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Allied health treatment request

All allied health practitioners requesting approval to provide treatment are expected to complete this form and submit it to the insurer.

From June 2024, the Allied health treatment request (AHTR) replaces the previous Allied health recovery request.

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Background

SIRA, in consultation with scheme users, has developed a new approach to approve treatment requests from allied health practitioners. This work aligns to SIRA’s value-based approach to transform the delivery of health care in the NSW Workers Compensation and Compulsory Third Party (CTP) schemes (personal injury schemes).

Allied health practitioners delivering services in the NSW personal injury schemes are encouraged to complete the Allied health treatment request (AHTR) to request approval for treatment from the insurer managing a person’s claim.

The AHTR aims to:

  • improve the information provided to insurer case managers to guide treatment decisions
  • promote risk screening and collaboration to manage barriers to recovery
  • establish clear person-centred goals for treatment, focused on function and participation
  • use standardised outcome measures to demonstrate effectiveness of treatment
  • contribute valuable information about what the person can do now to assist in planning for recovery at work and usual activities.

Watch the video below for more information.

What is an Allied health treatment request?

An AHTR is used to request approval from the insurer managing a person’s claim before treatment and services are delivered. It outlines a person’s current clinical presentation, progress and barriers to recovery. It is an important communication tool for allied health practitioners to demonstrate they are adopting the principles of the Clinical Framework for the Delivery of Health Services (Clinical Framework) when treating people injured in workplaces and on the road.

The Clinical Framework sets out principles all health providers are expected to use when delivering services in the NSW personal injury schemes.

Who needs to complete the Allied health treatment request?

SIRA encourages all allied health practitioners delivering services in the NSW personal injury schemes to use the AHTR.

Using the AHTR is:

  • mandatory for SIRA approved allied health practitioners because it is a condition of approval to deliver services in the NSW workers compensation scheme
  • optional for non SIRA approved allied health practitioners
  • optional for practitioners requesting approval of treatment for people with a severe injury or an exempt worker.

When should I complete an Allied health treatment request?

Requirements vary based on the scheme you are working in and the time after injury (Table 1).

Contact the insurer managing a person’s claim if you are unsure if approval is required before delivering services.

Table 1: When to complete an Allied health treatment request

Workers compensation scheme Motor crash scheme

SIRA approved allied health practitioners:

In most cases, where treatment commences within the first 3 months from date of injury, complete an AHTR if more than 8 consultations are required. If treatment commences more than 3 months after the date of injury, complete an AHTR after your first consultation. See Table 4.1 and 4.2 in the Workers Compensation Guidelines for information about treatments available without pre-approval of the insurer.

Non SIRA approved allied health practitioners:

Complete an AHTR after your first consultation with a person with a claim, regardless of when treatment commences.

All allied health practitioners:

Complete an AHTR after your first consultation with the person with a claim (other than early intervention treatments).

How do I submit a request?

Submit the AHTR and any additional attachments to the insurer managing a person’s claim.

Check with the insurer on the best way to submit the form to them as this may vary from insurer to insurer.

For example, you may be required to send an AHTR to an insurer case manager or to a generic inbox designated for this type of request.

The new AHTR form

The Allied health treatment request (AHTR) is available as an interactive form which is designed to be accessible and completed using a PDF (portable document format) reader such as Adobe Acrobat.

Allied health treatment request form

Guidance on how to complete the form can be found below.

Please be aware:

Adding text to interactive (fillable) PDFs is limited by the size of the text fields provided, and one example of why they are best viewed and completed using a PDF reader.

For the AHTR, a scroll function will be activated in a text field if you input text beyond the visible text field size. Therefore, if you print an AHTR form that was completed using a PDF reader, you will not be able to see the full text input.

How to complete the AHTR

For information on how to complete the AHTR, please see the completed examples and explanatory notes below.

Completed examples

SIRA has collaborated with allied health practitioners to develop the following completed examples of the form. These can help if you are unsure about the type of information or level of detail required in the AHTR.

Explanatory notes

These explanatory notes:

  • provide guidance for allied health practitioners who deliver services in the NSW workers compensation and CTP schemes (personal injury schemes) on completing the Allied health treatment request (AHTR)
  • explain the purpose and requirements of each section of the AHTR.

How do I fill in the request?

