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Private Health Funds Requirements

PACFA Membership Requirements

Clinical Registration is a requirement of all Private Health funds.

All members who hold a provider number must complete their annual CPD and supervision requirements. All provider numbers will be cancelled if membership is not renewed by 31 July each year.

PACFA members who take leave will have their numbers closed, or, where possible, their numbers will be put on leave.

PACFA members who have a criminal conviction or who have an ethical complaint upheld against them may have their provider number permanently suspended by the private health fund, at the discretion of the fund(s).

Insurance Requirements

You must hold current professional indemnity and public liability insurance covering a minimum of $2,000,000 professional indemnity per claim and $20,000,000 public liability per claim.

You are required to upload a copy of your Certificate of Currency to your Member Portal > My Documents at least one month before your current certificate expires.

Your Practice Addresses

• P.O. Boxes are not accepted as a practice location.
• Your address may be visible on the health fund’s search functions.
• Some health funds limit the number of locations permissible.
• An address labelled ‘telehealth only’ will not be accepted.

A ‘Provide First Aid certificate HLTAID011’ is compulsory

This certificate must be renewed every three years. If audited, you must provide your current certificate within seven days of receiving a written request.

Upload your 'Provide First Aid Certificate HLTAID011' to your Member Portal > My Documents before expiry.

If your certificate expires, PACFA will close all provider numbers. HLTAID009 (CPR only) is insufficient.

Breach of Policy

Failure to meet the listed requirements is considered a breach of policy. It will result in the closure of your provider number without warning or notification.

Health funds have different waiting periods before a new provider number can be issued and are under no obligation to reissue one.

If closed, you must reapply for a Provider Number by completing the online application form.

PACFA is not responsible for members who have their numbers closed due to breaches or incorrect invoicing if a rebate was anticipated but not given by the health funds.

Before applying, read the Private Health Fund Policy.

HICAPS for Counselling Rebates

PACFA clinical registrants with active provider numbers can now offer clients the convenience of instant private health insurance rebates using HICAPS terminals. This includes face-to-face and telehealth counselling services.

Currently enabled funds include: Medibank, Bupa, GMHBA, HCF, Westfund, TUH, Doctors’ Health Fund, Teachers Health, HBF, nib, Pheonix Health and Defence Health .

In-Person Counselling with HICAPS

1. Swipe or tap the client's health fund card.
2. Select your provider details and enter the patient ID.
3. Choose the correct item number and enter the fee.
4. Review and submit the claim.
5. If there's a gap, process the client's payment.

See: How to process health fund claims on the terminal.

In-Person Counselling Item Numbers

Telehealth Counselling with HICAPS

• Ensure your client’s health fund accepts telehealth claims.
• Obtain the client’s consent before processing.
• Manually key in the membership card for telehealth sessions.

Telehealth Item Numbers

Resources & Support

• HICAPS Counselling Overview
• HICAPS Terminal Pricing
• HICAPS Provider Support