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• HCP1 Data Reporting Requirements & Process

  An outline of reporting requirements and HCP1 data process.

• Biomodels and Surgical Guides

  Information on Private Health Care Australia's (PHA) recently issued memo which provides an update for Health Funds regarding claims for surgical guides and biomodels on the Prostheses List.

• 2014

  Presentations delivered to AHSA participating funds in 2014.

• 2015

  Presentations delivered to AHSA participating funds in 2015.

• Definitions

  This section contains common medical definitions to assist funds.

• COVID-19 Information

  This section provides information for funds regarding COVID-19 and any developments.

• ECLIPSE

  This section contains information for member funds regarding hospital claiming via Eclipse.

• FAQ by Health Fund Members

  These are questions that are frequently asked by members of health funds.

• For Doctors

  Information on Access Gap Cover, Billing Procedures, Benefits, Participating Funds, Eclipse and Doctors wishing to participate.

• Hospital

  This page contains specification documents that are utilised by funds in the processing of hospital claims.

• Frequently Asked Questions (FAQ's)

  This section has frequently asked questions regarding rehabilitation that AHSA has received from member funds.

• Claims Management

  There are a number of AHSA services available to member funds in relation to hospital claims management and cost minimisation.

• Optical Agreement Information

  This section provides details about the AHSA Optical Agreements.

• Drug Information

  In this section you will find information regarding High Cost Drugs ( A number of Drugs have had their information updated August 2017)

• AHSA Services

  AHSA provides a range of different services to assist member funds with claims management.

• Hospital Contract Return Process

  This section provides information regarding the processes AHSA funds are required to follow regarding returning hospital contracts to AHSA.

• Claims Integrity Service

  Information regarding the Claims Integrity Project being undertaken by AHSA.

• Presentations and Learning Resources

  This page contains PowerPoint presentations and associated notes from presentations/training delivered by AHSA to participating funds.

• Hospital

  This section contains information regarding AHSA hospital contracts and relevant documentation.

• Audit FAQs for Funds

  This section contains the answer to some of the most frequently asked questions that the AHSA receives in relation to hospital auditing.

• FAQ's

  A list of Frequently Asked Questions regarding Prostheses to assist participating funds.

• Contract Information

  AHSA support information to assist in processing of hospital claims. This section includes important certificates and forms, AHSA and industry guidelines, the Business Partnership Agreement (BPA) and other important material.

• Devices and Procedures Information

  Information on the following medical devices and medical procedures has been provided to assist funds.

• Training & Education

  Relevant information and data resources that are available to AHSA Member Funds.

• Change Management

• Data & Technical Group

  The Data & Technical Group provides a forum for funds, software vendors and AHSA to discuss technical and data issues.

• Fund Product Templates

  AHSA funds are required to provide AHSA with details of all hospital products offered to members and advise AHSA of any changes to these products as they occur.

• Helpdesk

  An introduction to AHSA's online Learning Management System (LMS) - Learnbook - with instructions on how to register and access the platform.

• For Funds

  A password protected area which only registered AHSA partcipating fund staff can access.

• AHSA Newsletter

• PHI Reforms - Clinical Categories

  Resources and information for funds in relation to the Clinical Categories and Gold/Silver/Bronze/Basic PHI Reforms.

• Industry Guidance

  This section provides a guide to what it means to be a private patient in a public hospital, a private hospital or day facility as well as designed to provide you with clear information and transparency in your relationship with health funds.

• Data Collection Overview

  An overview of our data collections that we receive from funds.

• Data

  AHSA is responsible for looking after a number of data sets for AHSA participating funds. The data section contains information in the following areas: HCP1, HCP2, AN-SNAP, General Treatment - Dental, Medical Claim Lines, Membership Data & Hospital Claim Lines data.

• Data Warehouse

  AHSA has collected data provided by member funds and supplied it back to funds in the form of data cubes built from the AHSA Data Warehouse. All cubes contain data that is systematically vetted for errors and cubes are structured so that they are both intuitive to use and provide a broad range of reporting capabilities.