You are expected to complete an AHTR in partnership with the person with a claim by developing recovery goals together.
You remain responsible for:

  • completing an AHTR and submitting it to the insurer managing a person’s claim
  • making sure the information provided on an AHTR is accurate.

If you intend on sharing personal information that is not directly related to the compensable injury or illness, make sure you obtain informed consent.

Date services first commenced

Document the date services were initially delivered by your practice (whether by you or another allied health practitioner working in the same practice) to a person with a claim.

Total number of consultations to date

Document the total number of consultations delivered by your practice (whether by you or another allied health practitioner working in the same practice) to a person with a claim.

Section 1: Details of person with an injury

Document details of the person with an injury, including their occupation before the injury occurred, claim number and the date that the injury or accident occurred.

Section 2: Your clinical assessment

Compensable injury or illness

Document your diagnosis of the compensable injury or illness based on your assessment of the person on the day you complete the form.
If diagnosis is not within your scope of practice, document the compensable injury or illness specified in the referral to you or on the Certificate of Capacity/Certificate of Fitness.

For example, carpal tunnel syndrome, adjustment disorder with depressed mood, anxiety, neck pain.
Where relevant, specify the anatomical site involved. If your working diagnosis differs from the certifying doctor’s diagnosis, contact the doctor to clarify the diagnosis and appropriate management.

Current clinical signs and symptoms

Document signs and symptoms of the compensable injury or illness. For example:

  • Physical injuries may manifest as limited range of motion or reduced grip strength.
  • Psychological injuries may be more contextual, such as reduced concentration in the afternoon, difficulties falling asleep most nights or withdrawal from usual social and recreational activities.

Risk screening

Completing this section aligns to Principle 2 – Adopt a biopsychosocial approach in the Clinical Framework.

Identifying risk factors or conditions across the biological, psychological and social domains as early as possible during the assessment phase is essential because it informs and guides your treatment.

You should:

  • Ask the person with a claim to complete a validated risk screening tool if they have not already completed one within 4 to 6 weeks of the initial consultation.
  • Use a screening tool relevant to the person’s clinical presentation. You may also wish to use the flags model in the Clinical Framework.
  • Document the name of the risk screening tool used, most recent date administered and the score.
  • Share the results (with the person’s consent) with the insurer and other relevant scheme participants supporting the person’s recovery.

Pre-existing conditions

Document details of any pre-existing conditions identified during your assessment that may adversely impact the person’s recovery from the compensable injury or illness.

This may include relevant previous or current physiological injury(ies) or illness(es) and psychological injuries such as complex traumatic experience, emotional and mental health distress and personality vulnerabilities.

Capacity

Completing this section aligns to Principle 1 – Measure and demonstrate the effectiveness of treatment in the Clinical Framework.

Document information about the person’s capacity to perform certain activities relative to the injury(ies) or illness(es). Include their occupation if employed at the time the injury(ies) or illness(es) occurred. Under ‘Pre-injury capacity’, describe what the person could do prior to sustaining the injury or illness. Under ‘Current capacity’, describe what the person can do now (on the day of your most recent assessment).

Examples are provided in Table 2 and Table 3.

Table 2: Physical example – neck injury

Activity Pre-injury capacity
Describe what the person did before the injury(ies) related to this claim
Current capacity
Describe what the person can do now

Work:

Occupation, tasks, days or hours worked

  • Night filler at supermarket
  • Working part time – 16 hours (4 hours x 4 days per week)
  • Lifts 2 kg overhead
  • Lifts 5 kg from floor to shoulder height
  • Lifts 20 kg from floor to waist
  • Carries 10 kg occasionally
  • Push/pull up to 100 kg
    Sweeps floors for up to 30 minutes
  • Night filler at supermarket
  • Pre-injury hours
  • No overhead work
  • Lifts 2 kg from floor to shoulder height
  • Lifts 8 kg from floor to waist
  • Carries 8 kg occasionally
  • Push/pull up to 20 kg
    Sweeps floors for up to 10 minutes

Usual activities:

Activities of daily living, driving, transport, leisure

  • Plays social tennis for 2.5 hours per week
  • Pushes lawn mower for up to 2 hours
  • Empties full grass catcher – 10 kg
    Gardens for up to 2 hours prunes tall plants
  • Unable to play tennis
  • Pushes lawn mower for maximum 20 minutes
  • Empties half full grass catcher – 5 kg
  • Gardens for maximum 10 minutes continuously, then requires 10-minute break
  • No pruning above shoulder height

