TPH Oct 2014.pdf

ACC
TREATMENT
PROVIDER
HANDBOOK

This is a living document and will be updated as required

link to page 102 ACC Treatment Provider Handbook 2014
1.
Overview
Welcome
ACC’s role and our partnership with you
ACC’s role is to ensure that people in New Zealand receive the rehabilitation they need to
return to work or everyday life after injury.
Of course this isn’t a role that we perform alone, but one that we carry out in partnership
with you, and other health professionals who provide treatment and rehabilitation services.
It is your expertise and dedication that are the main drivers of your patients’ recovery.
However, the funding and support available through ACC play an integral role in creating
successful rehabilitation outcomes. Our partnership is therefore an important one, and it is
vital to the wellbeing of the clients we serve.
This Handbook has been created to help us work together as effectively as possible in this
partnership. It gives you a thorough overview of what ACC is, how it works and, most
importantly, the processes that need to be followed to ensure we work together in the best
interests of our clients.
The Handbook covers everything from your responsibilities as an ACC-registered
treatment provider to details about how to lodge claims, order ACC resources and invoice
us for your services. It also talks about the important of our clients’ right to privacy and
your role to play in this.
If you’re not familiar with any of the terms used in the Handbook, please refer to the
Glossary. You can also get more information by calling one of our toll free enquiry
numbers or sending us an email (you’ll find contact details on p4) or visiting our website at
www.acc.co.nz.
I trust you will find the Handbook both helpful and easy to use, and I wish you well as we
begin this important partnership together.
Yours sincerely
Scott Pickering
Chief Executive
ACC

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ACC Treatment Provider Handbook 2014
ACC on the map
KEY
AUCKLAND
Branches
Branches


· Manage high-complexity claims
· Auckland (Sale Street)
· Henderson
Service Centres 
· Counties Manukau
· Receive al  claims
· North Harbour
· Register claims
· Assess claims for cover (or stream to
Service Centres

the appropriate unit)
·
· Northern Service Centre
Manage accidental death, hearing
loss, and dental claims
Whangarei

· Assess requests for lump sum/
independence al owance, ancil ary
services, aids and appliances
· Process claim-related invoices to
service providers
· Provide additional support functions
$ Auckland 
(eg Provider Helpline, provider
Tauranga
registration)

$
H
  amilton
Whakatane


Short-Term Claim Centres 
Rotorua

· Manage low-complexity claims
Gisborne

New Plymouth
Inquiry Centre (in-bound calls) 

· Customer queries and cal  sweeping
Hawke’s Bay

Wanganui 
Weekly Compensation $
Palmerston North
·

Calculate weekly compensation
· Process weekly compensation
Porirua
 Masterton
payments to clients
 Lower Hutt


Nelson 
Wellington
WELLINGTON
Greymouth 
Branches 
· Wel ington
 Northwood
 Christchurch $
Other
· Corporate Office
· Sensitive Claims Unit
Timaru

· Serious Injury Unit
· Treatment Injury Unit
Alexandra
· Business Service

Centre
 Dunedin 

$ 

Invercargil

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ACC Treatment Provider Handbook 2014
How ACC cover works at a glance
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o
Injured person visits
Injured person & provider or hospital

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treatment provider or hospital
complete & lodge ACC45 Injury Claim form
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la in
im g
ACC receives claim & decides on cover
Decisions for specialised claims are referred to either the:
• Gradual Process team
•
C
Treatment Injury Centre
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• Sensitive Claims Unit
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• Dental team
irm
• Hearing Loss team
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• Accidental Death team
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Cover is declined:
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see also Review & Appeal
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process, or other care options
Cover is accepted
Minor claims
Low-complexity
High-complexity
(medical fees only)
(managed claim)
(managed claim)
M
ana
·
Provider helps client recover
Client is supported by:
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i
·
ACC partial reimbursement
Client is supported
n
• ACC case manager, or
g
of medical costs
by ACC case
•

National serious injury
t
coordinator
h
    coordinator
e claim
Provider helps client recover
Rehabilitation and/or treatment can include:
• acute treatment   • Public Health Acute Services   • elective surgery
• pharmaceuticals   • imaging   • specialised inpatient
f
ts
   rehabilitation   • training for independence • transport
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en
• weekly compensation  • home-based rehabilitation   • house or
p
   vehicle modifications  • rehabilitation programmes (eg Stay at Work,
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   social rehabilitation)
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ACC may review ongoing cover and/or entitlements at any time
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Accident Compensation Corporation
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ACC Treatment Provider Handbook 2014
Key ACC contacts for treatment providers
Provider Helpline
Ph: 0800 222 070
Email: [email address]
Client/Patient helpline
Ph: 0800 101 996
Urgent home help
Hamilton: 0800 222 891
Wellington: 0800 181 306
(fax numbers during
ACC office hours)
Christchurch: 0800 222
Dunedin: 0800 633 632
359
Provider Registration
Ph: 04 560 5211
Email: [email address]

Fax: 04 560 5213
Post: ACC, PO Box 30 823
Lower Hutt  5040
ACC eBusiness
Ph: 0800 222 994 option 1  Email: [email address]
Medical fees units for
For regions north of New Plymouth and Gisborne:
invoices, schedules,
ACC32 treatment
Post to: ACC Northern Service Centre,
Fax: 09 354 8301
requests
PO Box 90 341, Victoria Street West,
Auckland  1142
For New Plymouth, Gisborne and all areas south
Post to: ACC Dunedin Service Centre,
Fax: 0800 222
463
PO Box 408, Dunedin  9054
Stationery Order Line
Ph: 0800 802 444
(forms and brochures)

