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Note: You should not rely solely on the answers provided here. The contracts applicable to each provider and all relevant legislation must be consulted to determine the full rights and liabilities applicable to any service provider or funder.

When a GP can claim

a GP can claim a subsidy if the casual patient is:

    • is a child or young person aged 17 years or under; or
    • a Community Services Card holder, or
    • a High Use Health Card holder.

Fees for General Medical Services

  Casual User

Fee per consultation 

(Excluding GST)
1 A child under 6 years of age $31.11
2 A child or young person aged 6 to 17 years who is the dependent of a holder of a Community Services Card $17.78
3 A child or young person aged 6 to 17 years who is the dependent of a holder of a High Use Health Card $17.78
4 A child or young person aged 6 to 17 years who is not the dependent of a holder of a Community Services Card or High Use Health Card $13.33
5 A person aged 18 years or over who holds a Community Services card $13.33
6 A person aged 18 years or over who holds a High User Health Card $13.33

If you have not been paid for an entire GMS claim

Call the Sector Operations Contact Centre (0800 855 066) to find out whether the claim has been received and, if so, the reason for non-payment.

If the claim has not been received it will need to be resubmitted to Sector Operations. If the claim is now over 2 months old it will need special approval from Te Whatu Ora before Sector Operations can process it.

If your claim has been processed but it has not been paid at all

If the contract number is not valid, or if the payee number is not correct, a payment may be stopped or may be directed to the wrong account. In most cases these claims can be amended by Sector Operations, once the correct information is provided.

A claim can also be rejected if it is not formatted correctly, in these cases the claim will need to be resubmitted once your claiming software is updated.

Error messages on the variance report

Error 0513 – Invalid NZMC

The New Zealand Medical Council (NZMC) number given has expired or is not in Sector Operations’s database.

Check your records and call the Sector Operations Contact Centre on 0800 855 066 with the correct details so that adjustments can be made. If the NZMC is correct then Sector Operations will need to check that the Doctor's Annual Practising Certificate (APC) is still valid and covers the dates of service of the claim.

Error 0517 – Claim is stale

The dates of service on the claim are more than 2 months old and will require special approval from Te Whatu Ora before we can release payment. 

Write to Te Whatu Ora providing details surrounding the reason for submitting late claims. It is at the discretion of Te Whatu Ora to approve these claims for payment.

Error 0520 – Invalid service for contract

The contract number given has expired or is not in Sector Operations's database.

Check your records and call the Sector Operations Contact Centre on 0800 855 066 with the correct details so that adjustments can be made. If the contract number is correct then Sector Operations will need to check that the Doctor's Annual Practising Certificate is still valid and covers the dates of service of the claim.

Error 9999 – Place holding error code

This indicates that the patient has another error under their transaction number, if an incorrect immunisation claim has also been made ,for example using the wrong vaccine codes, then the GMS will also be rejected with the error 9999.

If a school student is over 18

School students over 18 years old are not claimed at ‘J’ rates.

Once a patient has turned 18 they are classed as an adult and claimed at the ‘A’ rates, regardless of their circumstances.

Claiming an immunisation and GMS claim on the same day

As long as a full consultation unrelated to the immunisation was undertaken with the patient, then both services can be claimed. You may not claim GMS if you have only assessed and immunised the patient and did not provide any other unrelated services.

Making multiple GMS claims

As long as full and separate consultations were given then multiple claims can be made. Multiple claims cannot be made for 1 lengthy consultation or a consultation that covered a number of different issues. The patient must be treated at different times during the day.

Claiming GMS and ACC for the same patient from a single consultation

If a patient is seen by a doctor and the patient has 2 completely separate complaints, 1 accident related, 1 medical problem, then the doctor can make 2 claims. The 2 problems must be quite separate and each must be worthy of a full consultation, with distinctly separate supporting clinical notes.

How to submit amended variance reports

Amended variance repots cannot be faxed. Claims need to be re-submitted electronically.

Understanding variance reports

You might receive a variance report that lists a lot of patients, but nearly all the money has been paid.

When a claim is paid at a different rate from the amount claimed, a variance report is automatically generated. This report will list any patients who have missing or amended information.

A variance report will often list the patients who have no NHIs supplied, but these patients will have been paid if the claim reached the 70% target of supplied NHI’s. Check the ‘amount claimed’ and ‘fee payable’ columns to see if the patient’s subsidy has been paid.

GMS payment timeline

Payment turnaround time is based on the way Sector Operations receives your claims.

  • If you send your claims electronically, they will be processed within 10 working days of receipt of a valid claim.
  • If you send your claims on discs they will be processed within 15 working days of receipt of a valid claim.
  • If you send your claims on paper they will be processed within 20 working days of receipt of a valid claim.

Where to send discs and manual claims

Send all completed claim forms and discs to:

GMS claims
Sector Operations
PO Box 1026
Wellington 6140