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Preparing for Medicare Claiming (AU-Only)

Learn how to prepare your account for Medicare online claiming with Zanda, including data entry tips and FAQs. No fees for using Medicare with Zanda!

This article covers everything you need to know about preparing your account for online claiming through Zanda. Follow the steps below to configure your insurers, practitioners, services, and client records — then you'll be ready to start submitting claims.

There are no fees for using Medicare (AUS) with Zanda. It is completely free.

In this article

Getting Ready for Medicare Online Claiming

You must first complete the HW027 Online Claiming Provider Agreement form and submit it to Medicare.

See Registering for Medicare Online Claiming for full instructions.

Step 1: Register for Medicare Online Claiming

  • You can register via your existing PRODA account.
  • Alternatively, complete the HW027 form and submit it to Medicare.

If PRODA does not recognise your Zanda Location ID (Minor ID), complete the HW027 form and email it to: provider.forms@servicesaustralia.gov.au

Step 2: Configure Medicare as an Insurer

Zanda automatically adds Medicare Australia as an insurer for Australian accounts. Verify the settings:

  1. Go to User Menu > Account Settings > Payments > Insurers
  2. Select Medicare (or add it if missing)
  3. Ensure Type = Medicare Australia
  4. Enable Show on Invoice
  5. Add invoice text (e.g. Medicare Provider Number:)
  6. Click Save

Step 3: Add Provider Numbers to Practitioners

Each practitioner must have a provider number linked:

  1. Go to User Menu at the top-right > Account Settings > Team > Practitioners
  2. Open the practitioner profile
  3. Go to Insurers > Add Insurer
  4. Select Medicare (Australia)
  5. Choose the correct Service Type
  6. Enter the Provider Number (no spaces)
  7. Assign location
  8. Click Save

Tip: Add separate entries if a practitioner has different provider numbers per location.

Step 4: Add Medicare Item Codes as Services

Each Medicare item must be set up as a service:

  1. Go to User Menu at the top-right > Account Settings > Billing > Services
  2. Click Add Service
  3. Enter:
    • Name
    • Item code (in Code field)
    • Duration
    • Price
  4. Set Tax = Tax Exempt
  5. Click Save

Repeat for all item codes.

Step 5: Set Up Client Records for Medicare

Add Medicare Details

  1. Open client record
  2. Go to Billing > Insurance
  3. Click Add Insurance
  4. Select Medicare Australia
  5. Enter:
    • Medicare number
    • IRN
  6. Click Validate Medicare Data
  7. Save

Add Bank Details (if required)

  1. Go to Billing > Billing Setup
  2. Enter bank details
  3. Save

Note: Not required if already registered with Medicare.

Setting Up a Claimant for a Minor

  1. In the client profile, go to Contacts tab
  2. Add parent/guardian
  3. Ensure required details, including the contact Medicare details and home address are completed. 
  4. Save.
  5. Go to client protfile > Billing > Billing Setup and set Bill To as the contact
  6. Save

Step 6: Add a Referral to a Client

  1. Open client record
  2. Go to Profile > Referrals
  3. Click Add Referral
  4. Enter referrer details
  5. Set:
    • Start date
    • Validity period
    • Default toggle
  6. Save

Setting a Preferred Service on Appointments

  1. Open client profile
  2. Go to Billing > Billing Setup
  3. Select Preferred Service, (such as a Bulk Bill service, or any other service you are registered to provide with your Medicare Provider number)
  4. Save

This pre-fills services for new appointments.

Data Entry Tips

Accurate data entry ensures successful claims:

  • Medicare claimants need a first and last name, date of birth and their Medicare card details.
  • Provider numbers must not contain spaces
  • Medicare numbers and IRNs must not contain spaces
  • Add claimant as a contact if different from patient
  • All patients need a Medicare card number and reference number (the expiry is not required for claiming). 
  • Validate Medicare details after entry
  • Services must include item codes
  • Add client bank details if needed
  • Referrals must be linked before claiming
  • To collect Medicare details through an intake form and automatically save them to the client’s profile, add the Insurance Details Linked Profile Field to your form in Tools > Form Designer. This field captures the client’s Medicare number, IRN (reference number), and expiry date, and writes the information directly to the client’s insurance profile when the form is submitted. This works with both the old and new Client Portal experiences. For full instructions, see: Using the Form Designer
  • If a client is covered under Reciprocal Health Care Agreement and you validate their card, you will see this notification message: 

Frequently Asked Questions

How are rebates calculated?

Claims are sent directly to Medicare, which applies the correct rebate based on item code and service date. Zanda does not calculate rebates.

Do I need the HW027 form if I already use HICAPS or ECLIPSE?

Yes. The HW027 form is still required before you can submit claims via Zanda.

Do I need to enter bank details if the client already registered them with Medicare?

No. Medicare will automatically pay the rebate.

Do I need a PKI Certificate?

No. Zanda manages this on your behalf.

Can I delete invoices or appointments linked to Medicare claims?

No. To preserve audit history, these cannot be deleted.

Instead, you can write off the invoice.