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)'.

 


 
Seek External Clinical Advice v9.0
Summary
Objective
To request a report from an independent third-party provider answering questions on the standard of care (if relevant), physical injury, 
causation, background population risk (necessary part of treatment), ordinary consequence of treatment etc.
Background
External Clinical Advice (ECA) is an opinion solely based on the paper file review from an independent provider. It helps to answer 
the questions on the standard of care (if relevant), physical injury, causation, background population risk (necessary part of treat-
ment), ordinary consequence of treatment etc.
The ECA’s role is to comment on clinical facts, accepted standard practice, whether a failure has occurred and likelihood of an injury 
occurring, taking into account the particular clients contributing factors.
ECA's do not interpret the legislation. It is the role of the Specialist Cover Assessor (SCA) and Cover Assessor (CA) to interpret the 
legislation against the clinical facts, and obtain further internal advice if required.
Owner
Expert
Procedure
1.0 Determine external clinical advice required
Specialist Cover Assessor
Confirm ECA is required.
NOTE When would you seek ECA?
• When you need specialised advice regarding failure, standard of care, appropriateness of the chosen
treatment pathway, identification of a physical injury, causation and determining what contribution patient
specific factors had in contributing to developing an injury and that advice would help you to determine
cover.
• When you've had a conversation with a Review Specialist or following internal guidance and you
determine external clinical advice is needed.
• You are not required to seek internal clinical advice before accessing external clinical advice.
Identify the speciality of ECA needed.
NOTE How do you identify the specialty of ECA needed?
• Identify who was the consultant that the care was provided under.
Be mindful that this is not always the most appropriate speciality to provide comment eg client had
cardiothoracic surgery and developed a bacteraemia, which then resulted in a sternal wound infection. It
may be more appropriate to seek advice from an infectious diseases physician in this case.
• Look up their speciality and sub speciality to ensure that you are seeking advice from a peer with similar
training and registrations.
(eg when considering cases where the treatment has been provided at a rural hospital, be mindful that a
rural hospital does not have emergency physicians in their emergency department which is usually run by
Rural Health General Practitioners).
• An ECA provider cannot provide comment on another practitioner's care if they do not have the same
qualifications.
Example: an Obstetrician should not be providing comment on the standard of Midwifery care, we should be seeking 
comment from a Midwifery ECA if this is required.
NOTE Where can you access a list of ECA disciplines and specialities?
Click on the link below and navigate to the Provider details.
Treatment Injury ECA Referral tool
NOTE What if you are unsure of the correct ECA discipline and/or speciality to use?
• Go To 'Seek Internal Guidance' process. Use Tier 1 (self service) and Tier 2 (Hotline) guidance
processes.
PROCESS Seek Internal Guidance
NOTE Can you request an ECA provider by name?
You can instruct Recovery Administration on the medical discipline and speciality required. The Recovery Admin-
istrator will then select the next available provider, with the discipline and speciality required, that has capacity to re-
ceive a referral.
You can request an ECA provider by name, if that provider has previously provided ECA advice on the same claim.
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2.0 Contact client or representative and explain need for external clinical advice
Specialist Cover Assessor
Contact the client and confirm you are speaking with the right person by asking ACC's identity check questions.
Identity Check Policy
Explain that you are referring for external clinical advice, the reason seeking advice, what information will be included in the 
referral, what the advice will be used for and the possible outcomes.
NOTE What else do you need to make the client aware of?
Inform the client of the timeframe you expect to receive the written advice.
Sometimes the ECA may confer with other similar experienced vocationally registered health professionals for ex-
ample a blind review
The next steps after receipt of the written advice.
NOTE What if the client does not agree to proceed to ECA?
Find out why the client does not want to proceed to ECA and consider their reasoning and alternatives which may in-
clude making a cover decision based on the clinical information that is held on the claim. Agree with the client the next 
step.
In Eos, add a contact note as a record of the conversation.
