Sector Operations has three offices throughout New Zealand.
Wellington
The role of Wellington Sector Operations is to process, pay and administer non-pharmaceutical claims (27 million per year). They also provide claimant support to enable the efficient and effective management of the claiming process.
Structure
Sector Operations Wellington is made up of a number of teams as follows:
- Senior Management
- Finance
- Information Technology
- Payment Processing
- Contact Centre
- Information Services.
Payment Processing
The Wellington team processes all claims for non-pharmaceutical medical and medically related services including:
- General Medical Services (GMS)
- Maternity
- Immunisations
- Practice Nurse
- Dental
- Wide range of Minor Benefits.
Contact Centre
The Payment Processing Team and Contact Centre provide a support service to both purchasers and providers. The Contact Centre provides specialist staff to ensure all health professionals have quick and easy access to accurate information on the claiming process, agreements, compliance and patient eligibility with Sector Operations.
Claimants may access the Centre via the 0800 free phone number during normal business hours, or by fax and/or letter.
Whanganui
The role of Whanganui Sector Operations is to process, pay and administer pharmaceutical claims (42 million per year) and to provide claimant support to enable the efficient and effective management of the claiming process.
Structure
The Whanganui team provides payment and support to contracted health providers for all pharmaceutical and pharmacy-related services in New Zealand. These include:
- Payments processing
- Processing support
- Special authority
Payments Processing
The Whanganui team processes claims for retail pharmacies and hospital pharmacies, drug wholesalers and other health providers.
Payment Processing also undertakes the following:
- Community Services Card Fax Service
- High Use Health Cards
- Special Authorities applications
- Oral Health adolescent enrolments
The Payment Processing Team and Contact Centre provide a support service to both purchasers and providers. The Contact Centre provides specialist staff to ensure all health professionals have quick and easy access to accurate information on the claiming process, agreements, compliance and patient eligibility with Sector Operations.
The Contact Centre also provides information about and issues National Health Index (NHI) numbers and Community Services Card (CSC) validity information. Claimants may access the Centre via the 0800 free phone number during normal business hours, or by fax and/or letter.
Dunedin
Sector Operations Dunedin provides the infrastructure to manage approximately 14,600 agreements and 160,000 payments per year for the health and disability sector. This enables the Ministry and DHBs to track contract commitments and monitor performance and expenditure against those commitments. It also provides a helpdesk facility for providers, clients, Ministry and DHB staff.
Structure
Sector Operations Dunedin is made up of a number of teams as follows:
- Senior Management
- Agreement Administration
- Information Services
- Payments
- Information Management.
Agreements Team
The Agreement Administration Team produces the agreement (contract) documentation and enters contract and service details into the contract management system (CMS). The Agreement Administration Team is also responsible for collecting Performance Reporting data from providers.
Payments Team
The Payments Team enters invoice data, in order to enable payment. The team also processes payments based on eligibility criteria, and makes reimbursements of claims. The provider payment team also enters performance data when reports are received.
Information Management
The Information Management Team produces information by reports from the data received by the systems above.