This is an HTML version of an attachment to the Official Information request 'Guidelines and Process for Referring Claimants to a ACC Accredited Clinician (Case Manager initiated)'.

 


 
Request Clinical Records v64.0
Summary
Objective
To request medical or clinical records from a client's vendor, so that we have enough information to make a cover, support or treat-
ment decision.
Background
ACC must request medical or clinical records from a client’s vendor if we don’t already have enough information to make a cover, 
support or treatment decision. ACC can ask external vendors, including General Practitioners (GPs), District Health Boards (DHBs) 
and specific treatment vendors (such as physiotherapists or chiropractors) to provide ACC with medical or clinical records related to 
the case.
Client medical or clinical records help in a range of situations. They:
• help inform cover, support or treatment decisions
• provide further information about the injury, client and diagnosis
• help develop the rehabilitation plan
• help identify and manage any risks.
Each time we request information about a client or a claim, the client should be aware of the request and why we need the infor-
mation.
Owner
Expert
Procedure
PROCESS
Create or Update Recovery Plan
Recovery Assistant, Recovery Coordinator, Recovery Partner

PROCESS
Arrange Medical Case Review (MCR) Assessment
Recovery Assistant, Recovery Coordinator, Recovery Partner

PROCESS
Seek Internal Guidance
Clinical Advisor, Practice Mentor, Technical Specialist

1.0 Determine requirement for clinical records
Cover Assessor, Recovery Assistant, Recovery Coordinator, Recovery Partner, Specialist Cover Assessor
Check the claim for information already on the claim, before proceeding.
Determine what type of medical or clinical records you need to obtain by referring to the links below.
Request medical or clinical records Policy (Section 7)
Summary of the Health Information Privacy Code Policy
NOTE What if you require notes from Oranga Tamariki?
The process for this is scheduled to be written into Promapp as part of a larger piece of work.
In the interim, use the following document.
Oranga Tamariki Clinical Notes
NOTE What if you need clinical or medical records from a DHB?
Check if the reason for requesting the records aligns with one or more of the scenarios for requesting District Health 
Board (DHB) clinical records
Scenarios for requesting District Health Board clinical records
http://thesauce/team-spaces/chips/treatment-rehabilitation/treatment/reference/scenarios-for-requesting-dhb-clinical-
records/index.htm
NOTE What if you need to obtain Specialist records or High Tech imaging?
Specialist notes or High Tech Imaging contracts require them to send through their reports within 5 working days of 
the patient consultation. Only submit a request for these records if it has been more than 5 working days and they 
have not been received.
ACC > Claims Management > Manage Claims > Gather Additional Information or Advice > Request Clinical Records
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NOTE What are the timeframes for receiving information?
If you are requesting information from a DHB, the timeframe is:
• non-urgent request – 21 working days
• urgent request – 6 working days
If you are requesting information from a non-DHB (GP, Medical Centre), the timeframe is:
• non-urgent request – 11 working days
• urgent request – 6 working days
In Eos, in the Consent tab of the Recovery Plan, check if the client has provided authority to collect medical and other records 
from third parties or has an ATA in place.
NOTE What if there is no authority on the client's claim, or the authority has expired?
Refer to the NG GUIDELINES Obtain Verbal or Written Authority for guidance.
If an ACC6300 is needed, Go to the Obtain Client Authority to Collect Information process.
PROCESS Obtain Client Authority to Collect Information
NG GUIDELINES Obtain Verbal or Written Authority
NOTE What if you need notes older than 5 years and there are multiple claims for the client?
At least one claim must have a signed Authority to Collect information (ACC6300) within the current year. Discuss with 
the client if you need to request information not already on file. Document their verbal authority.
NOTE What if you are requesting Mental Health notes?
Before requesting Mental Health notes a signed ACC6300 Authority to collect information must be on the file.
NOTE What if you need notes where a client has an active claim, but you require notes for other claims for the same 
client that are inactive?
Check the other claims for information before proceeding to request information.
Request for notes on Multiple claims, but to one provider, Task on active claim noting all claim numbers
Request for notes on previous claims:
The task should be created on the active claim (if no active claim, task on the claim you need) in the task, note which 
claim number you need clinical notes for and add the vendor as a participant on claim
Check that the client has been seen by the Vendor you are requesting records from for this injury/claim.
NOTE What if the Provider is under contract?
To check to see if a Provider is under contract, search via MFP, if under contract a purchase order is not required. 