3.0 Request external clinical advice referral
Specialist Cover Assessor
Identify all the documents that need to be sent with the referral.
NOTE What documents do I need to include?
• ACC45 Injury Claim Form
• ACC2152 Treatment Injury Claim
• All clinical notes (including radiology reports, laboratory results and other miscellaneous medical records
on file)
• Treating specialist report
• Internal medical advice
• Letters and notes provided by the client
• Death Certificate
• Coroners/Autopsy reports
• Hard copies of clinical evidence (dental moulds, cytology slides, radiological images hard copy / CD).
Perform privacy checks on documents.
NOTE What do you need to check?
Check documents:
• are relevant to the referral
• do not contain any third party information
• do not contain any other information that needs to be withheld.
For details on what checks you need to complete before sending documents out, refer to NG supporting information 
Inbound and Outbound Document Checks and the Privacy Check Before Disclosing Information policy.
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
Privacy Check Before Disclosing Information Policy
NOTE What if you find information that needs to be redacted?
Send an email to Recovery Administration ([email address]) and include the document to be redacted plus 
your specific redaction instructions, before adding the redacted document to the document group. You must not create 
and add to a document group until all redactions have been completed. Wait until you get the correct information back 
on the claim and then you can create your document group.
Add the documents to the group.
NOTE What if there are documents incorrectly on other claims that need to be moved to the correct claim that has 
the referral-specific document group?
To move documents from one claim to the correct claim see the system steps below for Move a Document to Another 
Claim.
Move a Document to Another Claim
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NOTE What if there are documents from other claims that are relevant to the assessment?
When a request for a referral is required and there are additional supporting documents on another claim, it is impor-
tant to upload a copy of the documents to the claim that has the document group. This will ensure the right documents 
support the cover decisions for each claim, whilst retaining the original documents on the correct claims.
To upload documents from one claim to another:
1) Create a bulk print of all documents on the other relevant claim and complete mandatory fields and
description.
2) Open PDF document from email link.
3) Upload the PDF document to the relevant claim that has the document group for the referral.
4) Repeat if there are relevant documents on multiple claims.
The PDF should be renamed to something short but relevant, and identify which claim number the information came 
from so that it is included/printed in further referrals or copy files eg 'medical records and reports from claim 
100xxxxxxxx'
Do not create a bulk print on one claim and then move it to another claim, renaming it and using it in a referral for 
advice as it will not appear in any file copy subsequently used.
Manage document groups
Create a referral-specific document group with today's date and name it 'External Clinical Advice'.
Perform final privacy check as per step 3.0, b on any documents that have been added to document group called 'External 
Clinical Advice'.
NOTE What if more than one ECA is requested for the same claim?
Perform privacy checks as per step 3.0, b on documents to be sent to any other ECA.
NOTE What do you need to document on Eos regarding privacy checks?
You need to write in a contact on Eos that you have undertaken privacy checks for the document group labeled 'Exter-
nal Clinical Advice' and the date that this was undertaken.
Generate a Medical Assessment Referral task and choose the Medical Case Review type for Recovery Administration to 
action.
NOTE How do you generate and send a referral task for Recovery Administration?
Go to System Steps NGCM Create a Referral Task.
NGCM Create a Referral Task
NOTE How do you complete the eform that is associated with the medical case review type?
• Always select standard
• Record the basis of the claim in the Additional Questions for referral field
• Use the Additional Comments field for your specific ECA questions
• Record the ECA specialty and sub-specialty required (eg GP specialising in xxxx)
It is not necessary to link the document group to the task. The recovery administrator will be able to locate the corres-
ponding document group that has been correctly labelled.
Clinical questions guide
NOTE What if hard copy clinical evidence needs to be sent with the referral (ie specimens and radiological im-
aging)?
You will need to send the whole ECA referral yourself via courier so that the hard copy clinical material is together with 
the full referral. See below note about additional information you need to include in the task in this situation.
