Document ID: chunk:federal_register_of_legislation:C2024A00070:clause:1_20aaa:p1
Version: federal_register_of_legislation:C2024A00070
Segment Type: clause
Provision Reference: sch 1 cl 20AAA (pt 1/4)
Character Range: 7048–9926

20AAA  Simplified billing assignments: additional matters

Insurer has arrangement with professional etc.
 (1) 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) any of the following conditions is satisfied:
 (i) the insurer concerned has an arrangement with the professional for the provision of treatment to persons insured by the insurer;
 (ii) in the case of hospital treatment authorised by the operator of a hospital (see subsection (7))—the insurer has an arrangement with the operator of the hospital for the provision of treatment to persons insured by the insurer, and the operator of the hospital has an arrangement with the professional under which treatment is provided to persons insured by the insurer;
 (iii) in the case of hospital‑substitute treatment authorised by an organization (see subsection (7))—the insurer has an arrangement with the organization for the provision of treatment to persons insured by the insurer, and the organization has an arrangement with the professional under which treatment is provided to persons insured by the insurer; and
 (b) the arrangement or arrangements (as the case may be) cover (wholly or partly) a liability of the insurer, the operator of the hospital or the organization to pay fees and charges in respect of the professional service; and
 (c) the right to payment of the medicare benefit has not been assigned under an agreement entered into under subsection 20A(1).
 (2) For the purposes of subsection 20A(2A), if subsection (1) 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 whichever of the following is applicable:
 (a) if the claim for the medicare benefit is made by an approved billing agent—the approved billing agent;
 (b) otherwise—the insurer.
Note: The insurer or approved billing agent must notify the assignor within 6 months of being paid the medicare benefit: see subsection 127(3).

Request made by assignor
 (3) 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) unless paragraph (b) applies—the medicare benefit is covered by a 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