCP annual report 2023-24
This annual report of Hospital Casemix Protocol (HCP) data outlines health statistics received from private health insurers detailing information relating to patient, medical and financial data for the financial years 2019-20 to 2023-24.
PHDB annual report 2023–24
This updated annual report of Private Hospital Data Bureau (PHDB) data outlines health statistics received from private hospitals detailing information relating to patient data for the 2023–24 financial year.
GT-Dental data specification – Insurer to department – 2025–26
The Hospital Casemix Protocol (HCP) data specification for General Treatment-Dental files for 2025–26 details the financial, clinical and demographic data that hospitals must provide private health insurers. Private health insurers must then provide this data to us. Effective from 1 July 2025.
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