When completing the e-form, in the 'Purchase Order Number required' drop down box, select 'No'.
NOTE What if the client has been seen by (including but not limited to) a Specialist or Surgeon at a Private Hospital?
Contact the Specialists rooms to confirm where this request should be sent. Eg. Private Hospital or Specialists rooms. 
Add the specialist name to the request for information.
NOTE What if the claim is for a client with a Mental Injury?
Contact the treating provider to confirm they hold the records and confirm the email address to send the information 
request.
If the email address provided has not been verified, go to Verify Provider and Vendor email addresses then return to 
this process.
In Eos, check the correct Vendor is entered as a participant on the claim.
NOTE What if the Vendor hasn't been added as a participant?
Add the Vendor as a participant to the claim
NOTE What if the provider has not been set up as a Vendor?
In MFP, confirm the provider is not a Vendor. In the task to Recovery Administration, note the use of Vendor ACC De-
fault J99966.
Manage Participants
In Eos, add a NGCM - Information Requests activity and complete as per the Requesting Clinical Records system steps.
Requesting Clinical Records
Complete the eform with all the relevant information.
NOTE What if the information request relates to notes needed to make a cover decision?
Edit the task and change the priority to 'High'.
NOTE What information do you need to include in the information request task?
Refer to the 'Referring Tasks to Recovery Administration - Principles'.
Referring Tasks to Recovery Administration - Principles
NOTE What if the information request is for a Treatment Injury claim?
Complete a TI11 referral form and refer to the document below for guidance on where to send this for DHBs
Request clinical records/report for Held Treatment Injury
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NOTE What if the request for clinical notes is from a DHB?
Refer to 'Contacts for requesting District Health Board clinical records' to locate who to request the information from.
Contacts for requesting District Health Board clinical records
NOTE What if the request is for hard materials?
Clearly state in the task description "Hard materials [type of material] required from [provider] to be sent to [your ad-
dress]".
NOTE What if you are requesting medical notes for multiple claims from the same vendor?
Note the following in the task:
• Specific "from" and "to" dates.
• If you are requesting additional notes for a claim from the same vendor, to avoid duplication check the from and to 
dates on the previous request.
For example: 1st request for medical information "from" date is 21/06/2019 to 21/08/2019 (Present date in which the 
purchase order was created). Next request will go "from" 21/08/2019 "to" 21/10/2019.
NOTE What if the Vendor is a DHB?
In the NGCM - Information Request, note that the client's ACC6300 needs to be sent with the request.
NOTE What if you are requesting information prior to seeking internal guidance or information has been requested 
by an advisor?
Create a reminder action, clearly documenting why the notes are needed and recommended next steps.
Add a note in the Recovery Plan, under the Recovery Area recording the reason for the information request.
NOTE What if you're a Cover Assessor?
Edit the 'Confirm Cover Decision' task and add the details to record the request for information.
2.0 Review request for clinical records
Recovery Administrator
Upon allocation of the 'NGCM - Requested Information' task in Salesforce, open the associated task in Eos and select [Do 
Task] from your task queue.
Review the task to check Recovery Team member has provided the name of the Vendor.
NOTE What if the information needed is from overseas?
Refer to the Making an overseas payment link below for more information.
Making an overseas payment
http://thesauce/team-spaces/chips/compensation/weekly-compensation/process/paying-overseas-client/index.htm
NOTE What if the name of the Vendor hasn't been provided in the task?
The Vendor details should be included in the task. If the details are missing, contact the requestor for the information 
and ask them to add as a Participant on the claim.
NOTE What if the vendor has not been added as a Participant on the claim?
The Recovery Team member should be adding the vendor as the Participant on the claim. but if this has not been 
completed, contact the Recovery Team Member asking them to add the Vendor as a participant before creating the 
purchase order
NOTE What if the vendor is noted as Vendor ACC Default J99966?
Some records may be requested from Vendors who are not set up as an ACC Provider. In this case, the Vendor De-
fault of J99966 is used.
NOTE What if the request is for medical notes for multiple claims?
When requesting notes on Multiple claims, but to one provider, the Purchase Order is created on the active claim; all 
claims numbers should be listed in the letter.
Request for notes on previous claims:
When requesting notes on a previous claim, the task should be received on an active claim which notes the claim 
number the notes are needed for. Purchase Order and request letter should be completed on the previous claim 
number. Close the request task- this will create a follow up task, edit this follow up task with the previous claim number 
the Purchase Order was created on.
