Use the Provider Details & Direct Credit Authority Form to register your provider numbers with AHSA for Access Gap Cover (AGC) and update your registration details.
This form replaces the previous Change of Registration Details Form and is now used for all updates to your existing information, including bank details, and billing contact information (e.g. email, phone, fax, contact person, and postal address).
Once received, AHSA will confirm your registration or change of details via email.
Note: Please make sure that you complete all sections of the form and supply all required information and documents for authentication. Refer to the checklist at the end.
Forms can take up to 14 days to process.
Forms can take up to 14 days to process.
Loading files...