All District Health Boards 22 June 2018
Dear PHO Chief Executive Officers Zostavax Additional Payment: Notice of How to Claim On 1 June 2018, you were advised that PSAAP agreed an additional payment of $15.00 (GST exclusive) will be paid to general practices if Zostavax and Influenza vaccines have been given to the same patient during the same consultation. This is effective from 4 June 2018. It is agreed that for the 2018 season Zostavax additional payments will be claimed through PHOs, by way of invoice to their DHB. In the case where a PHO crosses DHB boundaries the invoice is to be addressed to the lead DHB. PHOs are required to send their DHB a list of NHI numbers and the date the vaccine was given. PHOs can then send monthly invoices to the Ministry of Health to process for payment on behalf of the DHB. Invoicing requirements are attached as an Appendix to this letter. The parameters of the additional payment applicable from 4 June are: Patients aged between 65 and 80 at time of vaccination; With a code of “ZOSTR”; and Given a Zostavax vaccination on the same day as the Influenza vaccine. Some PMS providers have developed queries to support practices to extract this information. For PHOs that use IQE or Analytique, please contact Datacraft Analytics who will supply query logic that can be adapted to identify these claims appropriately for your practices. We recommend that PHOs inform their practices on how this will be implemented locally. Zostavax and Influenza vaccine claiming and payment issue As also advised on 1 June 2018 there was an issue with the claiming and payment process, where double payments were made in error when Zostavax and Influenza vaccines had been given to the same patient during the same consultation. DHBs have agreed that double payments already made will not be recovered. Following feedback from practices, PHOs and DHBs are currently discussing how we can fairly compensate practices that acted in good faith by ‘unticking’ the Zostavax claim box and might otherwise have received these double payments.
All District Health Boards PO Box 23075 Wellington 6140
04 801 2430
2019 Influenza season The Ministry of Health will work with PMS vendors to ensure that the dual Influenza and Zostavax payments will become part of standard claiming processes from the 2019 Influenza season.
Yours sincerely
Dr Nick Chamberlain Chief Executive, Northland District Health Board Lead District Health Board Chief Executive for Primary Care cc:
General Managers Planning and Funding, All DHBs Primary Care Portfolio Managers, All DHBs
Appendix 1: Invoicing Requirements Purchase Unit (PU ID) PHOI0003 Immunisation
Unit Price excl. GST $15.00
GST Rate (%)
Payment Type
15
CMS
PAYMENT DETAILS Price The price we will pay for the Service you provide is specified above. Note that all prices are exclusive of GST. Invoicing We will pay you on the 20th of each month for the services you provide in each invoice period so long as we receive a valid GST tax invoice form you. The invoice must meet all legal requirements and must contain the following information: a. b. c. d. e. f. g. h. i. j. k. l.
provider name (legal entity name) provider number (legal entity number) provider invoice number contract number purchase unit number or a description of the service being provided date the invoice is due to be paid/date payment expected dollar amount to be paid period the service was provided volume, if applicable GST rate GST number full name of funder
Invoicing Address Send invoices to: providerinvoices@moh.govt.nz or post to: Provider Payments Ministry of Health Private Bag 1942 Dunedin 9054