HEALTH FUND NEWS
AHM ( Australian Health Management ) - now pay rebates for telehealth consultations for Nutrition .
HCF – advised that their database issue has been resolved but there may be gaps in registration for some providers due to the complexity of the system . Clients can resubmit invoices for assessment .
Defence Health – has requested ATMS to confirm the following to providers active with Defence Health :
1 . Defence Health Fund Rules do not permit the payment of benefits if the treated member is a partner , dependent , parent , sibling , or business partner of the servicing provider .
2 . By definition , a provider can only perform one initial consultation with a member . Initial consultations attract a higher benefit than a subsequent consult . Providers who charge multiple initial consults receive higher payments from the fund than they should . Please remind your members that only one ‘ initial consult ’ is allowed for any patient per condition . Defence Health will seek reimbursement for any overpayments made due to incorrect billing .
3 . Over the next 12 months Defence Health wants to build a better understanding of how different practices service members . Defence Health may ask providers to share information and analyse claims data . If Defence Health observes any unusual claiming behaviour , they will notify the provider and may arrange a site visit or audit .
Medibank and AHM : Changes to billing standards
ATMS , along with all other provider associations , has been advised that Medibank and AHM will no longer accept handwritten or stamped accounts from 1 April 2021 . If providers do not comply with this notice by 1 April 2021 , their status as a recognised provider of Medibank and AHM may be reviewed and they may be suspended or cancelled .
Members have until 1 April 2021 to move to electronically issued invoices ( emailed or printed ). Invoices must meet Medibank requirements for Ancillary Billing Standards . These details are on our website here : https :// www . atms . com . au / health-funds / health-fundterms-conditions /
BUPA : Revised Ancillary Provider Terms
BUPA has updated its Ancillary Provider Terms , and these will come into effect from 1 February 2021 . These Terms will apply to all ATMS members who are recognised by and lodge treatment claims with Bupa . These details are on our website here : https :// www . atms . com . au / health-funds / health-fundterms-conditions /
All health funds : Clinic telephone numbers
Please update your clinic telephone number / s with ATMS . Claims will be rejected if no telephone number is available at your active clinic location / s . This is one of the requirements of the health funds .
Health Funds
ATMS is a ‘ professional organisation ’ within the meaning of section 10 of the Private Health Insurance Accreditation Rules 2011 . This potentially allows ATMS accredited members to be recognised as approved providers by the various private health funds . Approved health fund provider status is , however , subject to each individual health fund ’ s eligibility requirements .
Consequently , membership of ATMS does not automatically guarantee provider status with all health funds . Please also note that several health funds do not recognise courses done substantially by distance education , or qualifications obtained overseas .
Additional requirements for recognition as a provider by health funds include :
• Clinic Address ( Full Street Address and telephone number must be provided – Please note that some health funds may list your clinic address on their public websites )
• Current First Aid Cert ( HLTAID003 or HLTAID011 )
• Current Senior First Aid
• Current Professional Indemnity Insurance ( some health funds require specific minimum cover amounts . Please refer to the individual health fund terms and conditions for further information )
• Compliance with the ATMS Continuing Education Policy along with any additional continuing education requirements stipulated by the health fund
• Current National Registration ( where applicable )
• Compliance with the Terms and Conditions of Provider Status with the individual health funds .
ATMS must have current evidence of your first aid and insurance on file at all times .
ATMS now recommends all members renew First Aid or insurance at least 14 days before the expiry date . It is important that you notify ATMS of these changes promptly so that the information is updated to the health funds and claims can continue to be paid out to your clients without interruption .
Additional Information : If you are treating minors in your clinics , health funds require a copy of your Working with children / Working with vulnerable people card . Please forward these details to ATMS so this information is updated to the health funds .
When you join or rejoin ATMS , or when you upgrade your qualifications , you will need to fill out the ATMS Health Fund Application and Declaration Form available on the ATMS website . Once this is received , along with any other required information for health fund eligibility
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