Table 3: Psychological example – depression

Activity Pre-injury capacity
Describe what the person did before the injury(ies) related to this claim
Current capacity
Describe what the person can do now

Work:

Occupation, tasks, days or hours worked

  • Team leader, managing 10 staff
  • Worked full time – 40 hours per week
  • Ability to concentrate up to 2 hours without a break
  • Advanced interpersonal and communication skills
  • Responsible for complex decision making for themselves and to assist their staff
  • Acting in project manager role with no staff supervision responsibilities
  • Working 16 hours per week (4 hours x 4 days per week)
  • Concentration limited to 15 minutes
  • Challenges in managing difficult interpersonal interactions or complex decision making

Usual activities:

Activities of daily living, driving, transport, leisure

  • Primary carer for 3 school age children
  • Ability to concentrate in evening to assist children with homework
  • Usually remained calm and patient with children
  • Continuous sleep around 7 hours or more per night
  • Physically active and attended a yoga class once a week
  • Too fatigued to assist with homework (partner undertaking this task)
  • Limited patience and snappy with children some days of the week
  • Continuous difficulties falling asleep
  • Sleeping less than 4 hours per night
  • Lack of interest or motivation to exercise or attend weekly yoga class

Standardised outcome measures

Completing this section aligns to Principle 1 – Measure and demonstrate the effectiveness of treatment in the Clinical Framework.

Standardised outcome measures (SOMs) are tools that assess a person’s current and future health status. You can also use them to demonstrate effectiveness of treatment and justify treatment requests.

Choose at least one outcome measure that is reliable, valid, sensitive to change and relates to the:

  • person’s injury, for example, the Neck Disability Index or the Depression Anxiety and Stress Scale
  • functional goals of your treatment
  • functional demands of the person’s work and/or usual activities before the injury(ies) or illness(es).

Note: Documenting range of motion alone is not a SOM.

The AHTR has three columns to record SOM scores:

  • Initial score – record the date and score of the first SOM completed.
  • Previous score – record the date and score of the SOM on the previous AHTR. If this is the first AHTR submitted for a person, write ‘N/A’ (not applicable) in this column.
  • Current score – record the date and score of the latest SOM completed.

Interpretation of score(s)

Document a brief explanation of the score(s) to help the insurer understand what the scores mean for the person’s progress toward treatment goals and return to work or usual activity.

SIRA does not mandate the use of any particular SOM. Use your clinical judgement when selecting a SOM appropriate to a person’s clinical presentation.

When using the Consultation C item code, SIRA approved allied health practitioners are expected to use two or more SOMs or evidence-based risk screening tools relevant to the person’s clinical presentation. This clinically justifies why higher intensity or an increased level of specialty treatment is required.

The use of SOMs is a critical component of value-based health care and helps the person with a claim and the allied health practitioner monitor progress towards recovery together.

A range of SOMs are available on our website:

Section 3: Barriers to recovery and strategies to address

Completing this section aligns to Principle 2 – Adopt a biopsychosocial approach in the Clinical Framework.

Barriers to recovery

Use the information from your assessment and risk screening to identify potential barriers to recovery. This may be done using the flags model in the Clinical Framework or via comprehensive history taking.

Barriers may include physical, psychological, social and/or other factors or conditions such as:

  • non-compliance with self-management or treatment
  • current medication regime
  • lack of support at work
  • social isolation
  • negative impact of concurrent non-compensable health concerns
  • distress with claims dispute process.

Strategies

Apply appropriate strategies to address issues and/or barriers identified. This may include:

  • Tailoring your treatment approach to address the barriers. You can do this by talking to the person with a claim, treating doctor or other health providers in the treating team.
  • Recommending ways the insurer can assist. You can do this by recommending a referral to other services such as a workplace rehabilitation provider.

Would you like any of the following assistance?

You can request the insurer to:

  • contact you to discuss issues relevant to the person’s recovery or to request further assistance such as referring the person to a workplace rehabilitation provider
  • arrange a case conference with some or all members of the support team (the person, insurer, nominated treating doctor, employer, workplace rehabilitation provider and other treating providers) to discuss treatment or any barriers that are limiting recovery
  • arrange a referral to an independent consultant to seek guidance on how to overcome barriers and progress the person’s recovery.