• Exclusion/Restriction Schedules

  AHSA has developed schedules with theatre bands that will be added to AHSA EPM contracts. These schedules will allow AHSA member funds to be able to calculate appropriate out of pocket expenses for members who have an exclusion or restriction product.

• Hospital Contract Termination Processes

  This section contains information regarding termination processes and information to assist AHSA funds.

• Podiatric Surgery

  This section covers relevant information on processing surgical podiatric claims.

• Quantity

• AGM & Member Meetings

  This section contains information, dates, minutes etc on AHSA AGM and Members Information Seminars.

• Seven Day Rule

  This section provides the Department of Health's interpretation as to how the 7 day rule for readmissions is calculated.

• Multiple Procedures - Where not all procedures are covered under the policy

  When a member has multiple procedures and not all of them are covered under their hospital product.

• Item SN429 - Smith & Nephew Tape Fixation

  This page provides information on prostheses item SN429. It includes a memo from PHA containing further information and AHSA position and recommendations.

• Medical

  The AHSA negotiates, on behalf of our participating funds, various types of medical arrangements with doctors who perform inpatient services nationally, for the benefit of their members.

• Reference Information

  This contains important and often used AHSA information including AHSA lists, forms & certificates, bulletins, guidelines and commonly used AHSA systems.

• Rehabilitation AN-SNAP Model (RAM) Information Presentations

  This section contains a copy of the Rehabilitation AN-SNAP Model (RAM) Information Session Power Point Presentation which was held for member funds in Sydney and Melbourne.

• Business Partnership Agreement (BPA)

  This section contains a copy of the current hospital Business Partnership Agreement (BPA), along with archived versions back to 2007.

• Fund Product Template

  AHSA funds are required to provide AHSA with details of all hospital products offered to members and advise AHSA of any changes to these products as they occur. This product information supports the Membership dataset.

• Maximum Threshold

• AHSA Medical Devices and Human Tissue List Additional Fields

• Sample Letter Templates

  Funds can edit these letter templates to suit, and write to Doctors about correct charges using the patient co-payment facility for Access Gap Cover.

• Watchman Device

  Information for member funds on the Watchman Device.

• AHSA Lists

  This section contains a number of commonly used lists produced by AHSA - including lists such as the MBS list, Current Agreement list and the Default Benefits list.

• Hospital Substitute Services (H-ST)

  This section provides details about the AHSA Hospital Substitute Agreements.

• Hospital in the Home

  Information regarding Hospital in the Home including a listing of AHSA approved HITH facilities as well as other relevant information.

• Automatic Data eXchange (ADX)

  The Automatic Data eXchange (ADX) is an extension to the Secure Data eXchange (SDX) which allows automation of sending and receiving files to and from AHSA securely via web services.

• Medical Devices and Human Tissue Products

  This section holds important information relating to prostheses on the current Prostheses List.

• AHSA Training Services

  A overview of the training and education program that AHSA provides to funds.

• Corporate

  This section contains documents and information that relate to the AHSA as a business.

• Bailey Nelson Optometrists

• Pharmaceuticals

  This section holds information relating to pharmaceuticals such as the current Exceptional Drug List and High Cost Drug Information.

• Acute Care Certificate Frequently Asked Questions

  Frequently Asked Questions regarding Acute Care Certificates.

• Business Rules

  This section contains copies of the current EPM business rules.

• EPM

  The Equitable Payment Model (EPM) is the AHSA hospital payment model for HPPA's. In this section you will find all relevant information regarding EPM. This section covers such areas as EPM business rules, current EPM hospitals, EPM training documentation and a whole range of other related EPM information.

• Leads Quantity

• Chronic Disease Management (CDM)

  This section provides details about the AHSA CDM Agreements.

• AHSA Guidelines

  This section has guidelines that AHSA have developed for member funds to utilise when assessing claims. The type of guidelines included are; type B & C procedures, special care units and other helpful guidelines.

• Mental Health Reforms - 2018

  Information relating to the 2018 Mental Health Reforms introduced by the Department of Health.

