Federal Register of Legislation - Australian Government

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Guides & Guidelines as made
These Guidelines provide for standards to apply to information about an individual’s claims stored in computer databases, under the Medicare and Pharmaceutical Benefits Programs. The National Health Act (section 135AA(5)) requires that the Guidelines must generally specify the ways in which information may be handled, and prohibits linkage of information except as permitted by the Guidelines. The Guidelines seek to ensure that separation is maintained between the two databases.
Administered by: Health
Registered 18 Sep 2008
Gazetted 09 Mar 1994
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014







1        Under section 135AA(4) of the National Health Act, 1953 I ISSUE further guidelines which vary the Medicare and Pharmaceutical Benefits Programs: Privacy Guidelines 1994, that were published in the Government Gazette, GN 48, dated 8 December 1993.


2        The amendment shall take effect when the period for disallowance expires.


3        The Guidelines as amended shall remain known as the Medicare and Pharmaceutical Benefits Programs: Privacy Guidelines 1994.

Dated 22 February 1994

KEVIN PATRICK O'CONNOR Privacy Commissioner



In Section A, after Guideline 3, insert Guideline 4

"4.    Obtaining Old Claims Information


4.1 The Commission may, after supplying the relevant personal identification number or provider number, obtain from the Department, old claims information held by the Department and related to the number supplied where the Commission needs that information to enable it to:


×           take action on an unresolved compensation matter

×           take action on an investigation or prosecution

×           take action for recovery of a debt

×           determine entitlement on a late lodged claim

×           determine entitlement for a related service rendered more than five years after the service which is the subject of the old claims information

×           fulfil a request for that information from the individual concerned or from a person acting on behalf of that individual

×           lawfully disclose identified information in accordance with the secrecy provisions of the relevant legislation and these guidelines


4.2 Any record of any information obtained under Guideline 4.1 shall be deleted from any data base on which it is held as soon as practicable after the action referred to in Guideline 4.1 has been completed; and in any case shall only be retained on any database for a maximum period of 3 months.


4.3 The Commission must make special arrangements for the security of records obtained in accordance with Guideline 4.1. These arrangements are to be described in a Technical Standards Report.


4.4 Where information is obtained in accordance with Guideline 4.1 the Commission shall keep a note of the action."



In Section B, repeal and replace Guideline 5.4 with


"5.4 Where the Department discloses claims information relating to patients in a de-identified form (other than in accordance with Guideline 4 or 6), the Department must be reasonably satisfied that the recipient is not in a position to re-identify the information."


In Section B after Guideline 6.6, insert


"6.7 Where the Department has given the Commission claims information identified by PIN in accordance with a request under Guideline 4, the Department shall keep a central record of that action."

In Section E "Meaning of Terms", repeal and replace the definition of "old information" with


""old information" is defined in section 135AA(11) of the National Health Act 1953 as "information to which this section [section 135AA of the National Health Act 1953] applies that has been held by one or more agencies for at least the preceding 5 years". In these Guidelines an alternative term, "old claims information " is sometimes used and has the same meaning."