A laboratory payment is where a patient is referred by a medical practitioner, oral surgeon, cervical smear taker, approved nurse or midwife for a laboratory test.
The laboratory then carries out the tests required and provides the referring practitioner with the results. The results are then passed on to the patient.
To receive payment for the test, the laboratory submits a claim file and/or invoice to Sector Operations which Sector Operations processes on behalf of the funding district health board.
What is a Schedule Test Purchase List?
A Schedule Test Purchase List is included in your contract with the funding district health board(s) and includes the following information.
|Test Code||An identification code for each individual pathology test. Format is either 1 alpha, 2 numeric eg, S01 or 2 alpha, 1 numeric eg, BA1.|
|Test Description||The full written description for each individual pathology test.|
|Price Per Test||The price (GST exclusive) that the funding district health board will pay the laboratory to carry out one completed testing procedure for a specified test.|
|Maximum Number||The maximum number of a specified pathology test that the funding district health board will pay the laboratory to carry out for any individual patients on any individual sample.|
|Approved Practitioner Type||This specifies which type of practitioner can refer a patient for each individual test. Referring practitioners can either be medical practitioners, oral surgeons, cervical smear takers, midwives or nurses.|
How much can I claim?
Each laboratory will receive a different amount for each of the tests that they are eligible to claim for. This is due to their being no national laboratory contract. Therefore, each district health board can contract with their laboratory service provider(s) as they please. The amount that the laboratory will receive per test is contained within the Schedule Test Purchase List.
How do I claim?
How you claim depends on the funding arrangement that is in place between the laboratory and district health board(s). There are two funding arrangements.
- Fee For Service (FFS)
- Bulk Funding
Fee for service
This arrangement means that you are paid for each individual test providing that each test meets the claiming criteria. Any test that does not meet the criteria is rejected. A claim file and an accompanying Claim Summary Form is required to be sent to Sector Operations Wellington. The claim file can be submitted on floppy diskette or on CD-ROM (providing that the funding district health board has given you authorisation to do so).
This arrangement means that you receive a set Service Fee on a monthly basis instead of being paid on a test by test basis. An invoice must be sent to Sector Operations Dunedin each month. In addition, a claim file and accompanying Claim Summary Form is also required to be sent to Sector Operations Wellington so that the claim data can be included in the national data collection.
Where should I send my claims?
All claim files must be accompanied by a Claim Summary Form and sent to:
PO Box 1026
I have run out of claim forms, where can I get some more?
Alternatively an electronic copy is available in the downloads section.
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.