Access Gap Cover (AGC)

AHSA collects personal information from doctors participating in Access Gap Cover, such as name, address and bank account details (for Direct Credit payments into a nominated bank account), as outlined in the AHSA Provider Details and Direct Credit Authority Form. AHSA collects this information on behalf of its participating health funds (see Disclosure section below).

Collection, disclosure and use of information provided

As a condition of Access Gap Cover registration and of making a claim under the Access Gap Cover scheme, doctors agree that AHSA and AHSA participating funds may in their discretion:

  • Collect information from the doctor registration form and other doctor communications with AHSA and AHSA participating funds (including, without limitation, forms and communications received before this condition came into effect and information from claims that submitted).

    This includes personal information (such as name, practice address, and other contact details); field of practice and additional qualifications or specialties, and information (including past claims data) relating to the charges rendered, the services provided (including where a doctor operates and their surgical partners) and doctor participation in the Access Gap Cover scheme (together, "the information");
  • Disclose the information and other information about a doctor to the public, including members of AHSA participating funds and referring doctors, including for the purposes of identifying Access Gap Cover providers, and setting out information relating to the charges rendered, quality of service and statistical information relating to their participation in the Access Gap Cover scheme; and
  • Use the information for internal statistical analysis.

Medical Purchaser Provider Agreements (MPPAs) and Hospital Purchaser Provider Agreements with Practitioner Agreements (HPPA/PAs)

AHSA collects medical provider numbers of individual doctors that are part of an agreement with a company / group of doctors (MPPA) or specific hospital (HPPA /PA). Where doctors are paid individually, AHSA also collects bank account details; otherwise AHSA only collects bank account details of the company / hospital.

By being part of the agreement, MPPA and HPPA/PA doctors consent to having their name, specialty and postcode made available to the general public.

Please note that "made available to general public" means the doctors name, practice location and/or billing contact details as well as specialty(s):

  • Will appear on a web search.
  • Will be included on General software
  • May be provided over the telephone or printed out and supplied to health fund members upon request.

AHSA uses medical claim data to ascertain doctors charging patterns to assist with negotiating rates for MPPAs, HPPA/PAs and H-ST agreements, and monitoring the effect of proposed or agreed increases.

Hospital-Substitute Treatment (H-ST)

Once AHSA has entered into an agreement with a doctor to perform a substitute service, AHSA will collect information in a similar manner as MPPAs and HPPA/PAs in order to manage the agreement, including electronic payment into bank accounts.

National Provider File

AHSA receives periodic updates of provider numbers in the National Provider File from Medicare Australia. This allows AHSA to keep abreast of provider changes which assists us to meet Australian Privacy Principles (APP) relating to the accuracy and completeness of information.


AHSA collects medical claims data of member health funds for all doctors, regardless of whether the claim was paid under Access Gap Cover, MPPA, HPPA/PA or where there is no agreement. This data includes provider number, member (patient) number, agreement type, charge and benefit for each MBS item number.

AHSA also collects de-identified medical claim data linked to episodes, as part of the Hospital Casemix Protocol (HCP), to meet statutory reporting obligations.


AHSA uses this information to:

  • Maintain a comprehensive database of AGC, HPPA/PA, H-ST and MPPA doctors, to ensure these doctors receive important information, such as new schedules or new agreements;
  • Enable AHSA to administer gap cover arrangements on behalf of member funds; and
  • Ensure that funds are able to pay claims directly into doctor’s bank accounts, where relevant.


As AHSA co-ordinates all forms of medical agreements and/or arrangements for doctors, we disclose your personal information (bank details, name and type of agreement and provider number) to ALL participating AHSA funds, even if doctors bill only some of these AHSA funds.

AHSA uses the medical claim data for statistical purposes internally. AHSA also discloses the medical claim data to Healthshare which allows members to search for specialists and gain some transparency on possible patient gaps.

AHSA discloses de-identified medical claim data to the Commonwealth Department of Health, as part of HCP, to meet statutory reporting obligations. Provider numbers are NOT part of this collection, so it is de-identified for doctors as well as members (patients).


To ensure that information about participating doctors is kept accurate and up-to-date, doctors must notify the AHSA as soon as possible if:

  • Bank account details are changed; or
  • It is discovered that bank account details have been provided or entered  incorrectly; or
  • Address, e-mail or telephone numbers have changed.

Please note that sometimes, doctors only notify the fund that they are dealing with at the time, of any changes or corrections to their personal information. As AHSA manages the process centrally, doctors must notify AHSA of these changes as well, to ensure that all funds have access to the correct information. This will avoid a situation where doctors may have to repeatedly inform different AHSA funds of these changes.

Doctors on the doctor listing/search should attempt to search for themselves on the web, and notify AHSA immediately if there are any problems. Alternatively, email the Access Gap Cover team at or call 1800 664 277 (Option 1).

For more information about Privacy in general at AHSA, click here.