GN 4.3 Invoices and reimbursements

Published: 12 August 2019
Last edited: 12 August 2019

Application: This guidance applies to exempt workers

Overview

Prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services ensures workers can remain focused on their recovery.

This guidance provides useful information for insurers regarding the payment of invoices and reimbursements as part of claims management.

S10. Payment of invoices and reimbursements
Principle
Workers and providers will receive prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services.

Payment of invoices

Invoicing requirements

To make payment, the insurer should ensure the invoice includes the following information:

  • worker’s first and last name
  • worker’s claim number
  • date of service
  • date of invoice (must be on the day of, or after the last day of service listed on the invoice)
  • SIRA payment classification number or AMA item number, where applicable
  • cost for each SIRA payment classification number or AMA item number, and duration (where applicable)
  • payee details
  • ABN
  • name of the medical practitioner or service provider who provided the service
  • SIRA approval number or medical practitioner’s Health Insurance Commission number (where applicable).

Questions regarding invoices can often be resolved quickly with a telephone call to the provider. If telephone contact is unsuccessful, then an email or letter should be sent to request clarification of the issue.

Insurers should always attempt to resolve an issue rather than not pay an invoice. Non-payment of an invoice can be detrimental to the relationship between the insurer and service provider and may negatively impact the worker’s recovery.

Note: A worker is not liable to pay, and a person is not entitled to recover from a worker, any amount in respect of medical or other treatment provided as a result of an injury, to the extent that the amount exceeds the applicable maximum fixed by the Authority - see section 60A of the Workers Compensation Act 1987.

Payment of reimbursements

Questions regarding reimbursements can also be addressed (and potentially resolved) with a telephone call to the worker.

Insurers should always attempt to resolve an issue rather than not pay a reimbursement to a worker. If telephone contact is unsuccessful, then an email or letter should be sent seeking clarification.

Insurers should proactively seek reimbursements when they know they are accruing. For example, if a worker regularly claims for travel to attend treatment and the insurer is aware that there are claims pending.

Proactively reminding a worker to submit reimbursements and establishing a regular timeframe for the lodgement of these claims can benefit both the worker and the insurer.

See also Standard of practice S.10 Payment of invoices and reimbursements.

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