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Clinical Services – Operational Guidelines
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This is living document and will be updated as required; the latest version is available on https://www.acc.co.nz
Clinical Services For Sports and Exercise Medicine
Operational Guidelines Effective 1 July 2019
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Contents
1. About these guidelines .......................................................................................................................... 4
2. Introduction ............................................................................................................................................. 4
3. Who can hold this contract .................................................................................................................... 4
4. Registrars ................................................................................................................................................ 4
5. Referral Process...................................................................................................................................... 5
6. Telehealth ................................................................................................................................................ 5
7. General Assessments ............................................................................................................................ 6
7.1. Initial assessments ........................................................................................................................ 6
7.2. Subsequent assessments.............................................................................................................. 7
7.3. Second opinion assessments ........................................................................................................ 7
7.4. Reassessment after 12 Months – CS500 ...................................................................................... 8
8. Pain Management diagnosis and procedures ..................................................................................... 8
9. Change of Diagnosis ............................................................................................................................ 10
10. Prior Approvals ..................................................................................................................................... 10
10.1. Additional consultations ............................................................................................................... 10
10.2. Additional high-tech imaging ....................................................................................................... 10
10.3. Additional injections ..................................................................................................................... 10
10.4. CSARTP Considerations ............................................................................................................. 10
10.5. Checking on the approval process .............................................................................................. 11
11. Medical Case Reviews and Medical Single Discipline Assessments .............................................. 11
11.1. Referrals for Medical Case Reviews and Medical Single Discipline Assessments ..................... 11
11.2. Declining a referral ....................................................................................................................... 11
11.3. Medical Case Reviews ................................................................................................................ 11
11.4. Medical Single Discipline Assessments ...................................................................................... 12
11.5. Reporting requirements for Medical Case Reviews and Medical Single Discipline Assessments 12
11.6. Timeframes for submitting MCR/Medical SDA report to ACC ..................................................... 13
11.7. Prioritising referrals ...................................................................................................................... 13
11.8. “Out of Town” Clinics ................................................................................................................... 13
12. Invoicing ................................................................................................................................................ 14
12.1. How do I get paid? ....................................................................................................................... 14
12.2. Invoicing for specialist tests ......................................................................................................... 14
13. Appendix I - Frequently asked questions (FAQs) about Clinical Services ..................................... 15
14. Appendix II - Frequently asked questions (FAQs) on Medical Case Reviews and Medical Single Discipline Assessments ....................................................................................................................... 16
15. Appendix III -Clinical Services Assessment Report and Treatment Plan (CSARTP) ..................... 17
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ACC contact details and Information sources
Information Sources
Operational Queries These Operational Guidelines can be found on the ACC website.
Your ACC Pānui This quarterly publication updates Suppliers, Providers and Vendors on what’s
happening across ACC’s business.
https://www.acc.co.nz/for-providers/provider-updates/your-acc-panui/
ACC Provider Helpline Ph: 0800 222 070 Email: [email protected]
ACC Client/Patient Helpline Ph: 0800 101 996
ACC Provider registration Ph: 04 560 5211 Email: [email protected]
Fax: 04 560 5213 Post: ACC, PO Box 30 823,
Lower Hutt 5040
ACC eBusiness Ph: 0800 222 994,
option 1
Email: [email protected]
Health Procurement If you have a question about the commercial aspects of your contract, you need to add or remove Named Providers or if you need to update your details, please contact the ACC Health Procurement team:
Email: [email protected]
Ph: 0800 400 503
Engagement and Performance managers
Engagement and Performance managers can help you to provide the services outlined in your contract. Contact the Provider Helpline or https://www.acc.co.nz/for-providers/provide-services/provider-relationship-team/ for details of the Engagement and Performance manager in your region.
Website The ACC website can provide you with a lot of information, especially our “for providers” section. Please visit https://www.acc.co.nz/for-providers/
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1. About these guidelines
This is a guideline to assist the implementation of the Clinical Services - Sports and Exercise Service Schedule (also referred to here as “the contract”).