• Approved Rehabilitation Public Hospitals - Victoria & Tasmania

  This section provides funds with a listing of those approved rehabilitation public hospitals for Victoria and Tasmania.

• Non Admitted Prostheses

  This section contains information in relation to AHSA having special arrangements for Cochlear Devices, Speech Processors, Insulin Pumps and Cardiac Remote Monitoring Devices in fitted in a non-admitted settings.

• AGC Provider Warnings and Terminations

  This section contains a spreadsheet with details of any AGC provider who has received a warning or has been terminated from AGC for not abiding by the AGC Terms & Conditions outlined under Clause 12.

• Healthshare

  Healthshare provides a directory which allows members and GPs to access information about which specialists participate in funds medical gap cover schemes.

• Mental Health Information Template

  This section has information about and a copy of the AHSA Health Fund Mental Health Information Template which was developed in September 2020 and came into effect from 1st October 2020.

• Secure Data eXchange (SDX)

  The Secure Data eXchange (SDX) is a system created to send and receive data safely between AHSA and other organisations such as member funds.

• Clinical Topics and Devices

  A collection of clinical terminology originating and collected from various fund queries to AHSA. These terms may be useful for fund's Claims Assessors and are often referred to in AHSA agreements or other AHSA published information.

• WA PHAWA Banding

  This section has historical information on the Private Hospitals Association of WA (PHAWA) theatre band system which is still utilised in a number of AHSA contracts.

• Chemotherapy

  Information on chemotherapy treatment.

• Psychiatric

  This section contains information on mental health to assist AHSA member funds.

• About the EPM Model

  This section contains EPM pesentations regarding the EPM model. AHSA has uploaded this material to assist funds with a better understanding of the EPM model in relation to the underlying model calculations, setting of step-downs, weight derivations and how to analyse and evaluate the effect of the EPM model.

• CWO

  Information on the CWO model and common topics regarding payments.

• Insulin Pump Funding Guidelines

  In this section you can download a copy of the Insulin Pump Funding Guidelines.

• Warranty

• Lead Flag

• Learnbook

  An introduction to AHSA's online Learning Management System (LMS) - Learnbook - with instructions on how to register and access the platform.

• AGC Benefits Review

  This page provides funds with information regarding the Access Gap Cover benefits review.

• 360 Med Care

  This page contains information on Kico 360 Knee

• ASCII and XML Files

  Download important ASCII and XML files including files such as the Notes File, Item Code Changes, MBS to Patient Classification, MBS to Theatre Band and Type B/C procedures.

• Health Industry Organisations

  Industry Bodies and Organisations websites associated with health in Australia.

• Rehabilitation AN-SNAP Model (RAM)

  This sections contains information in relation to the Rehabilitation AN-SNAP Model (RAM).

• Approved Psychiatric Public Hospitals - Victoria & Tasmania

  This section has a list of public hospitals in Victoria & Tasmania which AHSA have approved for psychiatric benefits.

• Bravo Capsule

  Information for member funds about the Bravo Capsule device.

• Lentis Foldable Intraocular Lenses

• Negative Pressure Wound Therapy

  Information for member funds on Negative Pressure Wound Therapy and Suppliers.

• Eyebenefit

  AHSA has an agreement with Eyebenefit Group whereby participating fund member gain a discount for products at a network of ninety independent optical outlets Australia wide.

• Project Huxley & CWO Model

  This section provides information regarding AHSA's new contracting platform - project Huxley

• Advocacy

  National and State based guidelines in consumer rights and privacy.

• Helpdesk

  Claims Submission Guidelines for the AHSA Helpdesk

• Custom Made Prostheses for TMJ (Jaw Joint)

  Information for member funds on custom made Prostheses for the Temporomandible Joint.

• Drug Eluting Balloon Catheter

  Information for member funds regarding the drug eluting balloon catheter used for Angioplasty.

• Medical Devices and Human Tissue List Item Recall

  AHSA has put together a listing of updated information on the recall of Prostheses Items to assist member funds.

