Getting prior approval for further treatment for allied health providers
You may need to get prior approval from us before we can fund more treatment for your patient. Find out when you’ll need prior approval and how to get it.
On this page
Prior approval for treatment extension requests via ACC32 is paused for specified treatment providers until 30 June 2022. An ACC32 form is only required for changing a diagnosis and medical or sports specialists.
When you need prior approval
If your patient has an injury we cover, you may need to get prior approval from us.
For regulation providers
This includes chiropractic, occupational therapy, osteopathy, physiotherapy, speech therapy and podiatry.
You need to get prior approval from us when:
- the treatment trigger number of 16 has been, or is about to be, reached
- it’s been more than a year since an allied health provider treated your patient for the first time
- you're adding or changing a diagnosis.
Acupuncture providers need to get prior approval from us when:
- the treatment trigger number of 12 has been, or is about to be, reached
- it’s been 12 weeks since the client's first treatment.
For contracted providers
You need to get prior approval from us when:
- the treatment trigger number of 50 has been, or is about to be, reached
- you're adding or changing a diagnosis.
Before requesting prior approval
There needs to be a clear link between your patient’s ongoing condition and the injury we cover.
When you ask for prior approval, you need to tell us:
- the claim number
- the date of the injury
- details of the injury
- what treatment you’ve provided so far.
If your patient is a new referral you can contact us to get this information.
Submitting a request for prior approval
We group requests for prior approval as ‘standard’ or ‘non-standard’. Most are ‘standard’ and follow an easy process.
Criteria for a standard request
Your request will be a standard request if:
- for regulated providers, your request is made within 12 months of the date of the injury or most recent surgery
- it's for an injury we've already covered
- it's the first request for further treatment from your clinic for the claim
- it's for the original diagnosis
- it's for a changed or added diagnosis that’s on the standard read code list.
You don’t need to include medical evidence for standard requests.
Submit a standard request
There are two ways to make a standard request:
Contact us for an immediate decision
You’ll need to let your patient know that we’ve approved further treatment.
Fill in the ACC32 request prior approval form
Complete the patient treatment and provider details sections of the ACC32 request prior approval form.
Complete the ACC32 application form online
Criteria for a non-standard request
If any of the standard criteria aren’t met you’ll need to complete the full prior approval form.
A request is non-standard when:
- for regulation providers, your request has been more than 12 months since the date of your patient’s first treatment
- for contracted providers, you've exceeded the profile of 50 treatments
- the request for treatment includes acupuncture
- it’s not the first request for further treatment from your clinic for the claim after the injury or most recent surgery
- it’s a request for hand splinting that exceeds $304.89 excluding GST
- it's for changing or adding a diagnosis that isn’t on the standard read code list.
Support your request with medical evidence, attaching:
- patient notes and reports
- outcome measures
- patient treatment plan
- any other relevant medical information.
We’ll consider each request on a case-by-case basis and tell you if we’ve approved or declined your request.
Submitting the ACC32 request prior approval form
You can submit the ACC32 request prior approval form through:
- the ACC32 online form
- your HealthLink account
- your practice management system.
Complete the ACC32 application form online
Email acc32@acc.co.nz
After you submit a prior approval form
If you’ve submitted a form, we’ll let you know our decision as soon as possible.
There may be a delay if we need a clinical advisor to assess your request, or we need more information. We’ll let you know if this happens.
When we’ve made our decision we’ll notify you and your patient.
Contact us
If you have any questions, contact us:
Phone 0800 222 070 (Monday to Friday, 8am to 6pm)
Email providerhelp@acc.co.nz