HCi recognised providers
~ terms & conditions
// HCi RECOGNISED PROVIDERS
What are HCi recognised providers?
HCi members can only claim for services given by hospitals and extras providers recognised by HCi.
For extras (also known as general treatment or ancilliary) providers to be HCi recognised, providers must comply with relevant legislation and agree to abide by HCi’s Terms and Conditions for HCi Recognised Providers of Extras Services (see below).
Becoming an HCi recognised provider
Most hospitals are HCi approved through an AHSA agreement.
Many extras providers have ARHG certification which qualifies for HCi recognition automatically.
If you are a health services provider without an AHSA agreement or ARHG certification, please complete this application for recognition form.
If you are already an HCi recognised Extras Provider, you can email us to update your details at any time.
The provision (or withdrawal) of recognition to an extras provider is at the sole discretion of HCi.
Terms & Conditions for HCi Recognised Providers of extras services
Effective 1 September 2022
1. Overview
1.1 These Terms and Conditions apply to you from the date you become a Recognised Provider of extras services with HCi. They also apply to any other person who initiates or provides services and/or goods on your behalf.
1.2 In order to become and continue to remain a HCi Recognised Provider, you must comply with these Terms and Conditions. It is your responsibility to regularly check the ‘For Providers’ section of our website to ensure you stay up-to-date with these Terms and Conditions, which may change from time to time without notice to you.
1.3 The provision or withdrawal of recognition to providers, is at HCi’s sole discretion.
1.4 Benefits paid to a HCi Recognised Provider, or to a member in respect of Extras Services supplied by a Recognised Provider are governed by HCi’s Fund Rules and prevailing legislation.
2. HCi Recognition Requirements
2.1 For recognition as an Extras Provider, you must be:
(a) a health professional and a supplier of health services that provides Extras Services in private practice,
(b) a member of a professional organisation that meets the requirements under Rule 10 of the Federal Government’s Private Health Insurance (Accreditation) Rules, and provide evidence of membership if requested to do so by us,
3. HCi Recognised Provider’s Obligations
3.1 As a Recognised Provider, you must:
(a) comply with all standards, guidelines, obligations and legislation relevant to their profession and/or private health insurance rules,
(b) ensure that all persons providing services to HCi members under your instruction, direction or control are suitably qualified and comply with these terms,
(c) not alter, amend, falsify or omit information on an account, invoice or receipt (enabling for example, a benefit to be falsely claimed),
(d) comply with the terms of any relevant electronic claiming system used to transact with HCi,
(e) assist with any requests for additional information or verification of a request for a claim payment to you, or to the HCi member for a service provided by you,
(f) repay within 30 days of HCi’s request, any benefits or money paid to the Recognised Provider where HCi reasonably determines that the Recognised Provider, or the HCi member who received the Extras Service was not entitled to it under HCi’s Fund Rules
(g) not discriminate against HCi members because they are covered by private health insurance, including charging them more than the usual fee, or charging then claims processing fees,
(h) notify HCi immediately of any information which could impact on your ongoing recognition as a HCi Recognised Provider, and
(i) comply with any other reasonable request from HCi.
4. Billing Standards
4.1 Patient accounts, invoices and/or receipts must:
(a) be issued electronically, including via email only (handwritten accounts are not accepted by HCi),
(b) be generated for each date on which services or goods are provided, on your official stationery, showing the date of service and with an individual invoice/receipt number,
(c) be marked as ‘duplicate’ if it is issued after the original document was issued,
(d) identify your business name, provider name and number, ABN, address (of the location services were provided) , telephone number and email address
(e) identify the full name and address of the person in respect of whom services or goods were provided,
(f) show all fees charged or chargeable, whether these have been paid and whether any discounts were applied
(g) identify the services and goods provided and detail the relevant item number/claim code, item descriptions ad, where relevant, the body part/tooth identification number for each service.