You will then need to complete activity 7.0 when you receive a General Task from Recovery Administration notifying 
you that this is ready.
NOTE What additional information do you need to include in the referral task?
• Specify at the top in the task description that the request is for External Clinical Advice.
• If you need to send hard material, also record in the task description "Hard material - Specialist Cover Assessor will 
send referral"
Refer to the document below for guidance on what kind of questions to ask the clinician.
NOTE What are the Service Level Agreement (SLA) with Recovery Administration?
The referral tasks route to the Recovery Administration team with an SLA of 24 hours.
NOTE What if the request is urgent and needs to be completed that day?
• Record Urgent External Clinical Advice at the top of the task description box.
• Set the task to high priority - Salesforce will push it through within the hour or sooner.
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NOTE What if additional clinical information is received after the referral has been sent to the provider?
• Create a CMO03 blank letter addressed to the ECA provider advising that we are sending additional information for 
them to consider as part of their report and state clearly what the additional information is: ie Medical notes from Gen-
eral Practitioner Dr XXX.
• Create another document group that will include a CM03 Blank letter and the additional clinical information for the 
ECA.
• Create a NGCM Send Letter task and link the documents for recovery administration to send on your behalf.
• You will need to complete privacy checks as per step 3.0, b and document in a contact on Eos.
4.0 Review referral task
Recovery Administrator
Following the task assignment in Salesforce, navigate to Eos and select 'Do Task' from your task queue.
Review the task to ensure it has all the information you need to proceed .
NOTE What if you don't have all the information you need to proceed?
If required information is missing from the task, contact the task creator.
If you need guidance on working within the Administration Team, refer to the link below.
NG PRINCIPLES Working in the Administration Team
NOTE What if the referral task indicates the referral is urgent?
Contact the task creator to discuss the urgency and work together to progress the urgent referral
5.0 Identify available ECA
Recovery Administrator
Check the Treatment Injury ECA Referral tool for the medical discipline and speciality requested and confirm the next ECA pro-
vider in line to receive a referral.
NOTE Where do I locate the Treatment Injury Referral tool?
Click on the web link below
Treatment Injury ECA Referral tool
https://accnz.sharepoint.com/sites/ECAReferraltool
NOTE Where can you find guidance on how to use and update the referral tool?
The TI ECA Tool Guidance Info document is located in the referral tool using the weblink provided above.
NOTE What if the referral task indicated the referral is urgent?
Work with the task creator to facilitate discussions with the relevant ECA provider to accept an urgent referral.
NOTE How do I know which ECA provider to use?
• Review the medical specialty and sub-specialty requested in the task.
• Search for providers which match the above requirement in the Treatment Injury ECA Referral tool:
- Provider details and filter specialty and sub-specialty (ie General Medicine, Infectious Diseases)
- Note the geographical location of the client listed in the request and select a provider from outside
of the client’s geographical location. If there are no providers outside of the geographical location of
the client, email your Client Service Leader who will escalate to Clinical Services for resolution.
NOTE How do I confirm the provider is available and has capacity to receive a referral?
In the Provider details tab of the Treatment Injury ECA Referral tool check:
• Their availability is "Yes"
• The provider's Annual Practicing Certificate (APC) is current
• The notes section, some providers like to be called and asked prior to sending whether the basis of the claim is 
within their scope of practice
• Compare the maximum referrals recorded (signaling the number of referrals they can manage at any given time), 
with the current volume already referred or wait-listed, and waiting receipt of advice
• If the maximum number of referrals has been reached and the referral is wait listed or waiting for an appropriate ECA 
provider to be recruited with the specific specialty needed. Recovery Administrator to contact Specialist Cover Asses-
sor to let them know
If in doubt, or specified by the provider, contact the provider to confirm capacity.
If the maximum referrals has not been reached and there is no wait-list, the provider has capacity to receive a referral.
NOTE What if you can’t confirm the provider has capacity to receive a referral?
