Get Latrobe Provider Registration Form

Completing the Latrobe Provider Registration Form is essential for medical providers to enable submission of claims through the Simplified Billing process. This guide provides step-by-step instructions for filling out the form online to ensure a smooth registration process.

Follow the steps to successfully complete the registration form.

1. Press the ‘Get Form’ button to obtain the form and access it in your online document editor.
2. Fill out Part A: Medical Provider Details. You will need to provide your provider name, specialty, and all applicable provider numbers.
3. Complete your mailing address, including state, suburb, phone, fax, email, web, and postcode. Ensure all information is accurate to avoid delays.
4. In Part B: Bank Details, authorize payments to be made by direct credit to your specified account. Include the account holder's name, financial institution, BSB number, branch name, effective from date, account number, and email for remittance advice.
5. In Part C: Declaration, confirm that all provided information is true and correct. This section requires an authorized signature along with the date.
6. After completing the form, ensure all fields are filled correctly. You can then save changes, download your completed form, or print it for your records.

Complete your Latrobe Provider Registration Form online today!