Dental Stationery
Ph: 0800 226 440
Sensitive Claims Unit
Ph: 0800 735 566
(sexual assault)
Health Procurement
Ph: 0800 400 503

(for health service
contracts only)
Fraud Helpline
Ph: 0800 372 830
Post: ACC, PO Box 1426
Wellington  6140
ACC website
www.acc.co.nz

My local ACC contact
Name:
Ph:
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Fax:
Email:
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Accident Compensation Corporation
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link to page 102 link to page 17 ACC Treatment Provider Handbook 2014
2.
How the scheme works & working
with us
About the ACC scheme
How the ACC scheme works
The ACC scheme provides comprehensive, 24-hour, no-fault cover and entitlements for all
New Zealand citizens, residents and temporary visitors who sustain certain types of
personal injury in New Zealand, generally those resulting from accidents. The Scheme is
mandated by law, in particular by the Accident Compensation Act 2001 (AC Act 2001).
ACC is responsible for:
·  helping to prevent the circumstances that lead to injuries at work, at home, at play,
on the road and elsewhere
·  providing cover for personal injuries, no matter who is at fault
·  reducing the physical, emotional and social impacts of people’s injuries by funding
timely treatment and rehabilitation that gets them back to work or independence as
safely and quickly as possible
·  minimising personal financial loss by paying a contribution to treatment costs,
paying lump sum compensation and providing weekly compensation to injured
people who can’t work because of their injuries.
We’ve put together a Glossary that helps explain the terms we use in our policies and
procedures for claims, treatment, and with providers.
Note: This handbook has been produced to assist you to work within the parameters of

the Scheme and what you need to know  about the legislation and regulations that govern
what we’re able to do.  We haven’t set out everything here and ask that, if in doubt and for
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legal purposes you refer to our governing legislation and regulations that apply.
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ACC’s governing legislation
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The AC Act 2001 is ACC’s governing legislation. It sets out what we are able to cover and
that the help we provide clients is both appropriate and of the required quality.
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ACC’s policy requirements
ACC has a number of policies and procedures to ensure that we deliver the outcomes
required by our legislation and provide appropriate treatment and rehabilitation for our
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clients.
These include:
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·  promoting current treatment protocols, guidelines and evidence-based practice
·  encouraging providers to stay up to date with the latest developments in ACC policy
·  requiring providers’ clinical records to be of a standard acceptable to their relevant
practitioner body and/or the HPCA Act
How the s
·  promoting compliance with the ‘Hauora Māori - Cultural Competency’ clause in all
provider contracts, when they work with Māori (see Services to Māori)
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link to page 29 ACC Treatment Provider Handbook 2014
·  promoting the Guidelines on Māori Cultural Competencies for Providers as a best-
practice model when working with Māori
·  monitoring appropriate outcomes for Māori
·  monitoring health care services
·  assessing provider claims, both random and targeted
·  investigating any concerns about the need for treatments, or the appropriate
number, length or quality of treatments
·  taking legal action if dishonest claims are made
·  recovering any funding for claims that are charged for inappropriately.
Legislative and policy requirements for providers
When we ask providers to assist in the treatment of clients we’re guided by three things:
1.  Legislation and policy.
2.  Standards set by professional bodies.
3.  Major health sector frameworks such as the Health Practitioners Competence
Assurance Act 2003, (the HPCA Act). The HPCA Act protects the public’s health
and safety by ensuring the competence of health practitioners for the duration of
their professional lives. Having one legislative framework allows for consistent
procedures and terminology across the many professions now regulated by the
HPCA Act.
For more information, see the HPCA Act online or the Ministry of Health commentary on
the Act.
Your partnership with ACC

Your role in our partnership
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We work with injured people and their families in an extended partnership with you, our
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treatment providers, other health sector professionals, employers and supporting groups.
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Some of you will have occasional contact with patients who become ACC clients, while
others of you may work with our clients daily. This handbook explains how to work with us,
and the formal arrangements such as policies, processes and tools that govern the way
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we work and the help we can offer clients.
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As a health services provider seeking funding to treat clients with ACC covered injuries,
you’ll have certain responsibilities. These include:
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·  complying with the ACC Act 2001, our polices and procedures, and your
professional standards when treating and making claims for ACC clients
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·  providing our clients with clinical treatment that meets the requirements of best
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practice and the standard of your professional body
·  providing treatment and advice that assist ACC clients to return to work and/or
independence
·  following the ACC Treatment Profiles. See the ACC Website
·  maintaining appropriate clinical records. See Clinical records
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·  invoicing appropriately, including those providers who are registered with more than
one professional body.
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ACC Treatment Provider Handbook 2014
We encourage you to get to know us and to feel free to make personal contact with us
locally, e.g. through your local Supplier Manager, or your local branch.
Supplier Managers – key contacts
Supplier Managers work in the community with our contracted and non-contracted
suppliers in the following ways:
·  providing education and support to treatment providers
·  helping treatment providers work within ACC’s policies and processes
·  managing performance as well as relationships.
You’ll find where our Supplier Managers are located on the map on the next page.