Check the task to determine if you need to generate a Purchase Order.
NOTE What if you don't need to create a Purchase Order?
Go to Activity 4.0 (d) Create and send request.
Identify the vendor type for the information request.
NOTE What if the information request is for GP records?
Go to Activity 3.0.
NOTE What if the information request is for DHB records?
Go to Activity 3.1.
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NOTE What if the information request is for Physiotherapy records?
Go to Activity 3.2.
NOTE What if the information request is for Specialist records?
Go to Activity 3.3.
NOTE What if the information request is for an ACC2152 Treatment Injury Claim?
Go to Activity 3.1 or if the request is for a non-DHB:
• Generate a blank ACC2152 Treatment Injury Claim form & the TI12 Clinical Information Request (ACC2152) letter
• Add the PO code ACC2152
• For quantity type 1
• Frequency ‘Quarter’
• Add an additional PO code ‘COPY’
• For quantity type 30
• Frequency ‘Quarter’
• Vendor Name/address
• Vendor ID
NOTE What if the request is for hard materials?
If the request is for hard materials (ie tooth sample), include the address of the staff member requesting it in the "How 
to send the requested information" section of the letter.
3.0 Request GP records
Recovery Administrator
View the [Add Info] tab in the task.
Create the Purchase Order.
Creating purchase orders using general + QE
NOTE What information do you need to create the Purchase Order?
Choose the appropriate Entitlement Code or a combination of codes:
MEDR – (is an hourly rate for the time taken by the Medical Practitioner to prepare and review the medical notes).
COPY – (is the cost for practice admin staff to photocopy and prepare existing medical notes that may be paper 
based).
*If you mark the request as 'Urgent', provide the reason.
After selecting the Entitlement code(s), proceed as follows:
1) Rehab Action / Claim: Treatment (Search)
2) Tick the 'Medical Notes/Reports – Tmt (Quick add)
3) Quantity Approved: MEDR - 1, COPY - up to max of 30
4) Frequency: Quarter
5) Purchase Method: Non-Contracted.
If there are questions for the GP vendor, select the 'MD02a GP - Further info - Medical Notes - Vendor' letter. In this 
case, select 'In total' as the [Frequency] when raising the PO, this will ensure the document template populates the 
right quantity. Alternatively, manually amend the template to change quantity from 0 to 1.
Approve the Purchase Order.
NOTE What if you get a Limited Payment error message when authorising the Purchase Order?
If you have received a request to amend a Purchase Order or create a Purchase Order for client reimbursements, 
change the limited payment indicator.
1) In Eos, go to the 'Validations' tab, select 'Edit' and update the Limited Payment List Indicator to 'No'.
2) Select 'OK'.
3) Go back to the Purchase Order to authorise.
Once you have authorised the Purchase Order and notified the vendor please remember to change the Limited Pay-
ment List Indicator to 'Yes'.
Generate the MD01a GP - Further Info - Medical Notes - Vendor letter by selecting 'add documents'.
Admin Template - MD01a GP Further Info - Medical Notes - Vendor
NOTE What if the request is for a Treatment Injury?
Generate the TI11 request instead of the MD01a.
Admin template TI11
NOTE What if the request relates to a Mental Injury claim?
Refer to the admin template for what needs to be updated in the MD01a letter.
MD01a GP Further Info Medical Notes - Vendor Mental Injury Template
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NOTE What if the request is urgent?
Update the sentence under the 'How to invoice ACC' with the following:
'Please forward the requested reporting within 5 days'.
When emailing add URGENT to the email subject line.
NOTE What if there are questions to be included in the information request?
Generate the 'MD02a GP - Further info - Medical Notes - Vendor' letter.
Admin Template - MD02a GP Further info - Medical Reports – Vendor
Amend the MD02a letter to include the 'from to dates' provided in the task by the Recovery Team member to read as follows:
"In order to consider this request we require copies of the following information from [Date] to [Date]"
3.1 Request DHB records
Recovery Administrator
View the [Add Info] tab in the task.
Create the Purchase Order.
Creating purchase orders using general + QE
Contacts for requesting District Health Board clinical records
NOTE What information do you need to create the Purchase Order?
Use Entitlement Code DHBC.
If questions need to answered by a DHB Specialist, use Entitlement Code: DHBR1.
