Te tuku kerēmeLodging claims

How to lodge, update and manage claims, search for the right read code and about our decision making process.

GP talking with young patient with crutches and caregiver

How to lodge a claim

Video transcript for How to lodge a claim

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Screen shows Chapter 4 How to lodge a claim. Clock shows watch time of 2 minutes 51 seconds.

Screen changes and text displays Emma Clabburn Clinical Advisor.

Emma is sitting in a chair facing the camera. A pot plant, water jug, cup of water and pen and notepad sit in a small table beside her.

Transcript

Emma Clabburn: Lodging a claim is the entry point into the ACC scheme and allows injured New Zealanders to access appropriate support. That’s why it’s important this is done correctly the first time. So, if you’re new to claims and think your patient has an injury we cover, here’s what you need to know about lodging one.

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Screen shows Where can I lodge a claim? Clock shows watch time of 22 seconds.

Screen changes to show Lodge a claim online.

Screen cuts back to Emma in the chair.

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The best and most efficient way to lodge a claim is online using a Practice Management System or our eBusiness Gateway. There’s more information on our website about what you’ll need to get set up, what ACC services your Practice Management vendor may offer, and our online lodgement services which are available for all providers.

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Screen shows How do I lodge a claim? Clock shows watch time of 36 seconds.

Screen changes to show Before you start: 1. Register with ACC. 2. Make sure you can lodge a claim. 3. Check if you patient’s injury is one we cover.

Screen cuts back to Emma in the chair.

Transcript

Before you fill out the claim form, there are a couple of things to get sorted first. If you’re not already, you need to be registered with us. Check you can lodge a claim. Most treatment providers, such as registered health professionals and locums can do it, but there are some exceptions. You will need to be able to identify the accident and the related injury. Finally, make sure you have all the information about your patient, the injury, and the accident ready.

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Screen shows Lodging a claim: 1. Fill out an ACC45 form. 2. Get patient declaration and consent. Clock shows watch time of 26 seconds.

Screen cuts back to Emma in the chair.

Transcript

Once you’ve gathered all the information, you can start by filling out an ACC45 form. Make sure you use the correct Read code, and always get the patient’s declaration and their consent. There’s a specific Read code to match a person’s diagnosis or injury type. These help us make sure the appropriate cover and support is in place. You can find out more about Read codes on our website.

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Screen shows What happens next? Clock shows watch time of 41 seconds.

Screen changes to show Claim accepted. Patient notified. We may contact you about complex claims.

Screen cuts back to Emma in the chair.

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After you’ve lodged a claim, we'll check if it meets cover criteria. Straightforward online claims are automated, and a decision can often be made on the same day. If that’s the case, your patient may receive a text message about our cover decision. The easiest way for you to check the status of the claim is to use your Practice Management System or our online system. For more complex, manual, and non-acute dental claims we’re likely to need a bit more time to make a decision. We'll get in touch with you if we need more information about the claim. So, that’s the essentials of lodging a claim. Now you’re ready do it yourself!

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Screen shows Chapter four How to lodge a claim.

Screen rolls through three statements: Make sure you have everything on hand before you start. Fill out an ACC45 form online. We’ll get in touch if we need more information.

Screen changes to show For more information and resources visit acc.co.nz/health-providers.

Screen changes again to show the ACC logo and tagline He Kaupare. He Manaaki. He Whakaora. Prevention. Care. Recovery.

Understanding claims and cover

When we accept a claim for cover it means there’s been an identifiable accident causing personal injury. Find out more about how we make cover decisions.

Understanding complex cover

Complex cover is when an injury isn't straightforward or if causation isn't immediately clear and we need information to make a decision.

Lodging a claim for a patient

Everything you need know about lodging a claim for your patient. This includes checking the type of claim and the forms you need to provide.

Using the right read code

Find the right read code for your patient’s injury to record on their claim. Each read code has a trigger number telling you how many treatments we’ll pay for.

Using SNOMED Clinical Terms

If you want to use SNOMED enabled software to lodge a claim, your software vendor must register with us to use our APIs.

Updating or changing a claim

You can fix small errors in a claim form after you've submitted it. You can also change the initial diagnosis or add a new one.

Sending patient notes

You can use our secure document transfer form on HealthLink to securely send patient notes through your practice management system (PMS).

Getting a decision on your patient's claim

In most cases, we approve claims without further information. Sometimes we’ll ask for more information or look at evidence before we make our decision.

Lodging occupational noise induced hearing loss claims

Audiologists are now able to lodge claims for occupational noise induced hearing loss (ONIHL). This will mean patients can receive faster access to treatment and result in cost savings.