✨ Health Services Claims Process
23 MARCH 2005
NEW ZEALAND GAZETTE, No. 55
(c) The Eligible Person must contact HealthPAC and obtain a payee number.
(d) The Eligible Person must submit to HealthPAC:
(i) a completed Breast Prostheses Claim Form; and
(ii) a Proof of Purchase for the Services.
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E5. Statement in Explanation of Claim
E5.1 In relation to any Claim for payment in accordance with this Notice, the Ministry may require the Provider and/or Eligible Person concerned to supply in writing or otherwise, a statement of explanation or substantiation of the Claim.
E5.2 If the Provider or the Eligible Person refuses to supply any information required by clause E5.1 or supplies an insufficient or unsatisfactory statement, the Ministry may:
(a) not accept the Claim either wholly or in part; or
(b) if the Claim has been paid, take the necessary steps to recover from the Provider or the Eligible Person, as the case may be, the whole or a specified part of the Claim and any associated costs or losses, as a debt due to the Ministry, or set off the whole or any part of such Claim against any amounts that may thereafter be payable to the Provider or Eligible Person in respect of any other Claim or Claims.
E6. Consumer Guarantees Act
E6.1 Where the Provider is required by the Consumer Guarantees Act 1993 or any other law, to refund payments for any Services provided to an Eligible Person, the Provider must:
(a) refund to HealthPAC any payment received from HealthPAC in respect of those Services; and
(b) refund to the Eligible Person the cost, if any, paid by the Eligible Person for the relevant Services.
E6.2 The Ministry will credit the entitlement account of the Eligible Person by the amount of any refund the Ministry receives under clause E6.1.
E7. Claim Forms
E7.1 Every Claim by a Provider or an Eligible Person for payment must be submitted to HealthPAC.
E7.2 A Provider claiming payment under clause E3 of this Notice must submit its Claim on the Claim Summary Form annexed as Schedule 1 to this Notice, or in such other format as is approved by the Ministry from time to time.
E7.3 An Eligible Person claiming payment under clause E4 of this Notice must submit his or her Claim on the Breast Prostheses Claim Form annexed as Schedule 2 to this Notice, or in such other format as is approved by the Ministry from time to time.
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Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2005, No 55
Gazette.govt.nz —
NZ Gazette 2005, No 55
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Service Specification for Health Services
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🏥 Health & Social WelfareHealth Services, Claims Process, Eligible Persons, Provider Requirements, Payment Procedures