Clarification sought on PHI recognition of allied dental practitioner provider numbers

While provider numbers for dental hygienists, therapists and oral health therapists were implemented back in July 2022, confusion remains over which funds require those holding a provider number to use it or if the holder can still provide services for and on behalf of a dentist and put the claim under the dentist’s provider number.  

The ADA believes the rollout of this complex government initiative is unsatisfactory, with its inconsistent implementation creating unnecessary challenges for both provider and practices.

While it seeks further clarification from each fund about its position, the ADA has obtained as close to comprehensive a list as possible from the Joint ADOHTA-DHAA Provider Number Expert Advisory Group, which is reproduced below.

It is, however, wise to check with your local health fund representative if you are in doubt or require further information regarding the individual arrangements that apply in your practice.

The ADA also wishes to remind members that as the holder of the provider number you are within your rights to determine how that number will be used and for what procedures.  Equally if you are an employer, you retain the right to determine the terms of employment of staff including the work to be undertaken. 
 
It’s important to note that there are currently no changes to the arrangements for treatments provided to eligible Australians under the Child Dental Benefits Schedule or the Department of Veterans’ Affairs as the same voluntary conditions remain in place with any mandatory requirements the preserve of a limited number of private health funds.

The ADA will continue to seek advice on each funds position and will update members once that information comes to hand.