Medical Claims - Supplier Information
Submitting a claim online
To submit a claim online, clients must provide the following for assessment:
GP referral letter to specialist or scan request referral form (e.g.x-ray, ultrasound)
If after seeing the Specialist they have been recommended for further investigations such as scans (MRI, CT scan etc), insurer will need the following for approval:
Specialist consultation letter as it details diagnosis and plan (investigation or treatment). Booking confirmation and estimate cost is NOT sufficient for assessment as it contains no medical information and/or
MRI, CT Scan referral
If it is a Cancer claim please get in touch with us and we will look after the medical claim
For on-going claims for the same condition, an approval is not required for follow up consultations – if the initial consultation was approved. Insurer might ask for an updated specialist letter to process the payment. This is to confirm if it is still medical necessary the client returned for consultation.
The timeframe is between 6-12 months depending on the provider therefore, it is good to have the latest letter when submitting the invoice. This will allow provider to process without requesting further information.
We are happy to answer questions but please have the following details if you have question. This will enable us to provide an accurate answer.
Checking for coverage
What is the condition they are wanting to claim on? Are they claiming surgical or something else?
If the clients want to know if a treatment is covered, please provide condition the treatment is for and name of drug of known.
Checking for payment (Client wanting us to follow up)
Claim/ Policy number
Date of invoice/receipts submitted
Amount of invoice/Receipts
Note: The insurer will ask these questions if we call to follow up/query. Common questions from clients as an example…
Wisdom teeth removal (unerupted and/or impacted) – Covered unless it is in the exclusions. Root Canal is not covered.
Standalone Psychatrist/Psychologist consultations, ADHD assessment, – not covered as under general exclusion for Mental Health.
Skin Doctors – There has been an increase in clients having consultations with “specialists.”
Please remind clients to seek prior approval for this as some of doctors are not considered as a “Specialist” under their medical policy wording.
Providers Claims details
Partners Life
0800 145 433
Monday to Friday 8.30am to 5pmFor on-going claims, please send the request to claims@partnerslife.co.nz and in subject line: Name, Policy number, Claim number It is important to have these details in the subject line so it will be attached to the claim/right queue for processing. Turnaround for approval today is
AIA
0800 500 108
Mon- Fri 8.30 am to 5.30pmMy AIA (they have to be registered to login to submit a claim)
Online claim form (Approval, reimbursement, invoice to be paid) Personally I recommend this one.
There’s also Live Chat (need to scroll down and select “start chat” new window will pop up for you to fill in details)
For on-going claims, please send request to nz.healthclaims@aia.com and in subject line: Name, Policy number, Claim number.
Nib
0800 123 642
Mon – Fri 8.30am to 5pmMember portal or through the nib App (download from Apple or Google play)
Video instructions available if they are not tech savvy. Here or can see the instructions here
For on-going claims, the app is the quickest way to get to nib. The turnaround timeframe is also shortly. Where via email, it is a manual process on nib’s end. If they do want to email, claims@nib.co.nz in subject line: Name, Policy number, Claim number.
Southern Cross
0800 800 181
Mon-Thu 8:00am – 5:00pm, Fri 9:00am – 4:30pm.Membership portal SX do not accept email for claims anymore.
Accuro
0800 222 876
Monday to Friday 9-4pmMake a claim through their member portal
They can also email the claim to claims@accuro.co.nz for processing. Information regarding claims with Accuro, here