After selecting the DHBC Entitlement code, proceed as follows with steps 1 – 6 as below. If you require further infor-
mation, please refer to the 'Creating purchase orders using general + QE System Steps' document below.
1) Rehab Action / Claim: Treatment (Search)
2) Tick the 'Medical Notes/Reports – Tmt (Quick add)
3) Quantity Approved: 1
4) Frequency: Quarter
5) Purchase method: non contracted
6) Choose the correct vendor. (Use the link above for contacts for requesting DHB Clinical Records).
NOTE What if the request relates to a Treatment Injury claim?
Create the Purchase order with the following details:
• Add the PO code DHB2152 & DHBC
• For quantity type 1
• Frequency ‘Quarter’
• Vendor name/address
• Vendor ID
If report writing (answering of questions) is needed, add DHBR1
Approve the Purchase Order.
NOTE What if you get a Limited Payment error message when authorising the Purchase Order?
If you have received a request to amend a Purchase Order or create a Purchase Order for client reimbursements, 
change the limited payment indicator.
1) In Eos, go to the 'Validations' tab, select 'Edit' and update the Limited Payment List Indicator to 'No'.
2) Select 'OK'.
3) Go back to the Purchase Order to authorise.
Once you have authorised the Purchase Order and notified the vendor please remember to change the Limited Pay-
ment List Indicator to 'Yes'.
Generate the ACC2386 - DHB request for copy of notes by selecting 'add documents'.
Admin Template - Clinical Records Request - District Health Board
NOTE What if the request relates to a Treatment Injury claim?
Generate a TI11 request instead of a ACC2386.
Admin template TI11
NOTE What if the request relates to a Mental Injury claim?
Generate the 'ACC2386 DHB request for copy of notes' letter. Using the instructions in the template modify the letter 
for a Mental Injury request.
ACC2386 Clinical Records Request District Health Board Mental Injury Template
NOTE What if there are questions to be included in the request?
Generate the 'MD02c-DHB-Further Info - medical reports - vendor' letter.
Admin Template - MD02c - DHB Further info - Medical Reports – Vendor
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3.2 Request Other Clinical records ie, Physiotherapist or Allied Health
Recovery Administrator
View the [Add Info] tab in the task.
Create the Purchase Order.
Creating purchase orders using general + QE
NOTE What information do you need to create the Purchase Order?
Use Entitlement Code: STPR.
If you have questions requiring answering by the Physiotherapist, Osteopath, Chiropractor or Podiatrist use Entitle-
ment Code: MEDR.
*A contracted physiotherapist may request STPR when they need to spend significant time reviewing and redacting 
information before sending the notes to ACC, in which case ACC should fund.
After selecting the relevant Entitlement code, proceed as follows:
1) Rehab Action / Claim: Treatment (Search)
2) Tick the Medical Notes/Reports – Tmt (Quick add)
3) Quantity Approved: 1
4) Frequency: Quarter
5) Purchase method: Non-contracted
6) Choose the correct vendor or just type in the correct vendor code.
Approve the Purchase Order.
NOTE What if you get a Limited Payment error message when authorising the Purchase Order?
If you have received a request to amend a Purchase Order or create a Purchase Order for client reimbursements, 
change the limited payment indicator.
1) In Eos, go to the 'Validations' tab, select 'Edit' and update the Limited Payment List Indicator to 'No'.
2) Select 'OK'.
3) Go back to the Purchase Order to authorise.
Once you have authorised the Purchase Order and notified the vendor please remember to change the Limited Pay-
ment List Indicator to 'Yes'.
Generate the MD01b Allied - Further info - Medical Notes - Vendor by selecting 'add documents'.
NOTE What if the request is for a Treatment Injury?
Generate the TI11 request instead of the MD01b.
Admin template TI11
NOTE What if the request is urgent?
Under 'How to invoice ACC', update the sentence 'Please forward the requested reporting within 10 days' to 5 days.
NOTE What if there are questions you need to include?
Generate the MD02b Allied - Further info - Medical Notes - Vendor letter.
Admin Template - MD02b Allied Further info - Medical Reports – Vendor
NOTE What if you need to fax the letter?
Generate the 'MD01b Allied - Further info - Medical Notes fax - Provider'.
Admin Template - MD01b Allied Further info - Medical Notes – Vendor
Amend the MD01b letter to include the 'from to dates' provided in the task by the Recovery Team member to read as follows:
"In order to consider this request we require copies of the following information from [Date] to [Date]"
3.3 Request Specialist or other records
Recovery Administrator
View the [Add Info] tab in the task.