Read this guide in conjunction with the contract and the ACC Standard Terms and Conditions.
Services must comply with the Clinical Services Service Schedule. Where there are any inconsistencies between this document and the Service Schedule, the Service Schedule takes precedence.
ACC will tell you when a new version of this guide is available on the ACC website at www.acc.co.nz.The guidelines can also be found under “Contracts” in the Resources area of the ACC website.
2. Introduction
The purpose of the Sports and Exercise version of the Clinical Services is to fund:
• specialist assessment and treatment services
• recommendations for onward investigations, non-surgical treatment and rehabilitation.
• various medical assessments in relation to determining diagnosis/es, causation, and/or treatment
and rehabilitation recommendations.
To ensure that all specialists are aware of the process for funding assessments, the services are clearly outlined in this document. ACC supports best practice for the assessment of all clients.
The information in this document is tailored to cover all sports and exercise physicians.
3. Who can hold this contract
The contract holder (the supplier) is any Sport and Exercise Physician who is a Fellow of the Australasian College of Sport and Exercise Physicians or a physician operating under a limited scope of practice issued by the Medical Council of New Zealand and who is supported by the Australasian College of Sport and Exercise Physicians.
Any contract holder who is not an individual must notify ACC of the individuals who will be Named Providers providing service under the contract. A specialist can be named on more than one Clinical Services contract, e.g. if they work in both public and private hospitals. The supplier is responsible for managing the contract and disseminating information to the named providers.
This Clinical Services contract version covers specialist assessment in the skill area of sports and exercise. Service must not be provided at a higher level of expertise than needed. While this applies to all services and is aimed at promoting appropriate delegation of tasks within the wider health care team, it is particularly important if multiple providers work within the same premises.
4. Registrars
Under this contract the contract holder (the supplier) may employ and use registrars to provide service to ACC clients. The use of registrars must be under the supervision of a Specialist named within this contract. The registrar must be enrolled in a vocational training programme formally recognised by the Medical Council of New Zealand and must work in an organisation and under a supervision regime formally approved by a relevant College. This relevant College is currently the Australasian College or
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Sports and Exercise Physicians.
The Contract Holder must supply ACC with the names of the registrars providing services to ACC clients, and a copy of (or electronical link) to their Annual Practising Certificate.
Registrars will not be named providers and may not provide independent, unsupervised services to clients.
Invoicing for the Registrars services must be in the name of the Supervising Named Provider as the accountability for the services rests with that Named Provider.
5. Referral Process
Clients can be referred into this service by*:
• vocationally registered medical specialists
• general practitioners
• any other treatment provider as defined in the AC Act 2001 (eg physiotherapists)
• ACC
*The exceptions to this are referrals for Medical Case Reviews and Medical Single Discipline
Assessments; these services can only be requested by ACC and require prior approval.
Referrals to a medical specialist under this contract from a primary care setting (integrated family health centre, medical centre or urgent care clinic) should only be made if the injury requires assessment or treatment that is within the scope of practice of the specialist and outside the scope of practice of the primary care provider.
Referrals for assessment and/or treatment will contain the following:
• client name
• ACC claim number
• date of injury
• injury diagnosis
• list of any previous known treatment and/or tests on this claim, and
• the rationale for requesting the specialist’s opinion.
If the referral does not meet these criteria the Supplier can decline the request.
6. Telehealth
All consultations and assessments*, except for MCRs and Medical SDA (CSM1, CSM2, CSA1, CSA2), may be conducted electronically according to the recommendations of the Medical Council of New Zealand and the relevant professional body.
*Consultation or Assessment means a meeting between a patient (client) and a clinician where the purpose of the meeting requires the utilisation of the clinician’s specialised medical training in a diagnostic or therapeutic capacity.
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7. General Assessments
General assessments are carried out by appropriately qualified medical practitioners who are registered with the Medical Council of New Zealand and who hold a vocational scope of practice and a valid Annual Practising Certificate.