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ACC Treatment Provider Handbook 2014
Supplier Managers on the map
For more information about Supplier Managers see Supplier Managers Contact Details
Northland: 1 SM
Whakatane/
Tauranga: 1 SM
Rotorua/
Taupo: 1 SM
Auckland: 4 SMs
* North * South
* West * Central
Hamilton/Waikato: 1 SM
New Plymouth/
Whanganui: 1 SM
Palmerston North: 1 SM
Hawke’s Bay/
Gisborne: 1 SM
Nelson/Marlborough: 1 SM

Wellington: 2 SMs
* Central, Porirua &
Hutt * Wairarapa,
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Wellington &
Palmerston North
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Christchurch: 3 SMs
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&
South Canterbury/
Timaru/Dunedin: 1
SM
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Central Otago/
Southland: 1 SM
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Accident Compensation Corporation
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link to page 12 link to page 12 link to page 17 link to page 46 ACC Treatment Provider Handbook 2014
What ACC covers
Treatment cover
ACC receives about 1.8 million claims a year for personal injuries including mental injuries.
See also, Rehabilitation and treatment entitlements and the full Treatment cover section.
The most common injuries we cover are caused by:
·  accidents at work, at home or on the road
·  work-related gradual processes, diseases or infections
·  treatment injuries
·  sexual assault or abuse.
Advice on cover criteria
If you’re unsure about advising patients on possible ACC cover, phone the Provider
Helpline on 0800 222 070 or email [email address]. Alternatively, ask your patient
to get in touch through the Client/Patient helpline on 0800 101 966 or by emailing
[email address].
Personal injuries
Personal injuries cover:
physical injuries (including fatal injuries) which typically include:
·  wounds
·  lacerations
·  sprains

·  strains
·  fractures
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·  amputations
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·  dislocations
·  some dental injuries
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work-related gradual process injuries, diseases or infections, which cover a range of
physical deteriorations caused over time by work or the work environment, e.g.:
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·  asbestosis
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·  work-related hearing loss
treatment injuries, i.e. physical injuries sustained while receiving treatment from registered
health practitioners.
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Mental injuries
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Cover for a mental injury is provided if it was caused by:
·  a physical injury
·  a specific event in the workplace
·  sexual assault or abuse.
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Accident Compensation Corporation
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link to page 102 link to page 57 link to page 113 link to page 102 ACC Treatment Provider Handbook 2014
Mental injuries caused by physical injuries
This is a category of mental injury that is always connected to an original ACC-covered
physical injury claim. If a person suffers a covered mental injury arising out of a physical
injury then it gets treated as a single claim, rather than separate claims.
Mental injuries caused by witnessing a traumatic event at work
This category of mental injury came into effect on 1 October 2008. It refers to an event that
was directly experienced by a person who was in close physical proximity to the event.
That means they need to have experienced the event by seeing or hearing it.
Mental injuries caused by sexual assault or abuse
Mental injuries arising from this type of criminal offence are called sensitive claims. For
more information see Schedule 3 of the AC Act 2001 or the Glossary.
Mental injury is a complex area and can sometimes be difficult to determine cover.
Decisions are made in each case on the basis of diagnosis and evidence provided by a
psychiatrist or psychologist in their report to us. In order to receive cover, the information
provided in the report needs to prove that their patient’s physical injury, the traumatic event
at work or the sexual assault or abuse was a direct and significant cause of the mental
injury.
For more details about the assessments used to determine treatment options for mental
injuries, see Mental injuries, sensitive claims and counselling.
What ACC is unable to cover
ACC is not able to cover:

·  injuries to teeth arising from their natural use, e.g. biting a boiled sweet
·  cardio-vascular or cerebro-vascular disease, unless they are a result of treatment
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injuries or work injuries involving effort that is ‘abnormally applied’ or ‘excessively
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intense’
·  gradual process injuries that are not caused wholly or substantially by work-related
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gradual processes, diseases or infections
·  personal injuries caused wholly or substantially by the ageing process (if medical
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opinion confirms that the injuries would not have happened without the ageing
process)
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·  personal injuries caused by illness
·  the emotional effects of injuries such as hurt feelings, stress or loss of enjoyment,
unless they result from a mental injury
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·  injuries caused by coughing or sneezing, or other internal forces
Situations where we’re unable to provide some entitlements
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In some cases a person’s injury will be covered, but we’re unable to provide some
entitlements, e.g. in some instances of self harm or criminal disentitlement (see the
Glossary). If you are treating a patient with a claim of this nature, please encourage them
to contact the helpline as soon as possible by phone on 0800 101 996.
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Accident Compensation Corporation
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ACC Treatment Provider Handbook 2014

Who ACC covers
Three categories of people covered by ACC:
·  all New Zealanders, 24 hours a day, whether or not they are earning an income
·  New Zealanders who are injured overseas (with certain criteria)
·  visitors to New Zealand (with certain criteria).
Code of Claimants’ Rights
All ACC claims are managed under the Code of ACC Claimants’ Rights. These rights are
covered in the pamphlet ACC2393 Working together to resolve issues.
The pamphlet explains what clients can do if they are unhappy with the service they
receive and outlines what they can expect from ACC in their dealings with us.
For more information see Code of Claimants Rights: respect, culture, and values.
Cover for Kiwis injured overseas
New Zealanders may also be able to receive support
back in New Zealand if they were injured overseas. They
just need to meet ACC’s ‘ordinarily resident’ criteria.
Eligible New Zealanders may also receive payment for
overseas treatment if they suffered work-related personal
injuries overseas. ACC isn’t able, however, to reimburse
New Zealand providers for treatment given overseas (e.g.

