Standard 15 - approval and payment of medical, hospital and rehabilitation services
Prompt approval and payment for medical, hospital and rehabilitation services ensures workers can remain focused on their recovery and helps to maintain the integrity of the scheme.
Approval and payment of medical, hospital and rehabilitation services
Principle: Prompt consideration will be given to approving medical, hospital and rehabilitation services and payment will be made as soon as practicable after services are invoiced.
Exemptions | Benchmarks | |
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S15.1 |
Before making a decision about approval for services, insurers must determine:
| Evidence on claim file. |
S15.2 | When approving services from workplace rehabilitation providers, insurers must ensure that services are consistent with the Nationally Consistent Approval Framework for workplace rehabilitation providers and the NSW Supplement. | Evidence on claim file. |
S15.3 |
Insurers must review service provider invoices prior to payment and ensure:
| Evidence on claim file. |