Sports and Exercise Physicians who hold this contract may provide up to five consultations (no more than three of which may be complex consultations) and a referral for two high-technology imaging procedures (but only one per modality) per claim without seeking prior approval from ACC.
Note that we would consider 4 or 5 consultations to be unusual, and we consider that the most common frequency would be 2 to 3 consultations. Accordingly, consistent use of 5 consultations per claim would be noted and enquiries made, as it may indicate a client whose progress we need to be aware of. Note that these are totals per claim, not per specialist.
If more than 5 consultations are expected, there should be a treatment plan in the clinical notes that details the expected rehabilitation outcome. This can be submitted via email using the standard Clinical Services Assessment Report and Treatment plan (CSARTP) document or by completing the online CSARTP (ACC32) form. Refer to the Prior Approvals section of this document for more information.
Initial assessments
This is the first specialist assessment (FSA) for a client. Specialists will ensure that the initial assessment takes place within 6 weeks of receiving the referral. If the specialist cannot meet this obligation they must refer the client to another specialist who has capacity to meet this requirement, or notify the ACC Case Owner where ACC has made the referral.
Clients will receive clinic-based procedures that do not need prior approval within 28 days of the assessment that determined the need for the procedure.
An initial assessment can be either Simple or a Complex depending on clinical best practice and client complexity.
• CS100 - Simple initial assessment is expected to take up to 45 minutes.
• CS200 - Complex initial assessment is expected to take over 45 minutes. The increased time is justified in the clinical notes.
The time for an initial assessment related to direct client time and does not include report writing, or reviewing scans and referrals when the client is not present.
NOTE: Initial assessments can only be claimed once per claim.
What should an initial assessment include?
The provision of a treatment plan that outlines:
• Identification of causation (especially whether or not caused by an accident)
• identification of further diagnostic procedures if causation or the characteristics of the injury require further investigation
• expected duration for Clinical Services assessment and/or treatment
• anticipated treatment
• any referrals required
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• the client’s capacity for return to normal function and/or employment.
NOTE: Initial assessments do not include assessments by an Anaesthetist (See Anaesthetist Specific Assessments).
Subsequent assessments
Subsequent assessments are used for assessments or consultations where specialists discuss the results of tests or interventions with the client and explore the resulting treatment and rehabilitation options. It is also used to provide necessary on-going management and/or conservative treatment, or if the client has not reached the outcomes predicted in the initial ARTP and needs a subsequent assessment or consultation.
A subsequent assessment can either be Simple or Complex depending on clinical best practice and client complexity.
• CS61 - Simple subsequent assessment is expected to take up to 30 minutes
• CS62 - Complex subsequent assessment is expected to take over 30 minutes. The increased time is justified in the clinical notes.
NOTE: A subsequent assessment may place on the same day as the initial assessment if an
intervening event (such as imaging) has occurred to justify it.
If 5 or more subsequent assessments are expected a treatment plan must be submitted to ACC. Refer to the Prior Approvals section of this document for more information.
Second opinion assessments
A second assessment is done when a second opinion is needed from an anaesthetist or other specialist while a client is being assessed or diagnosed, and/or having their ongoing care options considered. A second opinion may be requested regardless of whether the initial assessment recommended surgical or non-surgical care. All vocational scopes of practice can refer for second opinions.
While ACC does not currently limit second opinion consultations, where a specialist suspects that an ACC client or referrer is pursuing a more acceptable assessment than clinical considerations warrant (“Doctor shopping”), the specialist should advise the ACC provider helpline, including the claim number. ACC will pay for the assessment in such circumstances where the specialist has acted in good faith.
A second assessment can be either Simple or a Complex depending on clinical best practice and client complexity.
• CS400 - Simple second assessment is expected to take up to 45 minutes
• CS900 - Complex second assessment is expected to take over 45 minutes. The increased time is justified in the clinical notes.
This is direct client time and does not include report writing or reviewing scans and referrals when the client is not present.
Payments for second opinions
This type of assessment will be paid under:
• this agreement if the second specialist is a named specialist, or
• the appropriate regulations if the second specialist is not named in any current Clinical Services contract with ACC.
