The National Private Patient Hospital Claim Form is the standard national form to be completed for payment of benefits by health funds for all admitted patient claims for all privately insured patients in private and public hospitals and day hospital facilities in Australia.

This form was reviewed and updated by Private Healthcare Australia in 2019, with input from all health funds, and with comment requested from all key stakeholders prior to finalisation. The form was updated to comply with all current legislation and accompanying regulation, including the National Health Act 1953 and the Health Insurance Act 1973, federal and state privacy legislation, and Veterans’ legislation, and to comply with the current nomenclature of the International Classification of Diseases, Australian Modification, and with definitions in the National Health Data Dictionary. The implementation date for the revised Claim Form is 1 July 2019.

To download this document, click on the link below and save to a local drive.

National Private Patient Hospital Claim Form (PDF 110 KB)

National Private Patient Hospital Claim Form Completion/Guidance Notes:

To download the guidance notes, click on the link below and save to a local drive.

National Private Patient Hospital Claim Form Completion/Guidance Notes (PDF 93 KB)