Access Gap Cover (AGC) - AHSA collects personal information from doctors participating in Access Gap Cover, such as name, address and bank account details (for EFT payments), 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).
If doctors start billing using Access Gap Cover without completing the above form, AHSA collects this information from the individual fund for whom the doctor commenced billing.
Medical Purchaser Provider Agreements (MPPAs) and Hospital Purchaser Provider Agreements with Practitioner Arrangements (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 details; otherwise AHSA only collects bank details of the company / hospital.
Substitute Service Agreements (SSAs) - 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 HPPAs/PAs in order to manage the agreement, including electronic payment into bank accounts.
National Provider File - AHSA receives constant updates of provider numbers in the National Provider File from Medicare Australia, so that it is kept abreast of any changes to address details and new doctors, which assists us to meet Australian Privacy Principles (APP)relating to the accuracy and completeness of information.
Data - 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 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:
Note for AGC doctors - The AHSA Provider Details and Direct Credit Authority form, states the following:
Now that you are participating in Access Gap Cover, your name, practice location and/or billing contact details as well as specialty(s) will be made available to the general public and GPs unless you indicate by marking the appropriate box(s) below:
I do not wish to be included on a doctor listing (e.g. Web Search)
I do not wish my details to be made available to GPs
I do not wish my details to be provided to fund members over the phone.
If the information has been collected only from the fund (and not via the AHSA Provider Details and Direct Credit Authority form), the doctor's details are not published unless the doctor requests otherwise.
Note for MPPA, HPPA/PA or SSA Doctors - 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.
Note "made available to general public" means the doctors name, practice location and/or billing contact details as well as speciality(s):
AHSA uses medical claim data to manage the medical agreement / arrangement service to AHSA member funds, by determining billing methods of doctors (AGC, SSA, MPPA, HPPA/PA or no agreement), medical gaps, and to flag doctors to be requested to join AGC. Furthermore, this data is used to ascertain doctors charging patterns to assist with setting rates for MPPAs, HPPA/PAs and SSAs, and monitoring the effect of proposed or agreed increases.
As AHSA co-ordinates all forms of medical agreements and/or arrangements for doctors, we disclose your personal information (bank details, name, agreement type and provider number) to ALL participating AHSA funds, even if doctors bill only some of these AHSA funds.
The medical claim data is not disclosed to any outside organisation, and is used internally in a de-identified form, by provider number not doctor name.
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:
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, call the Access Gap Cover hotline on 1800 664 277.
For more information about Privacy in general at AHSA, click here.