New Zealand Gazette – 2005 – No. 55

Page 1376

✨ Health Services Claims Process

1376 NEW ZEALAND GAZETTE, No. 55 23 MARCH 2005

F6.
Set Off

F6.1
If a Provider owes the Ministry any amount under this Notice the Ministry may set off that
amount against any amount that the Ministry owes the Provider.

F6.2
If the Ministry exercises the power of set off, the Ministry must give the Provider 20 Working
Days written notice of the set off.

F6.3
When the Ministry exercises the power of set off, such set off must not prejudice the interests
of any Eligible Person.

F7.
Claim Review Process

F7.1
If an Eligible Person disputes any element of a Claim made by a Provider under clause E3
that relates to that Eligible Person, that Eligible Person may apply to HealthPAC for a review
of the Claim.

F7.2
Claim Review Process:

(a) The Eligible Person must submit his or her dispute in writing with supporting
documentation to HealthPAC.

(b) HealthPAC will notify the Eligible Person that the application for review has been
received.

(c) HealthPAC will notify the Provider that an application for review has been received and
will inform the Provider of the details of the Eligible Person’s dispute within 5 Working
Days of receiving the Eligible Person’s application for review.

(d) HealthPAC will request the Provider to respond to the issues raised by the Eligible
Person.

(e) The Ministry will then review all information from the Eligible Person and the Provider
relating to the Claim.

(f) If, in the Ministry’s opinion, based on reasonable grounds, the Eligible Person’s dispute
is not substantiated the Ministry will take no further action.

(g) If, in the Ministry’s opinion, based on reasonable grounds, the Eligible Person’s dispute
is substantiated, the Ministry may do one or all of the following:

(i) require the Provider to refund the payment received for the Claim to HealthPAC;

(ii) decide to no longer accept Claims from the Provider under clause E3 for a
period to be determined at the Ministry’s sole discretion;

(iii) decide to withhold any payment to the Provider in accordance with clause B10;
or

(iv) initiate any other remedies under this Notice or at law.

VUW Te Waharoa — NZ Gazette 2005, No 55

Gazette.govt.nz — NZ Gazette 2005, No 55

Parliament House (depicted) was completed in 1918 and remains the primary seat of Parliament.

✨ LLM interpretation of page content

🏥 Service Specification for Health Services (continued from previous page)

Domain🏥 Health & Social Welfare
KeywordsHealth Services, Claims Process, Eligible Persons, Provider Requirements, Payment Procedures, Set Off, Claim Review Process

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