Hygienist Treatment Claiming (AU)

Practitioners who don't have a provider number can now use a "Claim Practitioner" provider number for Health Fund Claims

Anke Michalik avatar
Written by Anke Michalik
Updated over a week ago

In Australia a provider number is needed to submit claims to a Health Fund. Some practitioners, like Hygienists, don't have provider numbers so the claim must be submitted using another practitioner's provider number. We have simplified the process for these practitioners to submit claims without affecting the amount they are paid.

The Hygienist can now assign a ‘Claim Practitioner’ who’s details will be used for submitting the claim to the health fund. Where the Hygienist has worked with only one practitioner on a treatment plan, then that practitioner (with a valid provider number) will automatically be selected as the 'Claim Practitioner'. Where there are multiple practitioners on a treatment plan, the hygienist can select from a drop down which practitioner will be used as the 'Claim Practitioner'

The Claim provider does not affect which provider will be paid for the treatments nor does it affect which provider has completed and invoiced the treatments.

New Terminology:
Claim Provider: This is the practitioner whose details (first name, last name, provider number) will be used to make the claim with the patient’s health fund. This does not affect or change the practitioner who completed the treatments being claimed or any subsequent payments or discounts allocated to those treatments.

Single Practitioner Treatment
A single practitioner doing work on a treatment with a valid provider number will automatically be assigned as the Claim Practitioner.

Practitioner and Hygienist Treatment
Where a Dentist with a provider number and a Hygienist without a provider number are working on the same treatment plan and both need to be claimed for, then the Dentist's provider number will be used as the 'Claim Provider' . A yellow warning triangle in the Provider Number column for the treatment completed by the Hygienist this indicates the Provider number for this treatment has been set to the Provider Number of the Claim Provider.

Before Claim Provider is allocated:

Claim Provider allocated:

Hygienist Only Treatment

Where only a Hygienist has completed a treatment for a patient and there is no Claim Provider to use, then a drop down in the Claim Provider will display all active providers with a valid provider number for the site

After selecting a claim provider, the provider number is applied to the Hygienist treatment:

The rest of the claim process remains the same.

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