Immunisation subsidy

If a claim is submitted to Sector Operations, the general practitioner cannot charge the patient for the service that was provided.

Can I submit an Immunisation claim and a General Medical Service (GMS) claim for the same patient and same date of service?

Both services may be claimed but only if a full consultation was undertaken with the patient. If the only service provided was an immunisation, then a General Medical Service claim should not be submitted to Sector Operations.

How can I submit my claims to Sector Operations?

To start claiming electronically you will need to contact a Practice Management System (PMS) vendor.

Claims may be submitted manually if approval has been given by the funding DHB. The most common claims that are received manually are ‘stale claims’ that are submitted more than 6 months after the Date of Service.

What is the GMS & IMMS HL7 Specification?

The GMS & IMMS HL7 Specification defines the messaging and communication standards for the electronic transfer of claims information between providers and Sector Operations. It defines the format of the electronic file.

What is a PMS vendor?

A PMS vendor is a company that supplies practice management software. Errors relating to the format of the claim file may need to be referred back to the PMS vendor.

How long will it take for my immunisation claim to be paid?

Claims submitted electronically will be paid no later than 10 business days from the date of receipt at Sector Operations.

Claims submitted manually will be paid no later than 20 business days from the date of receipt at Sector Operations.

If a claim is fully rejected and subsequently resubmitted, the payment date will be calculated from the date of receipt of the resubmitted claim.

What should I do if Sector Operations has received my claim but the whole file has been rejected?

There could be two possible reasons for the whole file being rejected. In both cases, no payment will be made.

Header level error

A header level error means that there is something wrong with the structure of the file.

All items within the file rejected

All items in a file may reject for a number of different reasons.

In both cases, refer to the ‘Rejected Electronic Claim’ letter and ‘Error Report’ and/or call the Contact Centre on 0800 855 066 for further information.

Some items within the claim file have rejected with errors. What do these errors mean?

If the Error Report that is attached to either a ‘Rejected Electronic Claim’ letter or ‘Buyer Created Tax Invoice (BCTI) is not sufficient, please refer to IMMS errors (Excel, 18 KB), a spreadsheet containing a list of possible error messages, a full description of what the error means and what needs to be done to correct the error. If further information is required, phone the Contact Centre on 0800 855 066.

I don’t understand the ‘indications’ that Sector Operations staff refer to on the phone. What do these mean?

The indication is the reason that the vaccine was administered. The scheduled reason, eg, 6 weeks, is used to report where the vaccination falls on the NZ vaccination schedule. Refer to the table below for the indication value that Sector Operations staff refer to and the description which is most likely what the provider will see on their screen.

Immunisation indication values

Indication value	Description
1	Over 65 years (Influenza)
2	Under 18 years, eligible condition (Influenza)
3	Eligible condition (Influenza)
4	Sexual or household contact
5	Primary course
6	Booster
7	Post partum
8	Low birth weight
9	HepB carrier mother
10	At risk for TB
11	Pre-post splenectomy schedule
12	At risk, no previous history
13	At risk of pneumococcal, previous PCV history
14	At risk, previous 23PPV
15	Pre-emergency
16	Pregnant woman
21	PCV catch up
6W	6 weeks
3M	3 months
5M	5 months
15M	15 months
4Y	4 years
11Y	11 years
45Y	45 years
65Y	65 years
Stn	Standard programme

I don’t understand the vaccine code combinations that Sector Operations staff refer to on the phone. What do these mean?

The vaccine code combination consists of three parts.

1. Vaccine Code (identifies the vaccine given)
2. Indication (reason the vaccine was administered)
3. Sequence (the dose number of the vaccine being given)

The table below represents the only valid code combinations that are possible for claiming through Sector Operations. The sequence should be between 1 and 99 unless specified otherwise. Note that age rules may also apply for specific vaccines.

If you do not see these valid code combinations on your screen, please contact your PMS vendor for assistance in determining the correct option to choose.

