New Zealand Gazette – 2011 – No. 79

Page 1862

✨ Health Regulations

1862 NEW ZEALAND GAZETTE, No. 79 8 JUNE 2011

(2) (a) an audiology provider is materially or intentionally in breach of this notice; or

(b) a claim made by that audiology provider is materially or intentionally false.

(2) If this clause applies, the Ministry of Health may, in addition to, or instead of, any other remedy under this notice or at law, withhold some or all of the payments due to the audiology provider until—

(a) the audiology provider has remedied the breach; or

(b) the Ministry of Health is satisfied of the veracity of the audiology provider’s claim.

(3) Before withholding any payment under subclause (2), the Ministry of Health must inform the audiology provider in writing—

(a) of the breach or false claim; and

(b) that, if the breach is not remedied or the Ministry of Health is not satisfied of the veracity of the audiology provider’s claim, within a specified period of not less than 20 working days, payments will be withheld after the expiry of that specified period.

(4) Subclause (2) overrides clause CD8(1).

Defined in this notice: audiology provider, claim, working day

Subpart CE—Reviews, audits, and inspections

CE1 Review of application or claim

(1) A person may, within 3 months from the date on which the person receives notice that an application or claim has been declined, request, in writing, that the services manager review that decision.

(2) If a person makes a request under subclause (1), the following process applies:

(a) the person must provide additional written information to the services manager in support of the person’s request;

(b) the services manager will consider the request and advise the person of the outcome of the review within 10 working days of receiving the request;

(c) if, having received the outcome of the review undertaken by the services manager, the person is still dissatisfied with the outcome of that review, the person may require the services manager to refer the matter to the EMS Review Panel to undertake a second review;

(d) the EMS Review Panel will review the services manager’s decision and inform the services manager of its decision within 10 working days of the receipt of the request for a review;

Gazette.govt.nz — NZ Gazette 2011, No 79

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✨ LLM interpretation of page content

🏥 Electronic claiming for hearing aid services (continued from previous page)

Domain🏥 Health & Social Welfare
KeywordsAudiology, Electronic claims, Payment terms, Claim processing, NHI number

🏥 Reviews, audits, and inspections for audiology services

Domain🏥 Health & Social Welfare
KeywordsAudiology, Reviews, Audits, Inspections, Claims, Appeals

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