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Overall responsibility for Clinical Services ARTP in the event of second opinions
The initial specialist remains responsible for providing the Clinical Services Assessment Report and Treatment plan (CSARTP) to ACC, and for including in it any recommendation made by the second specialist. The CSARTP can be found on - enter “ARTP” in the search function.
Reassessment after 12 Months – CS500
Reassessments are used for subsequent simple or complex assessments by the provider who carried out the initial assessment. The client must have been discharged from the care of the provider and a new referral is required before a reassessment can occur.
NOTE: Reassessments cannot occur within 12 months of the initial assessment.
Reassessments are distinguished from the CS61 and CS62 codes so that ACC can identify and report on lingering injuries.
allows client’s risk to be identified and managed early, this process can remain as is, but it is the responsibility of the clinical services provider to determine that an alternative arrangement to that described above is satisfactory in managing anaesthetic risk. An ARTP will not be held up in the absence of an attached anaesthetic pre-assessment form.
Any client who is classified as an ASA 3 or greater, no matter what procedure they are having, should be formally assessed by an anaesthetist.
It is up to the anaesthetist to determine the assessment level required, based on length of assessment as informed by client and surgical risk factors.
After this assessment, the anaesthetist must inform the Lead Supplier and surgeon of the perioperative plan and post-operative plan.
It is important that the Lead Supplier is notified of the anaesthetic plan (especially for any unusual cases) as they are responsible for the Elective Surgery contract and are therefore responsible for ensuring the necessary resources are made available based on the findings of the assessment. For example: arranging extra staff, additional services (such as HDU care), special equipment and applying for extra funding via non-core process. It is the responsibility of the anaesthetist to notify the Lead Supplier under the Elective Surgery contract of significant patient co-morbidities.
8. Pain Management diagnosis and procedures
The Clinical Services Contract complements the Pain Management Contract to provide more efficient and timely access to diagnosis and treatment for clients who have an ACC covered injury and are experiencing pain.
These interventions are funded for clients whose complexity does not warrant referral to the pain management service. For such clients who do not have chronic pain (measured by the OREBRO score) the referral pathway would be through clinical services for diagnosis and treatment. Injection codes been developed for these diagnostic and treatment procedures.
These injection codes may not be used in conjunction with the High Tech imaging contract. If a radiologist performs the procedure, the radiologist should invoice ACC under their High Tech contract. ACC’s expectation is that these procedures are to be performed by a suitably experienced specialist.
Imaging is real time imaging and includes ultrasound, x-ray and CT scans.
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Service Item Code Service Description Approval requirements
CSP1 Transforaminal injection steroid (always with image intensifier) and/or local anaesthetic
One pre-approved, 2nd and subsequent require prior approval via CSARTP
CSP2 Lumbar epidural steroid with or without local anaesthetic
CSP3 Lumbar epidural steroid with or without local anaesthetic with imaging
CSP4 Caudal injection steroid with or without local anaesthetic
CSP5 Caudal injection steroid with or without local anaesthetic, with imaging
CSP6 Simple injection of steroid and/or local anaesthetic into joint or bursa (hand, foot, elbow, shoulder, knee)
CSP7 Injection of steroid and/or local anaesthetic into joint under imaging
CSP8 Injection of anaesthetic agent around peripheral nerves
CSP9 Injection of anaesthetic agent around nerve using image intensifier or EMG
CSP10 Injection of anaesthetic agent around the
Sciatic nerve, using image intensifier or EMG
CSP11 Sacro iliac injection (steroid and/or local
anaesthetic)
CSP12 Lateral atlantoaxial injection steroid and/or
local anaesthetic under imaging
CSP13 Complex injection of steroid or local
anaesthetic agent into hip joint with imaging
Note: These procedures include specialist time for the administration of the procedure.
Refer to Prior approvals - Additional injections for applying for the prior approval process.
