Access Gap Cover Forms

In this section you can find all the forms you require in relation to Access Gap Cover. 

AHSA administers Access Gap Cover on behalf of a number of participating Health Funds. Administration includes registering providers and amending billing and banking details. It is very important to make sure you complete all sections of the relevant form.

If you are unsure of which form to use, please complete our Provider Registration form.

Should you have any queries please contact us.

  • Provider Registration

    These forms are used by Doctors to register for participation in Access Gap Cover. Only the Doctor can sign on the Provider Details form. Digital Signatures must contain valid encryptions and digital stamps. It is essential that you register the associated Provider Number you are using when submitting claims. You can also use this generic form to update changes to the email, contact, postal and/or banking information. It is very important to make sure you complete all sections of relevance on the form. Multiple Additional Practice Location forms can be used where there are more than 7 Provider Numbers to be registered.
  • Additional Practice Location

    Use this form if you are adding additional provider numbers which require the postal address, contact and bank information to be the same as an existing registered Provider Number. The existing registered Provider Number has to be listed in the top left box of the form. Where there are more than 7 Provider Numbers to be registered, you can use multiple Additional Practice Location forms to provide the required information. Please do not use this form to update your postal address. The Provider Registration form can be used to update all relevant information.
  • Change of Bank Details

    Use this form if you would like to only update existing bank account details to your current registration. The Dr is required to sign this form. No other signatures are accepted. Please do not use this form to register or update any existing information. We will assume all other existing billing details remain the same. If other details have changed, please complete the ‘Provider Details & Direct Credit Authority’ form instead.
  • Account Summary (Batch Header)

    The Account Summary Form acts as a Batch Header. This form must accompany all Access Gap Cover claims (up to 20 claims per form, per Fund). Doctors and/or Practice Administrators need to forward claims directly to the patients' Health Fund for processing. Please refer to the Participating Funds Contact List for more details.
  • Doctor Account

    This form is an invoice template and can be used for billing your patient. It must be accompanied with an Account Summary form when sending claims to Health Funds.
  • Estimate of Fees

    This form may be used by doctors to provide patients with an estimate of medical fees prior to their procedure (or as soon as possible in cases of emergency).