when accompanying sports tours). Providers can only
receive payment when working in New Zealand.
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See the information sheet ACC593 Getting help with an
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injury if you’ve been travelling overseas. You can order
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this online or by phoning the Stationery Order Line on
0800 802 444, option 0, and quoting the ACC number in
the title (e.g. ACC593).
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&
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ACC Treatment Provider Handbook 2014
Cover for visitors to New Zealand
Visitors to New Zealand are covered for personal injuries and ACC
can help pay for treatment while they’re in New Zealand once the
claim’s accepted. We’re not able to reimburse visitors for
rehabilitation or treatment costs in their home countries, or for loss of
income.
The information sheet ACC592 ‘Getting help if you’re injured visiting
our country’ can be ordered online or by phoning the Stationery
Order Line on 0800 802 444, option 0, and quoting the ACC number
in the title.
The brochure is also available in Māori, Samoan, Tongan, Cook
Island Māori, Chinese, Hindi and Korean. You can select the
brochure in the language you want at the ACC website under For
Providers > Publications > In your language.

Cover for Kiwis in New Zealand
The information sheet ACC583 Help for injuries explains for clients
how the claims process works in New Zealand.
You can order this online or by phoning the Stationery Order Line on
0800 802 444, option 0, and quoting the ACC number in title.

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Terminology: clients and patients
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ACC uses the word ‘clients’ to describe patients whose claims have been accepted for
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cover and have therefore become ACC clients. The term is used throughout this
Handbook to reinforce the importance of lodging claims in order to access entitlements for
people. We recognise, however, that you may prefer to use alternative terms.
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ACC Treatment Provider Handbook 2014
Cultural services
The Cultural Services team
ACC’s Cultural Services team is a group of cultural case advisors including Pae Ārahi
(Māori cultural case advisors), Pacific cultural case advisors and Asian cultural case
advisors. You can contact these advisors through case managers and other frontline staff
in ACC.
Code of Claimants’ Rights: respect, culture and values
All ACC claims are managed under the Code of ACC Claimants’ Rights..
The pamphlet explains what clients can do if they are unhappy with the service they
receive and outlines what they can expect from ACC in their dealings with us.
You can order this online or by phoning the Stationery Order Line on 0800 802 444, option
0, and quoting the ACC number in title.
It’s available in eight languages and each language has a different ACC number at the
beginning of the title:
ACC2393 (English), ACC5320 (Cook Islands Māori), ACC5321 (Samoan), ACC5322
(Tongan), ACC5323 (Māori), ACC5324 (Hindi), ACC5325 (Chinese), ACC5326 (Korean).
For more information, see the legislation covering ACC claimants’ rights.
Māori cultural guidelines
The ACC booklet ACC1625 Guidelines on Maori Cultural

Competencies for Providers can be viewed online. It was
created to help you give appropriate advice, care and
treatment to Māori clients.
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You can order this online or by phoning the Stationery Order
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Line on 0800 802 444, option 0, and quoting the ACC
number in title.
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The booklet comes with a DVD and is available as:
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·  an A4-size document with the code number
ACC1625, or
·  a shorter version with the code number ACC1626.
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Please quote the ACC number and your provider number
when ordering.
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link to page 66 ACC Treatment Provider Handbook 2014
Treaty of Waitangi
In line with our Treaty of Waitangi obligations for Māori and also our obligations to the
people of the Pacific Islands and Asia, ACC obtains input from Cultural Services for
appropriate service delivery and to ensure these clients have positive experiences of our
service.
Services to Māori
ACC is committed to ensuring that appropriate services are delivered to all who meet our
entitlement criteria. However, we know that Māori make significantly fewer claims than
New Zealand Europeans.
You can play a key role in helping to address disparities by, for example, ensuring that
your services are more engaging to Māori
If you’re a new provider you can indicate your ethnicity or language capability on the
ACC24 application form. This can enable us to offer your treatment services to clients
seeking services from culturally experienced providers.
Alternatively you can contact the ACC Provider Registration team by phoning 04 560
5211, emailing [email address] or writing to ACC Provider Registration, PO Box
30 823, Lower Hutt 5040.
All our service contracts have a ‘Hauora Māori – Cultural Competency’ clause. The clause
outlines the criteria with which providers must comply with during tendering and evaluation
processes and while delivering services to Māori. It aims to ensure that services are
delivered to Māori clients in ways that recognise and respect Māori cultural values and
beliefs.