• Food Allergen

  This section contains information on Food Allergen to assist member funds.

• Mental Health Telehealth

  Information to assist hospitals and patients/members by giving approval for mental health half day programs or outreach (Psychiatric in the Home) services to now utilise digital telehealth platforms as part of the program where a patient is not able to physically attend a healthcare setting or outreach service (Psychiatric in the Home) as normally contracted due to COVID-19.

• Exceptional Drugs List

  This section provides information regarding the Exceptional Drugs List (EDL).

• Rehabilitation

  This section contains information on rehabilitation to assist AHSA member funds.

• Kirschner Wires (K Wires)

  Information for funds regarding benefits payable for Kirschner Wires.

• Endobarrier

  Information for member funds regarding this technology.

• Cardiac Ablation Surgery

  Information for member funds on Minimally Invasive Cardiac Ablation Surgery (MICS).

• Alcon Product Recall

  TGA Alert regarding Alcon AL042 Cypass Micro-Stent.

• Vertebroplasty

  Information for AHSA member funds on the Vertebroplasty procedure.

• Home Support Service (HSS)

  This section contains information and the current contract in relation to Home Support Service (HSS).

• Hospital Claim Audits

  Details about AHSA's on-site hospital audit service including copies of reports for completed audits.

• Trial of Void

  What is a Trial of Void and how to identify these claims.

• PleurX Catheter & Drainage System

  Information for funds on the PleurX Catheter & Drainage System.

• Ophthalmic Laser

  Information for member funds on the Femtosecond Laser used for Cataract Surgery.

• Da Vinci Robotic System

  This section provides information on the Da Vinci Robotic System.

• Urogynaecological Mesh

  This page contains an update on TGA recommendations in regards to urogynaecological mesh.

• Continuous Glucose Monitoring (CGM)

  Information for member funds on Continuous Glucose Monitoring.

• Bone Graft Substitute Prostheses

  This section contains information on Bone Graft Substitute items.

• Cochlear Speech Processor Replacements

  Information in this section relates to Cochlear Implants and Sound/Speech Processor replacements or upgrades.

• Bone Conduction Speech Processor Replacements

  Information in this section relates to Bone Conduction and Speech Processors.

• Prostheses in Public Hospitals

  This section provides health funds with information in relation to all states and the costs of prostheses in public hospitals.

• VAC Therapy

  AHSA have developed 3 forms to assist funds in assessing requests that may be received for the funding of V.A.C. Therapy.

• Government Departments

  Australian Government Departments and Agencies websites.

• Accu-Chek Solo Micropump

  This section provides information to the funds on the Accu-Chek Solo insulin micropump and the associated funding recommendations.

• Abraxane

  Information regarding the drug Abraxane.

• Neulasta

  Information regarding the drug Neulasta.

• DRG and Coding Information.

  This page includes information regarding the code of ethics for clinical coders.

• Gliolan

  Information regarding the drug Gliolan.

• Cardiac Prostheses _ Perceval Sutureless Valve

  This section contains information in relation to Cardiac Prostheses. The intent is to provide funds with information in relation to new and existing cardiac prostheses for claiming purposes.

• Spinal (Intrathecal) Drug Infusion

  Information for member funds re Intrathecal (Spinal) Drug Infusion.

• Insulin Pumps

  This section contains information relating to the funding of insulin pumps currently listed on the Prostheses List.

• Prostheses Stickers

  This section gives funds an understanding to why Prostheses Stickers are important when assessing Prostheses items and the correct benefits.

• Non Prostheses Medical Devices Item Recall

  This section contains information in relation to Non Prostheses Medical Device Items.

• Laser Sheath

  Information for member funds on Laser Sheath.

• Endoscopic Vessel Harvesting (EVH)

  Information for member funds on this surgical technique.

• Cardiac Resynchronization Therapy

  Information for member funds on this therapy.

• EndoBarrier Liner System

  TGA alerts regarding the EndoBarrier Liner System.