For workers compensation scheme:

  • A list of independent consultants is available on the our website.

For motor crash scheme:

  • Insurers may refer you to an independent consultant listed on the our website or another expert.

Section 4: Treatment plan

Have previous goals been achieved?

Select if the goals on the previous AHTR (if applicable) have been achieved.

If the goals have not been fully achieved, document the reason(s) for this in Section 3: Barriers to recovery to help the insurer understand why there are delays to recovery.

Person with an injury's goals

Completing this section aligns to Principle 4 – Implement goals focused on optimising function, participation and return to work in the Clinical Framework.

You are expected to develop recovery goals in partnership with the person with a claim.

To achieve this, you should:

  • Undertake early and collaborative goal setting with the person to ensure you are focused on common objectives to achieve recovery. Collaborative goal setting also empowers the person to manage their own recovery.
  • Focus on measurable improvements in function and participation at work, home and in the community. If the person was working at the time they sustained the injury, document a work goal.
  • Make the goals specific, measurable, achievable, relevant and timed (SMART). Estimate timeframes for the person to achieve their goals. For example:
    • To return to my usual job as a retail assistant by 4 August.
    • To drive for an hour to my parent’s home by 6 July.
    • To return to training my child’s soccer team by 3 October.
    • To hang a load of washing on the line by 5 February.
    • To improve my concentration by reading the newspaper for 20 minutes per day by 12 April.
    • To meet up with friends once a fortnight for coffee by 3 March.

Person with an injury’s self-management

Completing this section aligns to Principle 3 – Empower the injured person to manage their injury in the Clinical Framework.

Empowering the person to self-manage their injury is a key treatment strategy and essential to recovery.

You should:

  • Encourage the person with an injury to use strategies to control their symptoms and learn to function despite their symptoms. For example, perform a home exercise program, activity scheduling, pacing, establishing a sleep routine and healthy down-regulation strategies.
  • Increase active strategies that support self-management as recovery progresses and decrease passive strategies.

Your intervention

Completing this section aligns to Principle 5 – Base treatment on the best available research evidence in the Clinical Framework.

Your intervention (treatment) should be based on the best available research evidence and the goals you develop in partnership with the person. Therefore, you are expected to document:

  • the treatment you intend to use to achieve the person’s work, activity or participation goals
  • the rationale for each treatment requested to help the insurer managing a person’s claim make a decision about approving or declining the treatment
  • the number of additional sessions anticipated before discharge
  • the anticipated discharge date.

Section 5: Services requested

Completing this section aligns to Principle 5 – Base treatment on the best available research evidence in the Clinical Framework.

The services requested should reflect the treatment documented in Section 4: Your intervention. Therefore, you are expected to document:

  • the type of service
  • the number of consultations or additional sessions anticipated (this is tailored to the person’s needs)
  • the frequency or timeframes to deliver the requested services
  • how the requested services will be delivered (in person or telehealth).

Submit an AHTR to the insurer managing a person’s claim with ample time before the requested treatment is proposed to commence. This provides the insurer sufficient time to review and decide to approve or decline the request.

Section 6: Your details

Before submitting an AHTR to the insurer managing a person’s claim, make sure you:

  • Provide your Australian Health Practitioner Registration Agency (Ahpra) number (for all health professions registered under Ahpra) or peak association membership number (if your health profession is not registered under Ahpra).
  • Provide your SIRA approval number (if you are a SIRA approved physiotherapist, chiropractor, osteopath, psychologist, counsellor or accredited exercise physiologist delivering services in the NSW workers compensation scheme).
  • Provide an individual email address and practice email address where you propose to deliver services.
  • Sign the form (must be the allied health practitioner who completed the AHTR in partnership with the person with a claim and will be delivering the services outlined in the AHTR). You create your digital signature by selecting the signature box on the AHTR.

Section 7: Insurer decision

Insurers will use the information you provide in the AHTR to approve or decline treatment. They may seek advice from their clinical advisor or an independent consultant as part of the treatment approval process.

Insurers may also refer the treatment request to an independent consultant.

The insurer managing a person’s claim will:

  • send their decision to approve or decline treatment in writing to the person with a claim
  • outline any reasons for declining services or approving some services only.

The insurer managing a person’s claim may also request more information from you to assist their decision making. Even when they request more information from you, they are expected to make a decision within the timeframes set out in the laws underpinning both schemes.

