Before your send your first claim, simply complete the Provider Registration Form and email or fax to AHSA, who will distribute the information to all participating AHSA Funds. AHSA will email a letter of confirmation and Summary once your Provider Number has been registered.
FAQs
Below is a number of commonly asked questions that AHSA receive from doctors. This section is designed to assist doctors by answering these questions.
How do I participate in Access Gap Cover?
Can I send a bill directly to my patients?
You cannot give the bill to the patient to take to the Fund. If you choose to use AGC, you will need to submit the unpaid claim to the health Fund on behalf of your patient.
Can I charge the full amount to my patient up-front prior to claiming from the health fund?
No. If you choose to participate in AGC, you can only ask the patient to pay the gap amount up-front, if there is a gap. Only unpaid AGC accounts can be submitted to the health fund. You are still required to put the total charge on the account to the fund (inclusive of any patient co-payment).
Can I charge a co-payment?
AGC enables you to charge your patients a co-payment of up to $500 per episode if you wish to do so. A written Informed Financial Consent must be provided to your patient prior to the surgery or as soon as possible in emergencies. It should be noted that your patient will prefer no gaps.
Please refer to Page 4 of the Billing Guide on ‘What is the maximum patient co-payment?’ and Page 11 – Step 3 (IFC).
Can I charge AMA rates and still use AGC for my patient?
If the gap amount falls within the maximum patient co-payment (allowable known gap), AGC is still applicable. Once the charges are above and beyond the defined known gap limits, Funds are only obliged to pay benefits up to MBS fee. Refer to page 4 of the Billing Guide on “What is the maximum patient co-payment (allowable known gap)? Also refer to clause 3 on page 3 of the AGC Terms and Conditions.
Do I need to complete a separate form if I want to change to be a Known Gap Provider?
No. Once you have registered with AHSA, you can choose between No Gap and Known Gap on a patient by patient basis.
When should I provide written Informed Financial Consent?
When there is a patient gap - you can use the Estimate of Medical Fees Form. It is crucial to the success of the scheme that your patients are correctly informed of their out-of-pocket expenses.
Can I be paid by cheque?
Fund payments are made via Direct Credit only.
How can I update my details?
Please notify AHSA of any changes to your postal address, email or other details in writing via email access@ahsa.com.au or fax 1800 670 898. AHSA will then update all AHSA Funds. You do not need to notify participating Funds individually.
Please be reminded that all correspondence from AHSA will be sent via the email you supplied under ‘Email address for AHSA Correspondence’ on the registration form. It is vital that you update AHSA of changes to your email address with preferably a generic email address (where possible) to enable AHSA updates and confirmation to reach you.
What if I no longer want to participate?
There is an opt-in, opt-out facility for Access Gap Cover, so you do not have to do anything to cease participation. Simply do not use the scheme where you don't want to.
However, if you would prefer to have your details removed from Access Gap Cover altogether, please submit your request in writing to access@ahsa.com.au with your specified Provider Number(s).
How do I know which gap rule applies if my patient is admitted before 1 July 2020 and discharged after 1 July 2020?
If the date of the 1st July 2020 falls part way through your patient’s episode:
• where the earliest medical service date in the episode falls before the 1st July 2020, the former gap rule will apply.
• where the earliest medical service date in the episode falls on or after the 1st July 2020, the new gap rule will apply.
Can a surgeon claim for the assistant on a separate account?
No. The surgeon cannot submit two accounts (using their own provider number) at two different times for the same episode. The rule states ‘Each medical provider must submit one claim only………’ (Refer 3rd bullet point on Page 4 of the Billing Guide)
If the surgeon wants to claim on behalf of the assistant, it must be on the same account as their own services for the same episode.
Also refer to Page 16 of the Billing Guide ‘What rules apply for assistance at operations?’
For further assistance, please contact the Medical Agreements Team.
Email: access@ahsa.com.au (Preferred)
Phone: 1800 664 277 (option 1)
Fax: 1800 670 898