TAC needs this information to determine if we can pay you beyond the TAC fee schedule. We may use or disclose this information to support the day-to-day management of the common law claim or claim for damages. TAC may also be required by law to disclose this information. TAC is currently reviewing how we handle supplier payments. We will consider approving above-average service agreements once this review is complete, with the exception of intergovernmental applications. In the meantime, TAC will continue to pay the anticipated fees for services. Please enter the item number and desired price you wish to claim. You acknowledge that the information you provide is true and accurate and that you are authorized to submit this form. The information collected on this form helps TAC decide if you are eligible to charge TAC in excess of the anticipated fee. You can complete this application while this review is pending and we will contact you once we have made a decision on your application. You can only complete this form if you are a registered TAC supplier and are currently serving TAC customers. If you are not currently serving a TAC client, your application will not be reviewed Please use this form to request a service contract with the above price.
If you need more information about our privacy policy, please call tac at 1300 654 329 or consult our privacy policy. Without this information, TAC may not be able to determine claims or assess whether treatment is appropriate and may not be able to approve other benefits and treatments. By completing this form, you agree to treat TAC clients in accordance with the clinical framework for the provision of health care services and that physicians at your clinic, including by telephone, communicate with the clinical committee as needed and necessary, in accordance with the client`s privacy obligations. .