Services for Asian and Pacific peoples
In the past few years ACC has also concentrated on increasing access for Asian and
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Pacific peoples through respective access strategies and community outreach. With recent
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evidence that shows improved access by Asian and Pacific peoples, ACC is now
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concentrating on achieving best rehabilitation outcomes for Asian and Pacific clients.
Rehabilitation and treatment entitlements - overview
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Managing rehabilitation
Rehabilitation is important in returning injured people to work and independence. To
enable rehabilitation ACC engages with providers to deliver necessary services. If a
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client’s injury is significant, it’s managed in a branch by a case manager who has access
to a panel of experts, typically a medical advisor, a branch psychologist, a technical
advisor and a team manager with a rehabilitation focus. These experts will help the case
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manager by giving direction for rehabilitation.
The aim of rehabilitation is to help restore a client’s pre-injury health, independence and
participation in society as much as possible.
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For more information on rehabilitation please see Section 7 - Rehabilitation.
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link to page 22 link to page 62 ACC Treatment Provider Handbook 2014
Managing treatment
Treatment includes:
·  physical rehabilitation
·  cognitive rehabilitation
·  examinations or assessments for the purpose of providing a certificate to ACC
(such as a medical certificate for time off work, or assessments to help determine
treatment plans).
ACC supports clients’ treatment by contributing to:
·  client consultations and procedures delivered by treatment providers, according to
the Injury Prevention, Rehabilitation, and Compensation [IPRC] (Liability to Pay or
Contribute to Cost of Treatment) Regulations 2003. See also, How ACC Pays.
·  treatment services such as elective surgery and hand therapy, usually under
contract
·  pharmaceuticals prescribed for ACC-covered injuries (see also Pharmaceuticals)
·  bulk funding to the Crown for emergency department, acute inpatient and follow-up
medical outpatient services, and some associated ancillary services.
Increasingly, multiple interventions are used alongside treatment, including ‘non-clinical’
tools such as exercise programmes and education for clients.
We encourage you to participate in early planning and discussions with clients, and may
also pay for you to attend case conferences where multiple parties, including families and
employers, can be represented.
What help clients can receive
ACC clients can receive a range of treatment and rehabilitation services and may also be

eligible for compensation.  The AC Act 2001, which forms the legislative base for most of
ACC’s activities, outlines what clients with approved cover may be entitled to receive.
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This includes:
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·  weekly compensation while a client is unable to work
·  lump sum compensation for permanent impairment
·  rehabilitation, which covers:
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- treatment
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- social rehabilitation (support in everyday living activities)
- vocational rehabilitation (support to maintain or obtain employment)
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- associated ancillary services.
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·  accidental death – help for survivors.
Details on these entitlements are listed in the sections below.
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link to page 70 ACC Treatment Provider Handbook 2014
Weekly compensation
Clients may be eligible for compensation for lost earnings if they need to take time off work
because of their injuries.
Only medical practitioners and nurse practitioners can certify time off work for ACC clients.
The exception is for the first week off work after a work-related personal injury, when the
client’s employer can nominate and pay a registered health professional, e.g. a nurse,
occupational therapist, physiotherapist, to complete the certificate.
For more information see Medical Certificates, ACC18.
Lump sum compensation
Lump sum compensation is generally available for clients whose injuries lead to
permanent impairment. The type of compensation available is based on claim type.
You can get more information through the Provider Helpline on 0800 222 070 or by
emailing [email address]. Your patient can get more information by calling the
Client/Patient Helpline on 0800 101 996.
The information sheet LSIAIS01 All About Lump Sum Payments & Independence
Allowances also gives details on lump sum compensation calculation procedures.
Social rehabilitation
Social rehabilitation is available to support clients whose injuries have a moderate or
significant impact on their lives. It supports the client’s rehabilitation through services such
as:

·  home and community support services, e.g. home help, child care, attendant care
·  equipment that is based on the client’s assessed needs, e.g. wheelchairs, shower
stools and walking frames
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·  modifications to the home or vehicle
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·  needs assessment services
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·  post-acute rehabilitation delivered by DHBs and some Trust Hospitals.
The aim of social rehabilitation is to help clients achieve as much independence as
possible. For details on the assessment criteria for social rehabilitation, see Social
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rehabilitation assessment
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Specialised rehabilitation
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Specialised rehabilitation is available to support clients whose injuries have a significant
long-term (or life-long) impact on their lives. It supports the client’s rehabilitation through
services such as:
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·  residential rehabilitation services
·  transition services
·  ‘Training for Independence’ programmes
·  community based services
·  disability support services
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·  education support.
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link to page 67 link to page 66 ACC Treatment Provider Handbook 2014
The aim of specialised rehabilitation is to help clients achieve the best possible outcomes
by providing early intensive rehabilitation and community support
For details on specialised rehabilitation, see ACC Contracts
Vocational rehabilitation
Vocational rehabilitation is available to help clients recovering from significant injuries to
maintain or obtain work, or to regain vocational independence. Where possible, it’s best for
clients to stay in their pre-injury jobs. Together with suppliers and providers, we can help
them to do this by:
·  reviewing their working environment and discussing ways to help them do all or
some of their work tasks as their rehabilitation progresses
·  providing equipment to help them at work
·  helping with pain management.
In some cases clients start in stay at work programmes before they return to work and
while they are rehabilitating. Employers are asked to take all practical steps to help injured
employees rehabilitate, regardless of whether their injuries are work related.
We have a range of tools to help clients who are unable to return to their pre-injury jobs.
These include:
·  initial occupational assessments which identify the types of work that may be
suitable for them
·  initial medical assessments which identify whether those types of work are
medically sustainable and if any further rehabilitation is required
·  work readiness programmes which include pre-employment preparation and/or
strengthening programmes and can include work trials.

