Australian Regional Health Group (ARHG) FAQs

You can review the terms and conditions related to your provider number by referring to Bupa's “Ancillary Provider Terms” document. This document outlines important information regarding provider responsibilities, claim eligibility, and compliance standards.

Bupa offers benefits for counselling and psychotherapy services provided by practitioners who meet Bupa’s recognition criteria, and hold a current Provider Number. Benefits for these services fall under the category called “Mental Health” in several Bupa Extras Products.

Benefits are payable for practitioners in private practice who meet Bupa’s provider recognition criteria for counselling services. In relation to provider recognition by Bupa for the purposes of paying benefits for counselling services, the use of the term “counselling” is understood to include “psychotherapy”.

Please see here for the eligibility criteria.

Bupa will issue a provider number for your practice location. If you practise in more than one location, a separate provider number will be issued for each location. You can register up to 4 provider locations with Bupa, unless we otherwise agree in writing. You should notify PACFA at [email protected] immediately if there are any changes to your practice address/es.

Yes, your Bupa provider number/s should be either printed or stamped on your official invoices and receipts. Additionally, your name, practice address, date of service, client name, item number, and item description (see below) should appear on the invoice.

Bupa pays benefits on an attendance basis. For counselling services provided by a Bupa recognised practitioner, a benefit is payable for one attendance, per member, per day, in accordance with the Bupa member’s product entitlement, yearly limits and Bupa’s fund rules. Services claimable are as follows, and invoices/receipts should be issued with the appropriate service description (as below) for the service provided to the Bupa member.

Service Description:

• Initial attendance – please note – a maximum of one initial attendance is payable per member, per provider, in a 12 month period
• Subsequent attendance
• A couple or family attendance
• Group attendance

Yes. As part of Bupa's response to COVID19, temporary provisions for telehealth were introduced. Bupa has since confirmed that telehealth will remain as a permanent provision for eligible customers.

No. Even for telehealth the provider numbers require a physical address- this means you cannot apply for a number for 'online only' you can only invoice with a physical address attached to the provider number we recommend continuing to use your practice address associated with a provider number for the invoices but use the code (as listed below) for the telehealth item number.

It is not mandatory to include the item number on the invoice if the description of the service is clearly stated. Different private health insurance funds will use different item numbers. If you chose to include the item number as well as service description, the relevant Bupa item numbers are listed below for your reference.

Bupa has certain business rules that govern the way claims are paid. Bupa would expect to be billed for an initial attendance in the following circumstances:

• when a new client commences treatment
• when an existing client starts a new course of treatment for a different condition to that previously addressed with counselling
• when an existing client has had a break in counselling for an extended period of time (over 2 years) and then recommences treatment

Yes. As a Bupa recognised provider, we understand that a range of different modalities may be used when working with a client. For the purposes of paying a benefit, Bupa will refer to all services provided by recognised providers under the banner of “counselling services” as “counselling”. Irrespective of whether the practitioner may consider the service provided to be “psychotherapy” or “counselling”, the appropriate service description from the list above should be used to describe the service provided at each attendance.

No. Bupa will pay benefits only for the actual provision of counselling services directly to a Bupa member. No benefits apply to the preparation and provision of reports and assessments.

No. Bupa members will need to submit their claims to Bupa by mail, at a Bupa Retail Store or online via MyBupa.

Benefits for counselling services will only be paid for members on the appropriate level of extras cover. Extras covers include benefits for services that are not inpatient/hospital services, many of which are delivered by allied health providers.

There are a number of factors that can affect what benefit is payable, including the product the member is on, waiting periods, and yearly limits. We recommend that the client should contact Bupa directly on 134 135 to determine their benefit entitlements.