For the workers compensation scheme:

  • A response must be provided within 5 working days after receiving a treatment request, otherwise it is automatically approved, in the following circumstance:
    • a SIRA approved allied health practitioner requests treatment within 3 months of the injury or illness (physical or psychological) and
    • the injury or illness (physical or psychological) has not been treated previously by an allied health practitioner from the same health professional group as the requesting allied health practitioner.
  • A decision must be made within 21 days (if pre-approval is required) after receiving all other treatment requests.

For the motor crash scheme:

  • A decision must be made within 10 days after receiving a treatment request.

SIRA monitors the timeframes in which insurers make their decision to approve or decline treatment. SIRA takes regulatory action on insurers who do not meet their legal obligations in responding to treatment requests in a timely manner.

Frequently asked questions

Please see the answers to common questions about the AHTR below.

How can I download and print the AHTR?

When you click on the link to the new AHTR, the form will open in your browser by default.

To download the PDF from your browser:

  • Use the top navigation bar to click on the download icon near the top right-hand side of the browser window.
  • When prompted, save the PDF file to a location on your device. Print the form if needed.

Allied health treatment request in a Chrome browser window

Example: Google Chrome browser

Why don't the PDF fields expand to show full contents when printing?

Because the AHTR is an interactive form, a scroll function will be activated in a text field if you include more text than the visible text field size. As a result, if you print an AHTR form that has more text than the visible field, you will not be able to see the full text input in the printout.

Check with the insurer about the best way to submit the form and any additional information or attachments you might need to include.

Are the risk screening tools and standard outcome measures (SOMs) mentioned on the form compulsory?

SIRA does not mandate the use of a particular screening tool or outcome measure. Health providers should use their clinical judgement to decide which one is most relevant based on a person's clinical presentation.

The risk screening tools and standardised outcome measures provided in section 2 of the AHTR form are common examples only and not a specific list. More information and a list of common SOMs can be found on SIRAs Standardised outcome measures page.

At least one SOM that is relevant to the person with an injury should be included on the AHTR to support evidence-based decisions and care. Please also see the completed examples above.

What is the difference between a risk screening tool and standardised outcome measures?

Screening tools and standardised outcome measures (SOMs) are ways of determining a person’s health status in the workers compensation and motor crash schemes and may be labelled differently depending on the type of injury and the person’s clinical presentation.

Risk screening tools (such as the Keele StarT Back screening tool and Short form Orebro Musculoskeletal Pain Screening Questionnaire) are used for early intervention to help diagnose and predict long-term disability, prevention from returning to work, and help to match patients to appropriate treatment.

SOMs are used to evaluate the effectiveness of treatment over time, measure changes as a result of specific intervention or treatment, and can be used periodically before, during and after treatment to monitor outcomes.

Is there a specific tool or approach when formulating SMART goals?

The treatment plan in section 4 of the AHTR should outline clear goals for treatment and recovery. These goals should be SMART: specific, measurable, achievable, relevant and timed.

More information and examples of SMART goals are provided under principle 4 of the Clinical Framework for the Delivery of Health Services.

How do I use the digital signature function of the AHTR?

The AHTR can be signed electronically using Adobe Acrobat. Please see information and technical instructions provided in the links below:

How to sign a PDF

  1. Open the PDF document and select E-Sign from the global bar. Alternatively, you can also select Fill & Sign from the All tools menu.
  2. Create your signature and initials if not already done. To do so:
    1. From the Quick actions toolbar, select Add your signature or initials .
    2. To add a signature, select Add signature. In the dialog that appears, type or draw your signature and then select Done.
    3. To add your initials, select Add initials. In the dialog that appears, type or draw your initials and then select Done.
  3. From the Sign panel, select your signature, move over to the field where you want to add it, and then select to place the signature.

Or, from the Quick actions toolbar, select Add your signature or initials and then select your signature.

For more information on filling your form, see Fill and sign PDF forms.

How do I flatten a PDF to preserve its contents?

Flattening a PDF combines all its contents into a single layer, effectively transforming it into a non-interactive document that can't be edited or modified in any way after export. Flattening is commonly used to preserve a document’s layout and prevent alterations to its content.

Always save a copy of the original PDF before flattening. Once flattened, the document can no longer be edited.

Please see the Adobe online resource ‘How to flatten a PDF: a step-by-step guide.’

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