Vaccine code combinations

Vaccine Code	Short Description	Long Description	Indication(s)	Sequence
33	23PPV	Pneumococcal polysaccharide	5	1 to 4
33	23PPV	Pneumococcal polysaccharide	6, 11	1 to 9
33	23PPV	Pneumococcal polysaccharide	12, 13, 14	1 to 2
20	DTaP	Diphtheria, tetanus toxoids and acellular pertussis	6W, 3M. 5M, 15M, 4Y, 6	1 to 99
99001	DTaP-IPV	Diphtheria, tetanus, acellular pertussis, inactivated polio	6W, 3M, 5M, 4Y, 6	1 to 99
99011	dTap-IPV	Diphtheria, tetanus, acellular pertussis, inactivated polio	11Y	1 to 99
210307	DTaP-IPV-Hep B/Hib	Diphtheria, tetanus, acellular pertussis, inactivated polio vaccine, hepatitis B, haemophilus influenzae type b	6W, 3M, 5M, 4Y	1 to 99
EVP	EVP	Emergency (pandemic) vaccine programme	15, 5, 6	1 to 99
EVPMnC	EVP meningococcal C conjugate	Emergency vaccine programme meningococcal C conjugate vaccine	5, 6	1 to 99
30	HBIG	Hepatitis B immune globulin	6, 9	1 to 99
52	Hep A, adult	Hepatitis A vaccine, adult dosage	Stn	1 to 99
83	Hep A, paed./adol., 2 dose	Hepatitis A vaccine, paediatric/adolescent dosage	Stn	1 to 99
43	Hep B, adult	Hepatitis B vaccine, adult dosage	4, Stn	1 to 99
44	Hep B, dialysis	Hepatitis B vaccine, dialysis patient dosage	Stn	1 to 99
08	HepB, paed	Hepatitis B vaccine, paediatric dosage	6W, 3M, 5M, 4, 6, 9, 96, Stn	1 to 99
48	Hib (PRP-T)	Haemophilus influenzae type b vaccine, PRP-T conjugate	6W, 3M, 5M, 15M, 6, 8, Stn	1 to 99
48	Hib (PRP-T)	Haemophilus influenzae type b vaccine, PRP-T conjugate	11	1
62	HPV, quadrivalent	Human papilloma virus vaccine, quadrivalent	5	1 to 99
165	HPV9	Human papillomavirus, 9-valent vaccine	5, Stn	1 to 99
99006	Influenza	Influenza	1, 2, 3, 16	1 to 99
10	IPV	Poliovirus vaccine, inactivated	6W, 3M, 5M, 4Y, 11Y, Stn	1 to 99
114	MenACYW-135	Meningococcal polysaccharide (groups A,C,Y and W-135) diphtheria toxoid conjugate vaccine (MCV4P)	Stn	1 to 99
99013	MenCCV	Meningococcal C conjugate vaccine	Stn	1 to 99
163	Meningococcal B, OMV	Meningococcal B vaccine, recombinant, OMV, adjuvanted	Stn	1 to 99
03	MMR	Measles, mumps and rubella virus vaccine	15M, 4Y, 5, 6, 7, Stn	1 to 99
260209	PCV10	Pneumococcal conjugate vaccine, 10 valent	6W, 3M, 5M, 15M, 21	1 to 99
260209	PCV10	Pneumococcal conjugate vaccine, 10 valent	5, 12	1 to 4
260209	PCV10	Pneumococcal conjugate vaccine, 10 valent	6	1 to 9
260209	PCV10	Pneumococcal conjugate vaccine, 10 valent	13	1
260209	PCV10	Pneumococcal conjugate vaccine, 10 valent	14	1 to 2
133	PCV13	Pneumococcal conjugate vaccine, 13 valent	6W, 5M, 15M, 21, Stn	1 to 99
133	PCV13	Pneumococcal conjugate vaccine, 13 valent	6	1 to 9
133	PCV13	Pneumococcal conjugate vaccine, 13 valent	5, 11, 12	1 to 4
133	PCV13	Pneumococcal conjugate vaccine, 13 valent	13	1
133	PCV13	Pneumococcal conjugate vaccine, 13 valent	14	1 to 2
119	Rotavirus, monovalent	Rotavirus, live, monovalent vaccine	6W, 3M	1 to 99
09	Td, adult	Tetanus and diphtheria toxoids, adsorbed for adult use	6W, 3M, 5M, 4Y, 11Y, 5, 6	1 to 99
99012	Tdap	Diphtheria adult dosage, Tetanus, acellular Pertussis adult dosage	6W, 3M, 5M, 4Y, 11Y, 45Y, 65Y, 5, 16	1 to 99
21	Varicella	Varicella virus vaccine	15M, 11Y, Stn	1 to 99
121	Zoster	Zoster (shingles) vaccine, live, for subcutaneous injection	65Y	1

How should booster doses of the HepB Paed vaccine (where the original Indication is 9 – HepB Carrier Mother) be claimed?

Booster doses should be claimed using Indication 6 (Booster).