Select the next appropriate provider with the right specialty and sub-specialty.
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NOTE What do you do if all providers with the required specialty and sub-specialty are at full capacity?
• Extend the due date of the task, aligning it to when the soonest expected due date for receipt of an ECA
from the identified providers. (This will keep the referral delay to a minimum).
• Record a rationale in the task as to why you are extending the task due date. (This will help identify
through reporting if additional ECA providers need to be recruited and added to the list).
Go to step b.
NOTE What do you do if there are no ECA providers on the Provider details tab with the required speciality and/or 
subspecialty?
• Email your Client Service Leader with the issue and they will escalate to Clinical Services for resolution.
• Extend the due date of the task out to three days to follow up resolution and record reasons why the task due date is 
extended. This information will be extracted for reporting as part of improving the ECA service.
Update the booking schedule recording the relevant details in the appropriate fields against the confirmed selected provider.
NOTE How do you correctly update the booking schedule?
Refer to 'Populating & Maintaining the Booking Schedule' within the TI ECA referral Tool Guidance info document lo-
cated in the Treatment Injury ECA Referral Tool. The document provides instruction on how to and what should be rec-
orded in the columns.
NOTE Why is it important to correctly update the booking schedule?
It is vitally important that the tool is updated and that requests that have been received are removed from the list. This 
allows users of the tool to accurately assess the work load of providers. This will enable visibility to your colleagues of 
referrals sent, when ECA is due, referrals on the waiting list and when provider has capacity so that another referral 
can be released.
NOTE How do you manage urgent referrals when other referrals are on the waiting list with a provider?
Contact the Specialist Cover Assessor who requested the referral and work together to enable the referral to be 
placed at the top of the waiting list queue.
(This should involve discussions with other Specialist Cover Assessors to agree priority based on each client situation, 
and to enable Specialist Cover Assessors to update clients on the status of their referral and expected timeframes).
6.0 Create purchase order
Recovery Administrator
In Eos, create a Purchase Order for the ECA referral by referring to the details in the e-form.
NOTE What do I add to the purchase order?
• In 'General Q+E' tab select 'Cover Assessment' under Rehabilitation Action, 'Treatment Injury-Cover' under
intervention, and 'Non-Contracted' under Purchase Method.
• On Select Ent - select ECA01
• Enter 10 units for quantity approved and set frequency as 'Quarter'
Create a purchase order
Add the vendor to the purchase order, as identified in the ECA booking schedule and Provider details, ensuring the vendor is 
also added as a participant on the claim.
Approve the purchase order.
NOTE What if the purchase order requires a higher delegation?
Save the purchase order and create and send a Request Authorisation Task from within the purchase order and send 
to a Recovery Leader for approval.
Refer to the link below.
NGCM - FINAL Request Authorisation for a Purchase Order - System Steps
NOTE What if you get a 'Limited Payment' error message when authorising the purchase order?
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, remember to change the Limited Payment List Indicator to 'Yes'.
7.0 Create and send referral documents
Recovery Administrator, Specialist Cover Assessor
NOTE When would a Specialist Cover Assessor complete this activity?
Only when hard copy clinical material is to be sent.
Recovery Administrators will complete the TI40 as much as possible and save the document as incomplete. Upon re-
ceipt of the General Task from Recovery Administration, the Specialist Cover Assessors will then edit the rest of the 
document through to completion and send the referral documents, ensuring all steps outlined in this activity are com-
pleted.
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Create and edit the TI40 External Clinical Opinion Request, (do not complete the document until sent to provider) - Vendor 
letter, populating with extra information. For Recovery Administrators, the information will be noted in the ECA task. Ensure you 
check that all relevant information within the task has been captured.
NOTE How do you edit the letter?
Edit the letter as below:
1) Check address against ECA list.
2) Delete the rows : injury, phone number and address.
3) Copy and paste the 'basis of the claim' information from the e-form.