The Clinical Services Contract still retains the following codes:
CST4 Injections or Joint Aspiration
CST5 Isolated Nerve Block
CST6 Regional block (not LA) or compartment pressure monitoring
CST10 Complex injection
Providers have the option of using either the CST codes or CSP codes as is appropriate.
Clients who have chronic pain and require intervention through a multidisciplinary team approach should
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be referred through the Pain Management contract.
9. Change of Diagnosis
A change in diagnosis may mean either that the provider has determined that the original diagnosis is no longer accurate or that the injury is not caused by an accident.
If a provider needs to notify ACC that the original diagnosis by which cover was granted has changed, complete the online CSARTP (ACC32) form.
Receipt of this form by ACC is for the record only, and does not automatically imply any further consideration of cover by ACC at that point; unless prior approval for additional consultations, high tech imaging, or procedures are requested as well.
10. Prior Approvals
Additional consultations
Prior approval is required for fifth or subsequent consultations and can be requested by either completing the online CSARTP (ACC32) form or the standard Clinical Services Assessment Report and Treatment plan (CSARTP) document – the latter should be emailed to [email protected].
This should be submitted as soon as it becomes apparent that more than 5 consultations will be required.
The online CSARTP (ACC32) form now offers the options to select CS61 and CS62 subsequent consultations beyond the agreed limit of five.
Use the dropdown option in the form to select CS61 or CS62 for subsequent consultations. This is available in the online form now.
Note - the text box is still required to specify:
• the number of additional consultations you are seeking
• the diagnosis selection range.
Additional high tech imaging
Prior approval is required for the third or subsequent high tech imaging (HTI)procedure and can be requested by completing the standard Clinical Services Assessment Report and Treatment plan (CSARTP) and emailing it to [email protected]
Additional injections
Prior approval is required for second or subsequent injections (SCP1 – CSP13) and can be requested by completing the standard Clinical Services Assessment Report and Treatment plan (CSARTP) and emailing it to [email protected]
CSARTP Considerations
The CSARTP (standard or online) should be completed to include a substantive statement of the prognosis for the client’s return to work or independence. All supporting document should be submitted along with the CSARTP.
ACC will not fund further treatment while a CSARTP is pending, so if a follow-up consultation resulting
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from, for instance, HTI is required, it should occur before the CSARTP is sent, and be within the 5-consultation limit.
Checking on the approval process
For information on where the approval process is up to, contact the ACC Provider Helpline 0800 222 070.
11. Medical Case Reviews and Medical Single Discipline Assessments
Medical Case Reviews and Medical Single Discipline Assessments are initiated by ACC and are used to
obtain an opinion from a non-treating practitioner who is a medical specialist, when ACC is unable to get
this from a treating practitioner. The provider (specialist) completing a Medical Case Review or Medical
Single Discipline Assessments is able to order tests or investigations if this is necessary for them to be
able to come to an opinion. They can also make recommendations for tests or investigations.
Referrals for Medical Case Reviews and Medical Single Discipline Assessments
Referrals for Medical Case Reviews and Medical Single Discipline Assessments may only be made by
ACC. ACC will not pay for services where Clients self-refer or are referred other than by a treatment
provider as set out under Clause 4.2.2 within the Service Schedule.
Declining a referral
The provider may decline a referral if:
• they cannot meet timeframes as set out under Clause 7.1.2 within the Service Schedule
• they do not have an appropriate medical specialist available in relation to the injury
• they consider that the referral is more appropriately managed under the Vocational Medical Services contract because:
o it includes consideration of a client’s employment as a major factor of the assessments;
o an assessment by an occupational medicine specialist of work restrictions, limitations, fitness for work, the ability to engage in employment or the ability to participate in vocational rehabilitation is required.
• The provider must notify the referrer if the referral is declined.
Medical Case Reviews
A Medical Case Review (MCR) is initiated by ACC and is used to obtain clarity about diagnosis/es and
assessment of causation together with recommendations for further investigations, treatment or
rehabilitation. An MCR can be used to help determine cover and ongoing entitlements. MCRs can be
purchased as either Standard or Complex, taking into account the complexity of the Client’s presentation.
