Prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services ensures workers can remain focused on their recovery and helps to maintain the integrity of the system.
Principle
Workers and providers will receive prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services.
Expectations
Benchmarks
S10.1
As soon as practicable after receipt of relevant documentation, insurers are to pay invoices that meet SIRA’s standard invoicing requirements for treatment that has been pre-approved or does not require pre-approval.
Payment no later than 10 working days from receipt of a valid invoice for approved treatment, or within a provider's terms, whichever is the later
S10.2
Insurers are to review service provider invoices before payment and ensure:
rates and items billed align with approvals
rates do not exceed the maximum amount prescribed by any relevant workers compensation fees orders, and
invoices contain all relevant information, including application of GST where appropriate.
Demonstrated in payment approval procedure (in Injury Management Program)
S10.3
Where there is likely to be a delay in payment of an invoice, for example in the case of illegible invoices or invoices submitted more than 12 months after treatment, insurers are to advise the relevant party of the reasons for delay and the anticipated resolution time.
Advice to relevant party within 10 working days of receipt of invoice
S10.4
Insurers are to reimburse workers for expenses that do not require pre-approval or for which pre-approval has been obtained as soon as practicable after receipt of relevant documentation.
Payment no later than 10 working days from receipt of relevant documentation
S10.5
Insurers are to advise the worker of the reasons for any delayed reimbursement and the anticipated time to resolution. For example, in the case of receipts submitted more than 12 months after the expense was incurred or where insufficient evidence was provided.
Advice to the worker within 10 working days of receipt of relevant documentation
Prompt payment of invoices and reimbursements for medical, hospital and rehabilitation services ensures workers can remain focused on their recovery and helps to maintain the integrity of the system.
In accordance with workers compensation legalisation, insurers are to pay invoices and reimbursements for medical, hospital and rehabilitation services promptly.
NSW workers compensation legislation requires the prompt payment of compensation following the acceptance of liability for the service.
The timely payment of invoices and reimbursements on all claims supports worker recovery through the development of trust and respect among treatment providers and other stakeholders.
Non-payment of an invoice can be detrimental to the insurer-health practitioner relationship, negatively impacting worker recovery.