• Transcatheter Aortic Valve Implantation

  This section contains information on Transcatheter Aortic Valve Implantation TAVI - for severe Aortic Stenosis to assist funds.

• Renal Sympathetic Denervation

  Information for funds related to exgratia funding requests for the Catheters used for this Procedure.

• Warranty Information

  This section contains warranty information relating to prostheses currently on the Prostheses List.

• Laser Assisted Peripheral Revascularisation

  Information for member funds on Laser Assisted Peripheral Revascularization for Critical Limb Ischaemia (CLI) / Peripheral Vascular Disease (PAD).

• Non Invasive Ventilation Therapy - CPAP & BiPAP

  This section provides information on Non Invasive Ventilation Therapy (CPAP and BiPAP).

• Peripheral Cutting Balloon

  Information for member funds on this technology for vascular surgery.

• Oncology Maintenance Service - OMS

  This section addresses the issue of hospitals charging inpatient rates for Oncology Maintenance Services.

• Electroconvulsive Therapy (ECT)

  This section contains information on Electroconvulsive Therapy (ECT) to assist funds.

• Keytruda (Pembrolizumab)

  Information regarding the drug Keytruda (Pembrolizumab).

• MBS Changes

  This page provides information on major MBS item changes that will impact Health Funds.

• Micra Leadless Pacemaker

  This section provides information to the funds on the implantation of Micra leadless pacemakers and the associated funding recommendations.

• Voriconazole (Vfend)

  Information regarding the drug Voriconazole (Vfend).

• Meropenem (Merrem)

  Information regarding the drug Meropenem (Merrem).

• Coflex Interlaminar Stabilization

  This section contains information for funds on Coflex Interlaminar Stabilization.

• Balloon Sinuplasty

  Information for member funds about the Balloon Sinuplasty procedure.

• Cardiac Electrophysiology Studies - Mapping & Ablation Procedures

  Information for member funds on EPS procedures.

• Bronchial Thermoplasty

  Information for member funds regarding Bronchial Thermoplasty.

• Newletters

• Obstructive Sleep Apnoea

  Information for funds on Obstructive Sleep Aponea.

• Intravascular Ultrasound (IVUS)

  Information for member funds on Intravascular Ultrasound technology.

• Cardiac Remote Monitoring System

  This section contains information in relation to Remote Monitoring including Funding.

• Deep Brain Stimulation (DBS)

  Information for funds on the procedure and implants for Deep Brain Stimulation (DBS).

• Denver Ascites Shunt

  Information for member funds on the Denver Ascites Shunt.

• Sacral Neuromodulation (SNM)

  Information for member funds regarding Sacral Neuromodulation

• Endo-Surgery Energy Products

  Information for funds on items such as the Harmonic Scalpel, Ligasure and Gyrus.

• MOHs and Shoulder Procedures

  Information regarding the National Procedure Banding Committee recommendations relating to MOHs and Shoulder procedures.

• Xiaflex / Dupuytren

  This section contains information on Dupuytren's contracture and treatment with Xiaflex.

• Endometrial Ablation

  This section contains information on Endometrial Ablation to assist funds.

• Transcranial Magnetic Stimulation (TMS)

  This page provides information regarding Transcranial Magnetic Stimulation (TMS).

• Endovascular Stent Grafts for Abdominal Aortic Aneurysm

  Information provided to assist funds with the reviewing of applications for the funding of custom made and customised endovascular stent grafts.

• Neurostimulation for Chronic Pain

  Information for member funds re Neurostimulation for treatment of Chronic Pain.

• Radiation Therapy for the Treatment of Prostate Cancer-Brachytherapy

  Information for member funds on Brachytherapy.

• Autologous Chondrocyte Implant (ACI)

  This section contains previous Medical Devices Lists distributed by AHSA to member funds.

• Cardiac Ablation Devices - Prostheses Claiming

  Information for funds on payment of Cardiac Ablation Devices

• Insulin Pump

  TGA alerts regarding Insulin Pumps.

• Spinal Surgery with Implants

  Information for funds relating to prostheses implants for spinal surgery.