Following rehabilitation, we may ask a client to have their vocational independence
assessed by an occupational assessor and a medical assessor. This is to ensure that the
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full extent of rehabilitation has been provided and we have addressed any injury-related
barriers to employment or vocational independence. The assessments will help determine
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whether the client can return to work full time or whether further alternative rehabilitation is
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necessary.
For details on vocational rehabilitation see Work and rehabilitation.
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Pain management services
Pain Management services aim to reduce a client’s pain through exercise activities and
education. Early screening can determine if a client will need further assessments to
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establish if they have an increased risk of disability.
A pain management programme works best for the client when there’s a clear connection
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between the programme and getting the client back to independence. This is achieved
when:
·  the programme sets client-specific goals to restore independence for pre-injury
activities, e.g. vacuuming, or getting in and out of a truck
·  the client can continue the programme once the formal supervision has finished, if
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·  the client is comfortable that there isn’t any other reason(s) for their pain, i.e. red
flags have been dismissed.

ACC has a range of tools to help clients identify, manage and recover from pain. These
include:
·  a functional reactivation programme
·  a progressive goal attainment programme
·  pain management psychological services
·  a pain disability prevention programme
·  comprehensive pain assessment
·  an activity focus programme
·  a multidisciplinary pain programme
·  interventional pain management
For details on vocational rehabilitation see Pain Management Services.
Accidental death – help for families
When we accept a claim for entitlements arising from fatal injuries, we can help with:
·  a funeral grant (to the maximum amount set by regulations)
·  a grant (for the spouse, children and other dependants)
·  weekly compensation for the dependants if the deceased person was in
employment at the time they died (the spouse can apply to convert this into a lump
sum)
·  payments to cover childcare for the deceased’s children.
Ancillary services

Ancillary services help clients to access treatment and rehabilitation. They include:
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·  pharmaceuticals and laboratory services
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·  emergency transport by ambulance, and transport to treatment
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·  transport to and from certain types of vocational and social rehabilitation
·  travel for support people in specific situations
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·  help with accommodation for clients and/or their support people.
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When a client’s care is being funded under the Public Heath Acute Services (PHAS)
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agreement, the DHB provides their ancillary services.
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Helping clients to understand what help they can receive
Our clients often ask their treatment providers about what help they
can get from ACC and how ACC works. While we don’t expect
treatment providers to understand all of the ins and outs of the
scheme the brochure ACC2399 Getting help after an injury covers
the basics of how we can help.
You can order free copies by phoning the Stationery Order Line on
0800 802 444, option 0, and quoting the ACC number in the title.
For detailed information you can direct clients to www.acc.co.nz.
Under ‘Making a claim’ where they can click on What support can I
get? They can also call the client/patient helpline on 0800 101 996.
If you have any questions about entitlements, please contact the
Provider Helpline either by phone on 0800 222 070 or by email at
[email address].

How ACC pays
Criteria for covering costs
ACC pays for, or contributes to, the costs of treating a covered personal injury. See also
Invoicing and payments and Electronic invoicing: eSchedules.
ACC makes decisions according to the AC Act 2001 and regulations, which states that
treatment must:

·  be necessary and appropriate
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·  meet the quality required
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·  be given the appropriate number of times, and ‘in person’
·  be given at the appropriate time and place
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·  be reasonably required to facilitate treatment (for ancillary services)
·  normally be provided by your type of treatment provider, and you must be qualified
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to provide that treatment
·  have prior approval (if required).
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In deciding whether these points apply to a client’s treatment, the AC Act 2001 says that
ACC must take into account the:
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·  nature and severity of the injury
·  generally accepted treatment for the injury in New Zealand
·
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  other treatment options available in New Zealand for such an injury
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·  cost in New Zealand of both the generally accepted treatment and the other
options, compared with the benefit to the client of the treatment.
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Requirements for providers seeking payment
Providers seeking payment from ACC for services or treatment must ensure that:
·  the service provided and invoiced for includes clinical records that meet ACC’s
recommendations and their profession’s standard
·  clinical records demonstrate that the treatment provided meets the legislative
requirements (listed above)
·  the treatment provided and the clinical records can withstand scrutiny through peer
review, an audit (medical or financial) or a medico-legal challenge
·  the date of an appointment is the same on the invoices as recorded in any clinical
notes.
Our policy on treating yourself or your family
ACC agrees with the statement of the Medical Council of New Zealand that “other than in
exceptional circumstances you should not provide medical care to yourself or anyone with
whom you have a close personal relationship”. ACC considers this to be relevant to all
types of treatment providers and includes treatment of work colleagues.
We generally consider it unacceptable and unethical for providers to claim payment from
ACC for treating those that are close to them. We will only consider paying for treatment in
exceptional circumstances.
Exceptional circumstances include:
·  acute treatment provided in an emergency situation where, in your reasonable
judgement, the need for treatment is urgent given the likely clinical effect on the

