Applying for a PKI (Location) Site Certificate

For Practices, Individual Providers, or Hospitals Without a Provider Number

If you already have a Site Certificate, then this page doesn’t apply to you. Please let your Altura Health representative know, or find out what Medicare forms you need to fill out here.

STEP 1 – Print out the Site Certificate Form
(HW001 – Site Certificate Form)

Below are some tips to help you complete the form.

  1. Site/Organisation Details section – enter your organisation information. The registered name and trading name should be exactly as they appear based on the ABN. If you are a sole trader, then put your name as registered with the ATO. If you rent rooms at a practice, do not put their organisation name.
  2. Certificate manager’s details section – you will need to elect someone in your organisation to be the contact person for your Site Certificate application (referred to as the CM – Certificate Manager). This can be a health practitioner, owner, or manager. However, Medicare will only talk with this person when relating to your Site Certificate. If the CM has a provider number, then please specify this in field 7 – ‘Provider Number’. Ensure to specify the ‘Minor Id’ in field 11 – your Altura Health Sales representative can give you this, starting with “ADV0….”
  3. Certificate manager EOI – If the CM you nominated has no provider number, they will have to submit additional IDs. See the FAQ below to learn which IDs are acceptable. If the CM has a provider number, indicate it in field 12.
  4. Authoriser’s details – This is based on your ABN as registered with the ATO, if the entity:
    1. is a sole trader – the sole trader can complete this section
    2. is a private or public company – a director of the company must complete this section
    3. is a trust – one of the trustees must complete this section.Note: Make sure that you put the Authoriser’s position (director/sole trader/trustee) in field 17. Also note that the Certificate Manager may be the same as the Authoriser. They will just have to sign the form twice.
  5. Authoriser EOI – If the Authoriser has no provider number, they will have to submit additional IDs. See the FAQs below to learn which IDs are acceptable. If the Authoriser has a provider number, indicate that in field 14.

STEP 2 – Print out the Acceptable Referee Identification Form
(HW004 – Acceptable Referee Form)

Below are some tips to help you complete the form.

  1. Applicant’s Details section – this is the Certificate Manager you elected on your Site Certificate Form in step 1 above.
  2. In field 3 – ensure to tick the appropriate option:
    1. If you are a sole trader or individual –  tick ‘A Site Certificate as a sole trader’
    2. If you are a business (ie. a Pty Ltd or public company) – tick ‘A Site Certificate (non individuals)’
  3. Site/Organisation Details section – this is your organisation name. The registered name should be exactly as it appears based on the ABN. If you are a sole trader, then put your name as registered with the ATO. If you rent rooms at a practice, do not put their organisation name.
  4. Applicant’s Declaration section – this should be completed by the Certificate Manager, same as in the Applicants Details section above.
  5. Referee’s Details section – have someone other than yourself complete this. A list of authorised referees are shown on the left of page 2. It includes doctors, nurses, etc. He must not be someone from the same organization, nor can he be related to the Certificate Manager or the Authoriser.
  6. Referee’s Declaration section – have the referee from the above section sign this section

STEP 3 – Certified Documents

You will need to provide some evidence, essentially documentation for Medicare to correctly identify you and/or the organisation. Please review the list below and see which applies to you and your business entity. Multiple could apply.
  1. If the Certificate Manager has no provider number, provide a copy of his IDs and have it certified by the Referee.
  2. If the Authoriser has no provider number, provide a copy of his IDs and have it certified by the Referee.
  3. If you trade under a Trust, also provide a certified copy of the First and the Last Page (signature page) of the Trust Deed. The Authoriser must be a signatory of the Trust.
  4. For all businesses or sole traders with a trading name, submit one of the following and have it certified by the Referee:
    1. A copy of the notice issued by the Registrar of the ABR bearing the business entity’s name, ABN and the Authoriser’s name as the business entity’s Public Officer;OR if unable to provide this
    2. A legal or regulatory document that proves the Authoriser has the capability to commit the business entity and the ABN (For example, a deed of appointment).
      The Authoriser must be listed as a director of the company.

STEP 4 – Submit the documents

Send your paperwork back to us using one of the following methods:

Fax: 02 9632 0096
Email: sales@alturahealth.com.au

Or you may send the paperwork directly to Medicare at ebusiness@humanservices.gov.au. If you want us to follow it up for you however, then you need to send it through us or copy us in when you email Medicare.

STEP 5 – Linking Your Provider Number/s to Your New Minor ID

If you haven’t done this part yet, proceed to this page to find out what other Medicare forms you need to fill out.

FAQ

Frequently Asked Questions

Send an email if you couldn't find an answer to your question here.

Who should be the Certificate Manager (CM)–the doctor or the facility manager?

The CM can be the business owner, manager or the doctor (with a provider number). However if the CM does not have a provider number, then more paperwork is required, so often it is easier to make the doctor the CM.

What sort of IDs can the CM and/or the Authoriser provide?

If the CM or Authoriser has no provider number, he or she will need to provide one certified ID from the Primary Group and one certified ID from the Secondary Group. See the table below.

Make sure to include a deed poll or marriage certificate if there is a difference in name on these documents.

Primary Group

  • Australian Passport
  • Foreign passport
  • Australian driver license
  • Australian Government issued proof of age card/photo card
  • Australian secondary student identity document (issued by a government agency or Australian school only)
  • ImmiCard

Secondary Group

  • Department of Foreign Affairs and Trade (DFAT) issued Certificate or Document of Identity
  • DFAT issued United Nations convention travel document
  • Foreign government issued documents (e.g., driver licences)
  • Medicare Card
  • Enrolment with the Australian Electoral Commission
  • Security guard/crowd control photo licence
  • Evidence of right to a government benefit (Department of Veterans’ Affairs or Centrelink)
  • Consular photo identity card issued by DFAT
  • Police force officer photo identity card
  • Commonwealth or state/territory government photo ID card
  • Aviation Security Identification Card
  • Firearms licence
  • Credit reference check
  • Australian tertiary student photo identity document
  • Australian secondary student photo identity document
  • Certified academic transcript from an Australian university
  • Trusted referees report
  • Bank or Credit card
  • Other authoritative online sources of evidence verified by a Third Party Identity Provider
What if I cant provide 2 of the above stated forms of ID?

In this case, the CM must provide a Statutory Declaration explaining why the CM is unable to provide the 100 points ID.

Can anyone be the Acceptable Referee, perhaps another doctor?

Yes, another doctor can be the Acceptable Referee. On the Acceptable referee form on page 2, it lists all professions who can be the Acceptable Referee.

Can I have two different persons certify various documents?

Yes, you can have multiple people to certify your documents. However, you will need the certifier to complete an Acceptable Referee form.