Provider payments

Providers include individual healthcare providers and provider organisations.

Individual healthcare providers

• Such as nurses, midwives, occupational therapists, physiotherapists, general practitioners, and radiologists or specialist doctors such as surgeons, obstetricians, gynecologists, and radiologists.

Provider organisations

• Such as Primary Health Organisations (PHOs), community-based providers, non-governmental organisations (NGOs), medical practices, laboratories, pharmacies, home-care services and hospitals.

Sector Operations offers healthcare providers:

• maintenance and distribution of services catalogues
• preparation of payment schedules
• maintenance and distribution of entitlements payment schedules
• receipt, capture, validation and processing of entitlements, registers, claims and invoices
• payment processing
• query and request management.

To provide and be compensated for certain services, a provider must have a valid Annual Practicing Certificate (APC).

Professional registration bodies, such as the New Zealand Medical Council, or the New Zealand Nursing Council, provide APCs. These details are submitted to Sector Operations.

Reference data containing provider and APC status information is submitted to Sector Operations regularly. This information is used to confirm the active registration of health Providers before approving and paying their claims.

Currently, the registration and maintenance functions are performed by the Sector Operations Agreement Administration team.

A provider can be either an individual (with a valid APC) or an organisation employing one or more individuals (with valid APCs).

Details of these providers are supplied by the Funder (usually a District) wishing to establish an Agreement with the provider. The provider details are captured in the Health Payment Systems.

Provider registrations and agreements are currently established and maintained by the Sector Operations agreements management team on the Funders’ behalf. In the future, Funders may wish to administer their own agreements using online solutions provided by Sector Operations.

Certain agreements cover services provided at specific facilities, for example the services provided at an aged care facility. Details about these facilities are captured and maintained to support the creation of payment schedules. These schedules list the patients being cared for at the facility and their services and subsidy entitlements.

Facilities may provide different levels of care for which different tax rates may apply.

Providers, suppliers and healthcare users submit claims, invoices and refund requests to Sector Operations.

For example:

• providers claim for health services and medication provided to health care users
• suppliers claim for products, generally artificial aids, that have been provided to healthcare users
• members of the public claim for refunds for health-related costs, such as travel or accommodation expenses
• Primary Health Organisations submit patient registers, which form the basis for capitation-based funding calculations.

Sector Operations process registers, claims, invoices and refund requests by:

• capturing and validating them against the Providers Agreement or against the health care user’s entitlement, and against the business rules specified for each claim type
• generating Buyer Created Tax Invoices or Remittance Advice
• making payments on the funder’s behalf.

Upon receiving a valid GST tax invoice, Sector Operations will pay you for the services you provide in each service period.

Invoices can take up to 14 days to process and approve, with payment released 14 days from the invoice date. This means that if payment is expected on the 20th of the month, your invoice should be submitted by the 5th of the month. If there is missing or incorrect information on your invoice, you will be notified via email.

Download and complete this application form and return it along with supporting documents by email or post.

Email

sector.operations@health.govt.nz

Post

Primary Care Team
Sector Operations
Health New Zealand | Te Whatu Ora
Private Bag 1942
Dunedin 9054

Make sure all details are provided to avoid delays when processing your application. You will be notified when your application has been processed.

For further information, contact us.

• Phone: 0800 855 066
• Email: adminsupport@health.govt.nz
• Subject: Payee Number Application