Check if there is a requirement to submit questions to the vendor.
NOTE What if questions are not needed for the information request?
Proceed to Activity 4.0 Send records request.
NOTE What if the Specialist or 'other' does not have a verified email address?
If you are requesting notes from a Specialist and they do not have a verified email address, then:
1) Call and verify as the first option
2) Only if absolutely necessary (if they don't want the request emailed) create a letter to FAX as per the steps in 4.0 e 
Note 1.
Create the Purchase Order.
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NOTE What information do you need to create the Purchase Order?
Entitlement Code: MEDR
Entitlement Type: Intervention Medical Notes / Reports - Tmt (Quick Add)
Quantity: 1
Frequency : In Total
Purchase Method Non-Contracted
Approve the Purchase Order.
NOTE What if you get a Limited Payment error message when authorising the Purchase Order?
If you have received a request to amend a Purchase Order or create a Purchase Order for client reimbursements, 
change the limited payment indicator.
1). In Eos, go to the 'Validations' tab, select 'Edit' and update the Limited Payment List Indicator to 'No'.
2). Select 'OK'.
3). Go back to the Purchase Order to authorise.
Once you have authorised the Purchase Order and notified the vendor please remember to change the Limited Pay-
ment List Indicator to 'Yes'.
Generate the MD02a - GP Further info - Medical Reports letter and modify as per the task. Send an email using the Medical 
Notes Request Email template and modify accordingly.
NOTE What if the request is for a Treatment Injury claim
Generate the TI11 request instead of the MD02a
Admin template TI11
Go to Activity 4.0 Create and send request.
4.0 Create and send request
Recovery Administrator
Edit the documents and letters:
1) Change the 'Staff Name' from your name to 'ACC'
2) Copy the document name under the 'Recipient Details' heading and paste into the Document Description' box
3) Untick 'Record a Contact' and then 'Next' (the document will be generated in Word for you to complete)
4) Complete the document using the information provided located in the 'Additional Information' tab
5) Check the details you have entered are correct
6) Save the document and close.
NOTE What if the task includes questions from a Recovery Team Member?
Refer to the NG GUIDELINES Sending Letters in NGCM to confirm whose signature should be used.
NG GUIDELINES Sending Letters in NGCM
In Eos, mark the documents as complete, and select OK.
Complete privacy checks on the completed documents.
Privacy Check Before Disclosing Information Policy
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
Create an email using the appropriate template and attach the document(s). Add the client's NHI at the beginning of the email
subject field.
NOTE What email template should you use?
If Purchase Order created, use 'Medical Notes Request (Purchase Order)
If no Purchase Order created, use 'Medical Notes Request'
Modify accordingly.
For notes being requested for a Treatment Injury claim, Include 'Treatment Injury' in the subject line.
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NOTE What if the request relates to a Mental Injury claim?
Create an email in outlook. Copy and paste the following text and modify accordingly:
Kia Ora,
ACC have received a claim from *client first name* relating to their Mental injury.
We require Mental health information from between 00/00/0000 and present, to help us make decisions about their 
claim.
Our preference is to receive all documentation by email, if this is not possible just let us know.
If you have any queries, please do not hesitate to email [email address] or call 0800 222 435 Ext. 22.
Ngā mihi
NGCM - FINAL Emailing from Eos using a Template - System Steps
NOTE What if the request is for records across multiple claims?
The Recovery Team Member will identify the claims in the task. Only one purchase order is needed (if required) on the 
active claim.
NOTE What if the Vendor's address has not been verified?
Go to Verify an Existing Provider, Vendor or Facility Email Address.
PROCESS Verify an Existing Provider, Vendor or Facility Email Address
NOTE What if the request is URGENT?
State this clearly in the body and subject line of the email.
NOTE What if the request relates to a Mental Injury claim?
If the claim relates to a Mental Injury (e.g. stress related injuries), you will need to manually remove the injury details 
from the Medical Notes Admin Email template(s).
NOTE: Details of a client's physical injury won't populate on the Medical Notes Requests email templates used by 
Recovery Administration for Purchase Orders or non-Purchase Orders for Sensitive Claims in the Assisted or Part-
nered Recover teams.
NOTE What if you need to send a FAX?