• CSM1 – A Standard Medical Case Review is expected to take up to 3.5 hours.
• CSM2 – A Complex Medical Case Review is expected to take more than 3.5 hours and less than 7.5 hours, as the Client’s injury is of unusual complexity or there are co-morbidities that appear to be affecting the Client’s recovery from injury; or the MCR will be undertaken in two parts whilst results of investigations are obtained.
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Exceptional Medical Case Reviews
In rare cases where an MCR requires more than 7.5 hours, ACC may request the provider to undertake
an Exceptional MCR. If on referral, the service provider believes the Client is exceptionally complex over
and above the cost available under the Complex category, please contact ACC to discuss.
A complete definition for MCR services purchased under the Clinical Services contract is set out within
the Services Schedule (Clause 7.2.4. to 7.2.6).
Medical Single Discipline Assessments
A Medical Single Discipline Assessment (Medical SDA) is initiated by ACC and is used to obtain
recommendations for the best onward treatment or rehabilitation. A Medical SDA cannot be used to
determine cover and ongoing entitlements.
• CSA1 – A Standard Medical SDA is expected to take up to 2.5 hours.
• CSA2 – A Complex Medical SDA is expected to take more than 2.5 hours and less than 4.5 hours, as the Client’s injury is of unusual complexity or there are co-morbidities that appear to be affecting the Client’s recovery from injury; or the Medical SDA will be undertaken in two parts whilst results of investigations are obtained.
Exceptional Medical Single Discipline Assessments
In rare cases where a Medical SDA requires more than 4.5 hours, ACC may request the provider to
undertake an Exceptional Medical SDA. If on referral, the service provider believes the Client is
exceptionally complex over and above the cost available under the Complex category, please contact
ACC to discuss.
A complete definition for Medical SDA services purchased under the Clinical Services contract is set out
under Clause 7.2.7 within the Services Schedule.
Reporting requirements for Medical Case Reviews and Medical Single Discipline Assessments
ACC’s expectations for each Medical Case Review and Medical Single Discipline Assessment report to include at least the following:
• The Named Provider’s qualifications and statement of impartiality as a non-treating practitioner;
• Any facts and assumptions on which the opinions and recommendations of the Named Provider are based;
• A summary of the clinical history and examination the Named Provider has completed;
• Clear recommendations;
• Reasons for the opinions and recommendations made by the Named Provider;
• References to any literature or other material used or relied on in support of the opinions and recommendations expressed; and
• A description of any examinations, tests or other investigations that have been relied on in support of the opinions and recommendations expressed.
In addition, MCRs must include:
• A statement on the mechanism of injury used to assess causation in the specific case. If this differs from that obtained by ACC (as expressed in the referral document) an explanation of the difference must be provided;
• A statement on general causation with explanatory rationale. General causation requires a
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recognition by the scientific community that the mechanism of injury could cause the diagnosis/es - this might be with reference to the peer-reviewed literature and/or a statement on biomechanical plausibility;
• A statement confirming whether or not the specific client and/or specific circumstances of this case would confer an exception to the general scientific understanding. If this is an exception, an explanatory rationale must be provided;
• A statement on specific causation with explanatory rationale. Specific causation requires an assessment as to whether the specified mechanism of injury caused the diagnosis/es in this particular case; and
• If there is evidence for general and specific causation, a statement as to why this explanation is considered more likely than alternative possible causes of the same condition, including it being idiopathic.
Where clarity about causation specific to a work-related gradual process, disease or infection is requested, statements as to the circumstances which caused the injury need to include:
• whether or not the personal circumstances of the client in relation to their employment led to exposure that caused the injury
• circumstances of the property or characteristics of employment or non-employment activities that caused or contributed to the injury
• the risk of the client suffering this injury compared to others in the workplace undertaking and not undertaking the same employment tasks and to others who are employed in that type of environment.
In addition, Medical SDA reports must include:
• Specific recommendations for any further investigations, treatment and/or rehabilitation with explanatory rationale;
• Demonstration of clinical reasoning and a rationale for decisions reached.