What is an alternative vaccine?

An alternative vaccine is a valid vaccine that may be used instead of the normal Schedule vaccine if, for some clinical reason the Schedule vaccine may not be used.

Are NHI numbers required for every patient within a claim file?

An immunisation claim file must contain at least 85% of valid NHI numbers. Therefore, 15% of the claims do not have to contain NHI numbers provided that they contain both Date of Birth and Surname. However it is advisable that you make every effort to obtain a patient’s NHI number and include this in your claim.

How do I submit a claim where a locum doctor has provided the service?

The Payee Number, Agreement Number, Registration Number and Name of the host doctor must be provided in addition to the Registration Number and Name of the locum.

How do I receive payment for claims that are over 6 months old?

Written approval must be received from the Funding/Portfolio Manager at the funding DHB. The provider should contact their DHB first to determine the process but in most cases the DHB will require the claims to be submitted manually to them with an accompanying letter explaining why the claims were not submitted within the contractual timeframe.

If approval is granted, the approval letter should be sent to Sector Operations with the claims.

If I have ongoing computer problems, can I obtain approval from my DHB to claim manually for a specified period of time or do I need to obtain approval each time I submit claims?

This will depend on the funding DHB. Some may require you to obtain approval each time but others may give you an exemption for a specific period of time. Sector Operations will keep a record of the exemption.

If I immunise a patient with more than one vaccine in a single visit, can I claim a separate fee for each vaccine?

No. One fee only will be paid per IMOA (ie, for one or more vaccines given on the same visit). Similarly, only one IMOA will be paid when influenza vaccine is given with another vaccine at the same visit on the same day. The exception for this is when influenza vaccine is co-administered with zoster vaccine.

Refer to the table below to determine which services to claim based on the vaccinations that were provided in a single visit.

Vaccination scenario	Claim code combination
	IMOA	IMFA	IMFV	IMZF
Administration of at least one vaccine (including zoster) other than influenza	Yes
Administration of influenza vaccine only		Yes	Yes
Administration of influenza vaccine and at least one other vaccine, with the exception of zoster	Yes		Yes
Administration of zoster and influenza vaccines only		Yes	Yes	Yes
Administration of zoster and influenza vaccines plus at least one other vaccine	Yes		Yes	Yes

Can I submit claims where a Nurse Vaccinator has provided the service?

Yes. The applicable Payee Number and Contract Number should be provided with the Nursing Council Number of the Nurse Vaccinator. The Payee Number and Contract Number will often be those of the doctor but may be for the nurse if the nurse holds their own agreement.

If your claim rejects and you believe that the correct information was supplied, please contact your PMS vendor for assistance.

If a patient receives a standard immunisation vaccine in addition to a pre/post splenectomy vaccine on the same day, am I entitled to an extra fee?

Yes. An IMOA (standard administration) and IMMB with indication 11 (pre/post splenectomy) should be claimed so that you receive an extra fee.

Claiming for children who are re-immunised following chemotherapy

General practices are able to submit an immunisation claim for services delivered when children are re-immunised following chemotherapy treatment.  The completed Immunisation Benefit Claim Details Form and Immunisation Benefit Claim Summary Form may be submitted to Sector Operations who will seek approval for payment from the DHB.  Send all completed manual claim forms to: Immunisation claims, Sector Operations, PO Box 1026, Wellington, 6104.

The indication value that best meets the definition for re-immunisation is 6 - booster.

An Immunisation claim cannot be submitted to Sector Operations for a vaccine that is not listed on the New Zealand Pharmaceutical Schedule.

See the Guide to completing the Immunisation claim form (docx, 1.4MB).

How often is the National Immunisation Schedule updated?

The National Immunisation Schedule is updated every 2 years as a result of recommendations made by the Immunisation Technical Working Group (ITWG) and subsequent approval by the Minister of Health. The details are published on the Immunisation page.

Where can I find more general information about immunisation?

Visit the Immunisation page.

What are the rules for the human papillomavirus (HPV) vaccine?

At this stage, there are no age validations for this vaccine.

Where do I send my manual claim forms?

Send all completed claim forms to:

Immunisation claims
Sector Operations
PO Box 1026
Wellington 6140

I have run out of claim forms – how do I order more?

Claim forms are available free by calling 0800 855 066. You will need to provide your payee number.

Please note: you should not rely solely on the answers provided here; the contracts applicable to each provider and all relevant legislation must be consulted to determine the full rights & liabilities applicable to any service provider or funder.