Fax the requests do the following:
(A) – For users with Fax Access
1). Print/Fax the request using RightFax
2). Navigate back to Eos
3). Add a new contact stating: "MD01a [document date and time], sent via fax to: [faxnumber] on [date and time]".
(B) – For users without Fax Access
1). Create the request
2). Update the task details with "Please Fax, Vendor #, Fax #, [Document attached]
3). Link the request to the task
4). Set the priority as 'High'
5). Transfer back to the Admin queue
For guidance on how to use RightFax refer to the document below.
RIghtFax Instructions
Perform despatch check.
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
Send the email.
In Eos, close the task. This will automatically generate a Follow up Requested Information task for Recovery Administration.
NOTE What if the request was set as High Priority?
Edit the Follow Up Requested Information task and set to 5 days.
NOTE What if you were requesting records across multiple claims?
Edit the description in the follow up task to include a list of all the claim numbers and dates are requesting records for. 
Copy the details from the task.
5.0 Review clinical records received
Recovery Administrator, Recovery Team Member
Following the task assignment in Salesforce, navigate to Eos and select 'Do Task' from your task queue.
Perform privacy checks.
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
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Privacy Check Before Disclosing Information Policy
In Eos, upload the information to the claim.
NGCM Filing Away - System Steps
Update the document and contact properties with an accurate description of the information received.
NOTE What if you are a Recovery Team Member?
Locate and edit the associated 'NGCM - Follow up Requested Information' task stating clinical records have been re-
ceived. Recovery Admin will update the 'Information Requested' tab and close the task.
Select the 'Information Requested' tab on the Recovery Plan subcase, mark the request as 'Complete' and state 'Information 
Received', select OK.
NOTE What if you receive medical records for a treatment injury claim?
• Cancel the “NGCM - Follow up Requested Information” task, using the reason “Original task inappropriate”, and 
enter the description “Treatment injury claim”
• Review if the claim is with a Specialist Cover Assessor or in TIC-Administration
• Generate an Alert you have mail task
• Transfer the task to a Specialist Cover Assessor or TIC-Administration department
Close the 'NGCM - Follow up Requested Information' task stating clinical records have been received. A NGCM - Review Re-
quested Information task will be auto generated and assigned to the Recovery Team or Individual managing the claim.
NOTE What if you receive a Review Requested Information Task and the information is incomplete?
Close the task.
Select 'Information Incomplet and click OK.
Add the details of the information that is missing in the comment box and select a target date.
Click OK. The task will auto-route to Recovery Administration.
6.0 Follow up request for clinical records
Recovery Administrator
Following the task assignment in Salesforce, navigate to Eos and select 'Do Task' from your task queue.
In Eos, check the 'Documents' tab to confirm the requested information has not been received before proceeding to contact 
the vendor.
NOTE What if you're unable to locate the information in the documents tab?
1) Check the shared inbox to see if the email has arrived but has not yet been filed away
2) If the information is in the shared inbox, file it away to the claim
3) Copy and paste the email subject line into the Salesforce search bar, opens the related task and close.
Contact the vendor to follow up on the requested information. Ensure that you check what has previously been requested and 
only follow up the request for subsequent information (using the date ranges on the request form).
NOTE How many times do you follow up with the vendor?
Make two attempts to follow up with the vendor.
1). Edit the task description with your initials, the current date, and the attempt number e.g. 'JL 18/09/2019 first follow-
up email sent'.
From the Documents tab in Eos, locate the original request email with attachment that was sent to the vendor in Activ-
ity 2.0. Attach this to a new email from template and add the additional content below. In the Email subject line, ensure 
that you include the wording 'Follow up requested information'.
"Please note, this request was originally sent on (date). To best support our clients, it would be appreciated if you 
could respond as soon as possible. If you did not receive this, please check your spam folder, and add our email ad-
dress to your contacts list to receive future emails from our Recovery Administration Team." HealthLink account hold-
ers should send the information to the HealthLink Mailbox: ACCSPECR.
• Reset the follow up task target date for two working days from today's date and transfer the task back into the 
Recovery Admin queue.
2). The second attempt should be made by phoning the vendor. If leaving a message, ensure you provide sufficient 
details for the vendor to identify the client whose information we require, e.g. NHI or claim number.
If you are successful in contacting the vendor, update the task description and change the target date to when you 
expect the notes as agreed with the vendor. e.g. 'JM 27/09/2019 called vendor - they will send later today'.
If, after two attempts, the medical or clinical records are not received from the vendor, go to task d.