Timeframes for submitting MCR/Medical SDA report to ACC
Providers who undertake an MCR or a Medical SDA are required to provide an MCR or Medical SDA report within eight business days of the Specialist completing a consultation. A detailed timeframe for submitting an MCR or Medical SDA is set out under Clause 7.1.2 of the Clinical Services Service Schedule.
Prioritising referrals
Please keep in mind that referrals for MCRs will be used by ACC to help make decisions regarding ACC
cover or entitlements which is a priority for ACC. Efforts by providers to prioritise MCRs are appreciated.
Should a provider have spare clinics or capacity to see clients for MCRs, please make sure this is brought
to ACCs attention.
“Out of Town” Clinics
ACC may make arrangements with a provider to visit a region (outside of the provider’s area of domicile)
to undertake a clinic. The case owner will work with the provider to ensure arrangements are made for
booking clients and meeting costs that are in addition to those available under the Clinical Services
contract. This includes clinic room hire, travel, travel time and accommodation as appropriate.
Frequently Asked Questions (FAQ) for Medical Case Reviews/Medical Single Discipline Assessments
We have compiled a list of FAQs relating to MCR and Medical SDA and prepared responses to these questions. Copies are available in Appendix II.
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12. Invoicing
How do I get paid?
Payment will only be made for services provided by the contract holder (if an individual) or by named providers on a contract held by a multi-provider entity such as a hospital.
ACC’s method of invoicing for services is electronic billing which makes the process faster, easier, and more efficient. Instructions on how to send in invoices electronically can be found on the ACC website. ACC needs the completed documentation before paying for the surgery provided.
The payment will be made to the supplier who holds the contract. If you are a provider named on a supplier’s contract you will need to discuss with the supplier how they will forward payment to you.
The Provider Helpline will answer queries relating to invoices and ARTP progress: free phone 0800 222 070.
Invoicing for specialist tests
Please send invoices directly to the processing centre ([email protected] North of Taupo or [email protected] South of Taupo) and not to the client service staff or branch. However, if the specialist test is not listed in the Clinical Services contract or the Cost of Treatment Regulations, then the specialist would need to contact TAC ([email protected]) for consideration. If approved they will be provided with a purchase order number which can then be quoted on their invoice and sent directly to the processing centre.
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13. Appendix I - Frequently asked questions (FAQs) about Clinical Services
1. What is a simple initial assessment?
As a general guide a simple assessment is an initial assessment that takes less than 45 minutes. This can only be used once per claim for each specialist. A more detailed description can be found in Clause 8.1.1 of the contract.
2. What is a complex initial assessment?
A complex assessment is an initial assessment that takes over 45 minutes to complete. This can only be used once per claim for each specialist. A more detailed description can be found in Clause 8.1.1 of the contract.
3. Can I charge a co-payment?
No. The price for each clinical service is the amount chargeable and no additional amount may be charged.
4. Where do I send the ARTP?
All surgery requests should be sent to [email protected]
All prior approvals the CSARTP should be sent to [email protected] (injections requests or additional consultations [sports and exercise only])
All initial ARTPs or those which do not require any approval should be sent to [email protected].
5. How do I find out more information on sending my invoices electronically?
Please contact the e-business team 0800 222 994 (option 1), or email [email protected].
6. The treatment I need to provide is not listed in this contract. What can I do?
Additional intervention assessments are available. Many of these need prior approval by a client service staff member, therefore it is best to contact ACC to discuss this. If the patient does not have a client service staff member, contact Provider Help on 0800 222 070
7. My patient does not have a case owner and needs more help from ACC. Who do I contact?
Contact Provider Help on 0800 222 070
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14. Appendix II - Frequently asked questions (FAQs) on Medical Case Reviews and Medical Single Discipline Assessments
• Q Can a General Practitioner refer directly for a MCR or Medical SDA?
A No. A specialist can accept a referral for a first or subsequent specialist appointment under the Clinical Services Contract from a GP, but not for a MCR or Medical SDA.