person of any delay in treatment
·  situations in rural areas where there is no other appropriately qualified treatment
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provider available to give the required treatment.
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We’re unable to fund:
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·  treatment provided in a non-emergency situation.
·  emergency treatment that would ordinarily be provided by a family member who is
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not a provider
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The provider claim lodgement framework
To enable us to verify claims lodged on behalf of patients, we have worked with
professional bodies to incorporate ‘scopes of practice’ into our frameworks.
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The ‘provider claim lodgement framework’ covers various injury types. It refers to common
Read Codes to show which injuries a provider can complete an ACC45 Injury Claim form
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and provide initial treatment for. If the injury is within the provider’s scope of practice we
can make a cover decision.
If the injury is not within a provider’s scope of practice (as defined in the provider claim
lodgement framework) the provider can give initial treatment and initiate the process of
How the s
completion of an ACC45 form. They must then refer the client to a medical practitioner for
confirmation of diagnosis before we can determine cover.
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This means the patient will see two providers before their claim is considered. ACC will
pay for the initial treatment but won’t be able to pay for any subsequent treatment until a
suitably qualified practitioner has completed lodgement. The types of providers this rule
applies to include acupuncturists, osteopaths and speech therapists.
For more information on lodging claims, see the online documents:
·  Provider claim lodgement framework
·  Lodge a claim electronically
·  Lodging a claim with ACC or an Accredited Employer.
How ACC funds providers in training
ACC only pays for treatment given by qualified treatment providers who take full
responsibility for their treatment.
If you’re a provider in training (e.g. an intern, or a university or polytechnic student
undertaking practical work for their study) we can provide funding if you’re:
·  already a qualified practitioner who is undertaking further study, or
·  unqualified but have gained consent from the client, and are supervised by a
qualified practitioner who is personally present throughout the treatment delivery
and takes responsibility for assuring its standard.
Note: An important exception is that sexual abuse counselling must always be provided by
a fully qualified counsellor.
Three ways to provide services to ACC
There are three different ways to provide services to ACC:

·  Service Contracts
Every ACC contract for services includes details of the invoicing and payment
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arrangements that apply to those who sign it. Contract terms can differ from the
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Regulations, and when this happens the contracted terms take precedence over the
Regulations.
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·  Payments under agreed costs
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Agreements between ACC and the providers based on the treatment costs. If an ACC
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case manager requests services at an agreed cost, you’ll need to request a seven digit
purchase order number from ACC. This needs to be included on every invoice. For more
information, phone the Provider Helpline on 0800 222 070 or email
[email address].
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·  regulations,  e.g. the:
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-  IPRC (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003
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-  IPRC (Ancillary Services) Regulations 2002
-  PHAS (Public Health Acute Services) Regulations 2002
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-   any later amendments (‘the Regulations’).
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Payments under Regulations
The Regulations cover a large number of treatment providers, including:
·  Acupuncturists
·  Audiologists
·  Chiropractors
·  Counsellors
·  Dentists
·  Hyperbaric oxygen treatment providers
·  Medical Practitioners
·  Nurses or nurse practitioners
·  Occupational therapists
·  Osteopaths
·  Physiotherapists
·  Podiatrists
·  Radiologists
·  Registered specialists
·  Speech therapists
ACC contributes to treatment costs at the rates/amounts specified in the Regulations. The
Regulations cover basic treatment provider costs, while Schedules to the Regulations
specify amounts for treatments/procedures types.
These include rates/amounts:
·  per consultation/visit, as long as you examined, assessed and/or treated the client
in person, for an injury or condition covered by ACC (for details see,
Consultations/Visits).

·  per treatment/procedure given to a client during a consultation/visit as long as the
Schedule includes an amount for that treatment/procedure for your type of provider.
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Providers’ payment options
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If you’re a ‘Specified Treatment Provider’ (or ‘Allied Provider’) working under the
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Regulations you have the choice of being paid on a per-treatment basis or on an hourly-
rate basis. These hourly rates are also specified in the Regulations. For details see,
Specified treatment providers.
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Treatment/Procedure guide for medical practitioners and nurses
For guidance on items in the Regulations for medical practitioners and nurses see Guide
to invoicing for medical practitioners and nurses.
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How to find Regulations online
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Information sheets regarding the Cost of Treatment Regulations, which give information on
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the amounts you are able to claim from ACC, can be found online at New Zealand
legislation.
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Privacy
We take privacy seriously
ACC deals with personal and health information for a large number of people. Sometimes
you’ll need access to this information to carry out services for ACC.
It’s important to us that we each do our part, and work together to protect this information.
This includes doing everything we can to make sure it’s not mishandled.
Not only does this help us meet the requirements of the Privacy Act 1993 and Health
Information Privacy Code 1994, but it also enables us to work with an enhanced level of
transparency on breaches/near misses.
To achieve a high level of transparency we expect all providers to have effective
preventative measures in place to avoid breaches and near misses.
What to expect
If you have access to personal or health information we would like you to:
·  work with us in a transparent way
·  notify us of potential risk
·  notify us of a breach or near miss
·  resolve issues as they arise
·  maintain a privacy register that includes breaches, near misses and remedial action
plans.
What do we mean by ‘breach’ and ‘near miss’?

