✨ Maternity Services Claims Processing
NEW ZEALAND GAZETTE
No. 40
1128
5.0 PROCESSING OF CLAIMS
5.1 Identification of pregnancy
The NHI number and Expected Date of Delivery will be used to uniquely identify the woman and her pregnancy and must be supplied with each Claim.
5.2 Claiming process
5.2.1 Authorised Practitioners can obtain advice on claiming from Health Benefits.
5.2.2 A Claim must be completed accurately, legibly and in full.
5.2.3 The Authorised Practitioner or Organisation making the Claim must sign each Claim. Where a Claim is submitted electronically, the Authorised Practitioner or Organisation must sign and retain a copy of the Claim.
5.2.4 The woman receiving the service must also sign the Registration form (except where a Claim for Registration needs to be re-submitted in which case it is sufficient to have a photocopy of the original Claim containing the woman’s signature).
5.2.5 An incomplete or illegible Claim will not be deemed to have been received by Health Benefits and shall be returned to the claimant within five working days, where the claimant is identifiable.
5.2.6 Every Claim must be in the format given in Appendix VII, or such other format as is approved by the Ministry of Health from time to time.
5.2.7 An Authorised Practitioner may nominate an Organisation(s) to receive payments under this Notice for that Authorised Practitioner’s services. The Ministry of Health will provide the Authorised Practitioner with the payee number of the Organisation(s).
5.2.8 Where the Ministry of Health determines that an Authorised Practitioner or Organisation has been overpaid or that an Authorised Practitioner or Organisation was not entitled to a payment, the Ministry of Health may deduct any over payment from any subsequent payment payable to the Authorised Practitioner or Organisation. Prior to making any deduction, the Ministry of Health will advise the Authorised Practitioner or Organisation giving the reason(s) for the deduction and giving the Authorised Practitioner or Organisation sufficient time to appeal against the deduction prior to it occurring.
5.2.9 Subject to clause D3.1.4, D5.2.5 and D5.2.10, in the event that two or more Claims are submitted for the same service, only the first Claim to be received shall be paid.
5.2.10 The Authorised Practitioner or Organisation can appeal against any partial payment, nonpayment or repayment by writing to the Ministry of Health with details of the complaint.
5.3 Timing of Claims
5.3.1 A Claim may only be made on completion of services. This includes the completion of a Module.
5.3.2 A Claim will be paid within twenty-two working days from the receipt of a valid Claim by Health Benefits. Payment will be made by way of direct credit.
5.3.3 Registration or a change of Registration must be received by Health Benefits no more than twenty working days after the date of Registration. Any other Claim for any Maternity Service other than Registration must be received by Health Benefits within six months of this service being completed.
5.3.4 Where a Claim for any Maternity Service provided under this Notice is received six months after the service has been completed, there will be a 10% fee deduction.
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Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2002, No 40
Gazette.govt.nz —
NZ Gazette 2002, No 40
✨ LLM interpretation of page content
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Processing of Claims for Maternity Services
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🏥 Health & Social WelfareClaims, Maternity Services, Payment, Registration, Authorised Practitioner