New Zealand Gazette – 2005 – No. 55

Page 1409

✨ Health Services Claims Process

23 MARCH 2005
NEW ZEALAND GAZETTE, No. 55
1409

F5.3 If the Provider or Eligible Person does not repay the overpayment in accordance with this clause F5, the Ministry may exercise its right of set off under clause F6.

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

VUW Te Waharoa — NZ Gazette 2005, No 55

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

The Executive Wing of Parliament (depicted) is universally known as The Beehive. It was completed in 1977 and remains the primary office for the elected Government of the day.

✨ LLM interpretation of page content

🏥 Claims Process for Health Services (continued from previous page)

Domain🏥 Health & Social Welfare
KeywordsHealth Services, Claims, Providers, Eligible Persons, Payment Process, Non Acceptance, Notification of Change

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