Document ID: chunk:federal_register_of_legislation:C2024A00070:clause:1_20aaa:p2
Version: federal_register_of_legislation:C2024A00070
Segment Type: clause
Provision Reference: sch 1 cl 20AAA (pt 2/4)
Character Range: 9668–12526

request made by the assignor for the purposes of this paragraph, in accordance with requirements specified in the regulations, to the following person (the responsible provider):
 (i) in the case of hospital treatment authorised by the operator of a hospital (see subsection (7))—the operator of the hospital;
 (ii) in the case of hospital‑substitute treatment authorised by an organization (see subsection (7))—the organization;
 (iii) in the case of hospital‑substitute treatment to which subparagraph (ii) does not apply—the professional; and
 (b) if a request mentioned in paragraph (a) has been modified, in accordance with requirements specified in the regulations, after the professional service is rendered, by the responsible provider or a person authorised by the responsible provider—the medicare benefit is covered by the request as modified; and
 (c) the request, or the request as modified (as the case may be), provides that the assignor's right to the payment of the medicare benefit in respect of the professional service is to be assigned to the insurer concerned or an approved billing agent; and
 (d) any requirements specified in the regulations are met; and
 (e) the right to payment of the medicare benefit has not been assigned under an agreement entered into under subsection 20A(1), or because of the operation of subsection (1) or (5) of this section.
Note 1: The operator of the hospital, the organization or the professional (as the case may be) must, if asked to, give the assignor a copy of the terms of a request made under paragraph (3)(a): see subsection 127(4).
Note 2: The operator of the hospital, the organization or the professional (as the case may be) must give the assignor a notification as soon as practicable after a request is modified under paragraph (3)(b): see subsection 127(5).
 (4) For the purposes of subsection 20A(2A), if subsection (3) of this section applies to the assignor's right to the payment of the medicare benefit in respect of the professional service, it is taken to be assigned to the insurer or approved billing agent mentioned in paragraph (3)(c) of this section.
Note: The insurer or approved billing agent must notify the assignor within 6 months of being paid the medicare benefit: see subsection 127(3).

Complications and related urgent unplanned services
 (5) For the purposes of paragraph 20A(2)(e), this subsection applies to the assignor's right to the payment of a medicare benefit in respect of a professional service rendered by, or on behalf of, a person (the professional) while hospital treatment or hospital‑substitute treatment is provided if:
 (a) another professional service (the related professional service) is rendered while the hospital treatment or hospital‑substitute treatment is provided; and
 (b) the right to payment of the medicare benefit in respect of the