Q How will outliers be managed for MCR referrals (i.e. rare cases which take for example 16 hours to complete the review)?
A There is an exceptional process available which is negotiated on a case by case basis with the ACC case owner.
Q Can I continue to provide MCRs and Medical SDAs outside of the Clinical Services Contract?
A Frequent providers of MCRs and Medical SDAs will need to hold the Clinical Services Contract. An individual Letter of Agreement may be used on occasion The terms, conditions and price paid when a letter of agreement is used are the same as the Clinical Services Contract. Some rare MCRs or Medical SDAs outside normal scope will always be contracted through a Letter of Agreement.
Q Does Clause 4.2.4(c) of the Clinical Services Contract mean referrals to occupational physicians should be re-directed to the Vocational Medical Services contract?
A No, this clause means that where a medical specialist receives a referral they think would be more appropriately managed under the Vocational Medical Services contract, they have the option to decline the referral. Occupational physicians are included in the Clinical Services Contract. This means occupational physicians should accept referrals for MCRs where the primary reason for referral relates to diagnosis or causation; and should accept referrals for Medical SDAs where the primary reason for the referral is to provide advice on onward treatment or rehabilitation. In cases where diagnosis or injury cause is not in question; and the client is no longer employed; and a rehabilitation plan needs to be developed requiring an occupational physician’s expertise, this is more appropriately referred under the Vocational Medical Services contract.
Q I cannot not see any provision for payment of travel related costs in this Clinical Services contract. Occupational Medicine Specialists currently travel to provincial areas to conduct MCR & Medical SDA assessments where there is no such resident specialist.
A Travel and accommodation costs are not able to be charged under the Clinical Services Contract. However, travel and accommodation costs to be paid separately by the claims management unit where they have requested a clinic be held in their province. In this situation, the actual delivery of the MCR or Medical SDA services is paid under the Clinical Services contract and travel and accommodation costs is invoiced separately as instructed by the ACC referrer.
Q If I am asked to undertake a clinic out of region to complete MCRs and Medical SDAs for ACC, how is travel, accommodation and clinic fees reimbursed as there is no provision in the Clinical Services Contract?
A If ACC requests that you undertake a clinic out of region, then there are provisions available for travel, accommodation and clinic room hire which are paid separately to the Clinical Services Contract. There is a set fee available for accommodation and other expenses incurred for clinic room hire and travel incurred at cost.
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15. Appendix III -Clinical Services Assessment Report and Treatment Plan (CSARTP)
Te Kaporeihana Āwhlna Hunga Whara
Please complete the form and sign the declaration. Keep this form for your records and send a copy along with any supporting
documents to ACC as follows:
• Prior approvals requests: [email protected]
• All other CSARTPs: [email protected]
Please tick box to indicate if this is an:
Initial Plan Updated plan Prior Approval request
1. ACC DETAILS This form was completed on [date]
Email address:
2. SUPPLIER DETAILS
Supplier name: Supplier number:
Specialist's name: Date of consultation:
Specialist Email address:
3. CLIENT DETAILS
Client's full name:
ACC Claim number:
4. CONSULTATION DETAILS
Injury details (including date and history of the injury, the initial and current diagnosis, and relevant medical history)
5. TREATMENT RECOMMENDED
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ACC procedure code
ACC procedure name
Date of proposed treatment
Activity modification (eg light duties)
Proposed plan
Review date (anticipated or known)
6. ATTACHMENTS
Please list and attach copies of any documents that support your recommendations
7. SPECIALIST DECLARATION
I certify that, on the date shown, I personally examined and/or treated the client. I have discussed their treatment options with them and advised why the recommendation is the appropriate treatment in this case. The client (or their representative) has authorised me to provide this information to ACC on their behalf.
Signature: Date:
Specialist name:
The information collected on this form will only be used to fulfil the requirements of the Accident Compensation Act 2001. In the collection, use and storage of information, ACC will at all times comply with the obligations of the Privacy Act 1993 and the Health Information Privacy Code.
