Provider payments

Sector Operations provides a variety of payment-related services for health providers.

Who are providers?

Providers include the following:

  • Individual health care providers, such as nurses, midwifes, occupational therapists, physiotherapists, general practitioners, radiologists, and specialist doctors such as surgeons, obstetricians, gynecologists, and radiologists
  • Provider organisations, such as DHBs, Primary Health Organisations (PHOs), community-based providers, non-governmental organisations (NGOs), medical practices, laboratories, pharmacies, home-care services and hospitals.

What services does Sector Operations provide for providers?

Sector Operations provides the following services for providers:

  • Maintenance and distribution of services catalogues
  • Preparation of payment schedules
  • Maintenance and distribution of entitlements payment schedules
  • Receipt, capture, validation and processing of entitlements, registers, claims and invoices
  • Payment processing
  • Query and request management.

What is practitioner registration and maintenance?

In order to provide and be compensated for certain services, a provider is required to have a valid Annual Practicing Certificate (APC). APCs are provided by professional registration bodies, such as the New Zealand Medical Council, or the New Zealand Nursing Council, and these details are submitted to Sector Operations.

Reference data containing provider and APC status information is submitted to Sector Operations on a regular basis. This information is used to confirm the active registration of health Providers before approving and paying their claims.

Currently, the registration and maintenance functions are performed by Sector Operations’s Agreement Administration team.

What is provider registration and maintenance?

A provider can be either an individual (with a valid APC) or an organisation employing one or more individuals (with valid APCs).

Details of these providers are supplied by the Funder (usually a district health board) wishing to establish an Agreement with the provider. The provider details are captured in the Health Payment Systems.

Provider registrations and agreements are currently established and maintained by the Sector Operations agreements management team on the Funders’ behalf. In the future, Funders may wish to administer their own agreements using online solutions provided by Sector Operations.

What is facility registration and maintenance?

Certain agreements cover services provided at specific facilities, for example, the services provided at an aged care facility. Details about these facilities are captured and maintained to support the creation of payment schedules. These schedules list the patients being cared for at the facility and their services and subsidy entitlements.

Facilities may provide different levels of care for which different tax rates may apply.

What is claims and invoice processing?

Providers, suppliers and health care users submit claims, invoices and refund requests to Sector Operations. For example:

  • Providers claim for health services and medication provided to health care users
  • Suppliers claim for products, generally artificial aids, that have been provided to health care users
  • Members of the public claim for refunds for health related costs, such as travel or accommodation expenses
  • Primary Health Organisations submit patient registers, which form the basis for capitation-based funding calculations.

Sector Operations process registers, claims, invoices and refund requests by:

  • Capturing and validating them against the Providers Agreement or against the health care user’s entitlement, and against the business rules specified for each claim type
  • Generating Buyer Created Tax Invoices or Remittance Advices
  • Making payments on the funder’s behalf.

 How do I apply for a payee number?

Download the application form:

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.

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