4) Consent form - delete appropriately as applicable.
5) Use option 1 (always delete option 2 and 3).
6) Change date to three weeks from current date (format BOLD).
7) Change signature to:
Recovery Administrator on behalf of the (Specialist Cover Assessor)
[email address]
Phone 0800 222 435 Ext 21
8) Copy the 'alteration' into the respective rows of the Treatment Injury Advice Form (ACC2187) and delete
the extra cells and rows.
9) Alter the email address on the ACC2187 from [email address] to [email address].
10) Ensure that the document is saved but do not complete the document at this time, as we need to send an editable 
version to the vendor.
Refer to the admin template below for additional guidance.
Admin template - External clinical advice
NOTE For Recovery Administrators: What do you do next if the referral task only requested a Purchase Order crea-
tion and approval due to hard copy clinical material needing to be sent by the cover specialist with the refer-
ral?
1) Ensure you have edited the TI40 as much as you can and save the document as incomplete.
2) Create a General Task and record that the purchase order has been approved and the referral is ready to
be completed.
3) Add the purchase order number to the task description.
4) Transfer the General Task to the referral request creator.
5) Close the Medical Assessment Referral task.
Go to step 8 (the Specialist Cover Assessor will complete the rest of this activity).
Link the referral to the document group 'External Clinical Advice'.
Perform privacy checks using the Inbound and Outbound Document checks.
NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
Check the provider's preference for receiving the referral. If the providers preference is by email and the request is not asso-
ciated with hard copy material, Recovery Administrator to ensure the provider's email address has been verified.
Update the Booking schedule in the Treatment Injury Referral tool with the date the referral is sent.
NOTE What if the email address has not been verified?
Go to (NGCM) Verify Provider and Vendor email addresses process.
PROCESS Verify Provider and Vendor email addresses
Treatment Injury ECA Referral tool
If email is the preference, create email using the requests and referrals template and attach the referral and document group. If 
you are unsure contact the ECA provider directly.
Use the email address as confirmed by the ECA provider and ensure the documents attached within the email are password 
protected.
Use the password recorded against the provider in the Provider details within the Treatment Injury ECA referral tool.
Emailing from Eos using a template - System Steps
NOTE What if the document is too large to email?
Break it up in chunks, if required.
NOTE What if the request is urgent?
State this clearly in the email.
NOTE What if the referral documents need to be sent via courier?
Recovery Administrators - Refer to the process link below (NGCM) Prepare and Send Client Information by courier.
Specialist Cover Assessors - Refer to the Information link below Sending medical material to External Clinical Advice
PROCESS Prepare and Send Client Information by Courier
Sending medical material to External Clinical Advice
Complete a final dispatch check to ensure the Client and vendor details are correct.
Send the email or courier to the ECA provider.
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NOTE What if the TI ECA provider requests an update to their details or availability?
Pass the information on to [email address] (
) to have the Provider list in the TI ECA 
Referral tool updated.
After sending the incomplete TI40 letter to the vendor, save the document as complete this will allow the document to be edited 
by the vendor (to convert the document into a non-editable pdf).
Close the assigned task and create a new "NGCM - Admin Request" task, edit the task description with "ECA Follow Up" and 
set the due date for three weeks time and put back into the queue.
Check that you have correctly updated the Booking Schedule in the Treatment Injury ECA Referral Tool (locate the entry with 
your clients name and the vendor who has been previously selected under point 5.0), with the date the referral was sent to the 
vendor and then calculate a three week ECA report due date.
NOTE Specialist Cover Assessors sending the referral will need to update the spreadsheet with the date referral 
sent and ECA due date.
8.0 Follow up request for external clinical advice
Recovery Administrator
Upon receipt of the NGCM - Admin Request task, perform a check of the documents on the claim to confirm the requested 
information has been received.
NOTE What if the ECA has been received?
1) Update the Booking schedule in the Treatment Injury ECA Referral tool with the ECA received date.