If they are received, go to Activity 5.0, 'Receive clinical records'.
NGCM - FINAL Emailing from Eos using a Template - System Steps
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NOTE What if the vendor has advised that they no longer hold the client's records as the client has transferred to 
another GP practice?
Make a note of what the previous vendor has advised on the NGCM – Information Not Received task once the NGCM 
– Follow up Requested Information task has been closed. Copy in the relevant notes that have been left on the task 
for the team/RTM to follow.
Close the 'NGCM - Follow up Requested Information' task.
Information Not Received
Copy and paste the task description from the 'NGCM - Follow up Requested Information' task into the 'NGCM - Information 
Requested not Received' task.
NOTE What other information should you include?
Include any other relevant information e.g. 'Voice Message says the clinic has closed down'.
7.0 Determine if clinical records are still required
Recovery Assistant, Recovery Coordinator, Recovery Partner
Review the 'NGCM - Information Requested Not Received' task to determine if you still require the medical or clinical records.
NOTE What if you no longer require the medical or clinical records?
Select the NGCM - Information Requested Not Received task. Follow the systems steps for Information not Received.
This process ends.
Information Not Received
NOTE What if you still require the medical or clinical records?
Close the 'NGCM - Information Requested Not Received' task.
In the 'Choose Next Step' screen, select option 'Continue to follow-up'.
An 'NGCM - Continue to Follow up Requested Information' task will automatically generate route to Recovery Adminis-
tration Team.
8.0 Continue following up request for clinical records
Recovery Administrator
Following the task assignment in Salesforce, navigate to Eos and select 'Do Task' from your task queue.
Continue To Follow Up Requested Information
Call the vendor - discuss the request to determine (if possible) the reason(s) why they have been unable to provide the re-
quested information.
NOTE What if the vendor is unable to provide the requested information?
Add the response into the task to notify the Recovery Team Member. In Salesforce, record this conversation as a con-
tact on the claim.
Close the 'NGCM - Continue to Follow up Requested Information' task, and select 'Information Requested Not Received'.
9.0 Review clinical records
Recovery Assistant, Recovery Coordinator, Recovery Partner
Confirm you have received the records requested,
NOTE What if you need help to interpret the information?
Go to the Seek Internal Guidance process.
PROCESS Seek Internal Guidance
NOTE What if the records received are incomplete?
Follow the system steps below.
Information Incomplete
Perform privacy checks.
Privacy Check Before Disclosing Information Policy
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
NOTE What if the clinical records require redacting or third-party information removed?
• Send a 'NGCM -Admin request task' to the Recovery Administration team to undertake any redactions.
• When tasking to Recovery Administration, provide clear instructions on the information that needs redacting.
NOTE: Do not add any third-party information into the task because this cannot be removed in the future and tasks 
are provided to a client when they request their claim information. Instead state ‘please remove third party information 
on page xx'.
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In Eos, open the 'NGCM – Review Requested Information' task, select the option to accept records and close the task.
10.0 Action incomplete request for clinical record, if required
Recovery Administrator
Following the task assignment in Salesforce, navigate to Eos and select 'Do Task' from your task queue.
Open the 'NGCM - Incomplete Information Request' task to determine what information is missing. To view the original infor-
mation request, go to the [Add Info] tab and then click on the 'Inherited' tab.
Information Incomplete
Contact the vendor to obtain the missing information.
NOTE What methods and templates do you use for this?
Call the vendor to discuss what's missing from the original request and ask if they can send the information to ACC. In 
Salesforce, record this conversation as a contact on the claim.
NOTE What if the vendor insists on an email?
Using the appropriate Eos template, email the vendor and attach the original clinical request and advise the vendor of 
the missing information as outlined by the Recovery Team Member in the task, and then close the task.
An email example could be:
"Thank you for sending the requested medical information on (insert date). We have reviewed the medical notes and 
noticed some information is missing. Could you please send a copy of (insert what information is missing here) to us 
at your earliest convenience. Thank you"
This will then create the NGCM - Follow up Request for Clinical Records task.
In Eos, close NGCM - Incomplete Information Request task. This will then create the 'NGCM - Follow up Request for Clinical 
Records' task.
Edit the 'NGCM - Follow up Request for Clinical Records' task and record your initials, today's date, attempt number and 
discussion had with the provider regarding the missing information.
Go to Activity 6.0, 'Follow up Request for Clinical Records' if required.
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