One form office use only | OpBill

OpBill - OFFICE USE ONLY

Welcome OpBill backend! This is your version only. The forms will go DIRECTLY to the forms@ email address, and will NOT be automatically sent. This is so you can check it and decide if you want to send this version. I have removed some areas of this form that are not required for you. 😉 CWL

I am a *

Surgical Assistant

Surgeon

Physician

Have you ever billed Privately?

Yes - I want to change to OpBill

No - this is my first time

Already using Opbill - Adding Provider Number

Change of Details

I am updating the following details (Select all that apply) *

Personal details (Address/Phone/Email)

Bank Details

Adding Provider Number

First Name *

Last Name *

Date of Birth *

AHPRA Number *

MUST include MED at the start please

ABN

If you do not provide an ABN here, you will not be able to bill WORKCOVER cases.

Email *

Mobile Number *

Practice Phone Number

Your Address *

Suburb *

State

Postcode *

BANK DETAILS

Where your money will be sent to

Bank Name *

Branch Address (Suburb Only) *

Account Name *

BSB *

Account Number *

Please do not use spaces

Bank Statement *

Maximum file size: 33.55MB

When updating your details, BUPA REQUIRES confirmation of the bank account that you have nominated above. This is either a BANK DEPOSIT slip, CANCELLED CHEQUE or BANK STATEMENT for verification purposes. If you don't add this, we cannot update your BUPA details. This is required EACH TIME this form is completed. (8MB File Limit)

Select STATE of practice *

Please note there is a limit of 11 provider numbers you can add to this form. If you require more than 11, please redo this form with ALL details completed

PROVIDER NUMBERS - ACT / NSW

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

PROVIDER NUMBERS - SA / NT

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

PROVIDER NUMBERS - VIC

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

PROVIDER NUMBERS - QLD

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

PROVIDER NUMBERS - WA

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

PROVIDER NUMBERS - TAS

If you know your Provider numbers, please enter them here. Click below to see our guide on how to obtain your provider numbers.

Provider Number

Please Select the Associated Hospital

BUPA Practice ID *

BUPA gives each Assistant a specific practice ID. Don't know yours? Just call BUPA 1800 060 239 and ask for your provider ID. This field cannot be blank

SIGNING

No or Known Gap *

NO Gap

KNOWN Gap

If you plan on charging patients an out of pocket expense, you will need to select KNOWN Gap. Please note that you will need to be responsible for chasing your own gap payments. We do not chase these for you. OpBill has no direct patient contact.

Privacy

Check this to prevent the health funds from publishing your details on their registers

Please note that with BUPA, all Medical Gap Scheme participants will be listed on their doctors register regardless of what you select here.

Please select the date of service of the earliest case you are submitting to OpBill *

Who Processed this form:

We use this to determine who at times may be given special discounts, prizes and more.

Signature *

Please allow jump to 3 minutes to process the form. You will get a success notification if the form was successful. Then check the Forms@ email which you will have to forward if you're happy.