2) Close the "NGCM - Admin Request" task.
3) Check if there is another referral on the waiting list with that provider that can now be released. If so,
locate the referral task, change the due date to today's date, and record in the task description that the
provider can now receive the referral.
4) Change the task to high priority so that the task can be allocated and actioned same day.
5) If you have received the ECA in Recovery Administration ensure the Specialist Cover Assessor has been
alerted that the ECA has been received.
Process ends.
If the ECA has not been received, contact the ECA provider to follow up on the report.
NOTE How do you contact the ECA provider to follow up on the report?
You can contact the provider by email or phone call and advise the ECA provider that the report is due back to ACC.
Ask the provider what the expected timeframe for ACC to receive this report.
Document this clearly in the contacts of the claim with the follow heading: ECA PROVIDER CONTACTED and write 
within the contact the agreed timeframe to receive the report.
Alter the 'NGCM - Admin Request Task' to reflect the new agreed timeframe and place back in the queue.
NOTE What if the ECA provider is not responding to follow ups?
If you experience repeated difficulty communicating with the provider, eg provider is not responding to a mix of emails 
and phone calls after three attempts, it is reasonable to engage the Specialist Cover Assessor to determine if the 
referral should be cancelled and a new referral sent to another ECA provider next on the list who has capacity to re-
ceive the referral.
NOTE What if the ECA provider indicates a lengthy delay and they haven't commenced the review?
ECA Providers are very good at advising delays or that they are unable to undertake the work. Some examples of this 
are, taking leave, or experiencing an increased workload in their routine practice (outside of ECA) and therefore 
unable to provide reports. If this occurs, inform the Specialist Cover Assessor and determine if the referral should be 
cancelled and a new referral sent to another ECA provider next on the list who has capacity to receive the referral.
NOTE For how long should you continue following up for the ECA report?
You should continue to follow up the ECA report for as long as required until the ECA report has been received.
NGCM - Admin Request tasks for follow up of the ECA report should never be closed unless the report has been re-
ceived or you have been advised by the Specialist Cover Assessor that follow up is no longer required.
Extend the NGCM Admin Request task due date to the new date the ECA is expected.
In the Booking Schedule, add in the comments field that follow-up has occurred and the expected new date of receipt of the 
ECA report.
NOTE Do not change the initial three week ECA due date recorded in the Booking Schedule as changing due dates 
will incorrectly inform provider service level agreement monitoring occurring in another part of the business.
9.0 Review report
Specialist Cover Assessor
Upon receipt of the ECA report or the Alert: You Have Mail task notification from the Inbound Document Management Team 
that the ECA report has been attached to the claim, open and review the document.
Perform Privacy and Relevancy checks on the received report.
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NG SUPPORTING INFORMATION Inbound and Outbound Document Checks
NOTE What if there are quality clinical issues or completeness concerns?
You are encouraged to deal directly with the Provider where you can, particularly if the concerns are around the 
completeness of the report, omissions or redactions.
However, the clinical quality team are particularly interested regarding any reports which lack clinical quality. Not only 
will the clinical quality team help you by reviewing the report with the Engagement and Performance Management 
team (EPM) talking with the Providers, learnings will be provided to all Providers.
If you have any concerns relating to the clinical quality of any ECA reports, please email the case through to 
[email address].
10.0 Determine next steps
Specialist Cover Assessor
Review ECA report and determine next steps.
Contact the client and confirm you are speaking with the right person by asking ACC's identity check questions.
Identity Check Policy
Discuss the report and next steps.
In Eos, add a contact note as a record of the conversation.
Go to 'Assess Cover for Treatment Injury Claim' step 5.0 Review additional information.
PROCESS
Assess Claim for Cover (Treatment Injury)
Cover Assessor, Specialist Cover Assessor

PROCESS
Consider Risk of Harm Questions
Cover Assessor, Specialist Cover Assessor

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