A breach is when personal information is disclosed to an external party when it should not
have been, e.g. by error, mistake or without legal authority.
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A near miss is when you can identify something you, or your staff, did that would have lead
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to a privacy breach but didn’t because the information wasn’t disclosed.
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Obligations
Every business has obligations under the Privacy Act 1993. When dealing with personal
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information, you need to ensure you comply with the 12 Information Privacy Principles that
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cover the collection, handling and use of personal information, set out in the Act. The Act
also requires every business to have a Privacy Officer to oversee their compliance with the
Act and investigate any complaints when they arise.
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A Privacy Pack has been developed to help you with managing the privacy of your client’s
person information. It is available from our website and was developed with information
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from the Office of the Privacy Commissioner.
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Further information can be obtained by contacting the Office of the Privacy Commissioner
either online at www.privacy.org.nz or by calling their helpline on 09 302 8655 (or 0800
803 909). You can also refer to ACC’s Privacy Management section on our website
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3.
Supporting quality
Resources for providers and clients
Resources to help you
ACC produces a range of resources to inform, encourage and support the use of best
clinical practice. They include:
Case studies
These are in-depth studies on the diagnosis and treatment practices used by providers for
particular health issues. They allow you to compare you own practices on selected health
issues with those of your peers, and with the views of expert commentators. Case studies
are developed by surveying treatment providers on their diagnosis and management of a
specific case, described in a vignette. The responses are then collated and published
along with expert commentary
Feedback reports
ACC has created a suite of feedback reports as part of its work to support performance
excellence. These are provided at both a provider and supplier level. The reports
summarise treatments provided and in some cases compare them with peer or overall
data. They aim to provide a valuable opportunity to help you self-evaluate and
consider decision-making approaches.
ACC reviews
ACC reviews summarise the latest best practice on injury management and rehabilitation
from a clinical perspective, drawing on recent available evidence and clinical guidelines.
The reviews are developed by clinical subject matter experts in conjunction with ACC staff
and relevant peer review groups.
Clinical practice guidelines
Clinical practice guidelines help providers and clients to make decisions about medical
care in specific clinical circumstances using the best available evidence. Developing
guidelines is a systematic process that involves reviewing evidence, consulting clinical
experts and working with multidisciplinary advisory groups
Well Said
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Well Said is ACC’s bi-monthly email newsletter and website for providers. It’s designed to
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help keep you up-to-date with what’s happening at ACC and things that could affect you. It
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includes everything from sector news and clinical best practice to key events that may be
of interest. It’s also where you can access the latest case studies and send us feedback.
You can subscribe to receive an email containing highlights of what’s in each issue at
www.wellsaid.co.nz. Or you can visit the website anytime and search through back issues
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Resources for clients
You can help your patients to understand their injuries by giving them information from the
‘caring for your…’ leaflet series. This series gives clients tips on how to look after their
injuries.
These leaflets are available from our website to order through the Publications section.
Research
Research involvement
ACC invests in ongoing research as part of our commitment to ensuring the most
appropriate rehabilitation and treatment for clients. This is often done in collaboration with
partners in the broader clinical and health sectors.
Our Research team conducts in-house research, and manages research done by external
agencies that is funded by ACC. We also partner in research, where initiatives can cover
consensus guidelines, evidence-based health care, and innovations in rehabilitation and
treatment.
Research advice
The Research team is committed to the principles of evidence-based health care. It helps
to inform our decision-making, guides our health purchasing and supports best practice
among treatment providers. The team’s objectives include:
·  providing advice to ensure that ACC’s purchasing decisions are based on good
evidence
·  promoting best practice in injury management and rehabilitation
·  evaluating new ACC services and primary health care initiatives
·  consulting and collaborating with health care providers
·  seeking feedback from providers and other partners through surveys and market
research
·  identifying new and emerging issues that might affect ACC in the future.
Research partnerships
The team uses accepted methods to summarise and evaluate existing clinical research on
effectiveness and safety. This is followed by a considered judgement process that involves
consulting treatment providers and other experts to recommend effective practice.
In partnership with a purchasing advisory group that also includes providers and other
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experts’, the team advises on which treatments, products and services ACC should
purchase.
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Visit our website www.acc.co.nz for recent evidence-based healthcare reports, Considered
Judgement Forms (which support the purchasing advisory group discussions) and
information about the Research team.
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Clinical records
ACC’s emphasis on clinical records
Your clinical records should show the history you obtained, the examination you
undertook, how you formulated your diagnosis, and how you planned a client’s treatment.
Reviewing your records will help ACC and others to see how you reached your
conclusions.
It can be easy to forget details of a client’s presentation or what you said and did in the
consultation/visit. Good clinical note-taking can help you to review your practice and avoid
uncertainties.
In the unlikely event of a complaint or adverse event for a client, good records help to
show your standard of care and document your decisions and advice. It is therefore vital
that you keep full and accurate clinical records, for your own and the clients’ protection and
support.
All bodies endorse the responsibility of professionals to regard record-keeping as a key
area of competence, and most have processes to support and encourage this. Each
profession also has its own standards for record-keeping, so check what your professional
body suggests.
All services that you provide and for which you invoice us must be supported by clinical
records that meet your profession’s standards and ACC’s recommendations. See What we
recommend for all clinical records
Requesting your clinical records
People wanting to lodge claims for injuries can have complex or confusing presentations.
ACC has a legislated right to view your clinical records at any time. Your clinical records
provide us with the necessary clinical evidence to determine whether your patients’ injuries
meet the legislative requirements for different types of cover and that your treatment was
necessary and appropriate.
If a patient’s injury is covered, they may be given treatment and other support as their
‘entitlement’. Normally, primary care consultations/visits get automatic financial
contributions under the Regulations, but for special services such as surgery, pain
management, weekly compensation and home help, we’re obliged to check that the
requested support is directly related to the client’s injury. Your records can be crucial in
helping us to determine entitlements and overall rehabilitation plans.
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We will require copies of relevant clinical records when you submit an ACC32 Request for
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Prior Approval of Treatment form.
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Requesting your clinical records – continued
Your clinical records might also be requested:
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·  by other agencies for other reasons, such as an adverse patient outcome or patient
complaint
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·  for certain invoiced services to ensure they are clinically justified
·  by other treatment providers (you’ll need patient consent for this)
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·  by your patients (you should be aware of the rules around such requests)
·  if your practice undergoes one of our periodic audits.
What we recommend for all clinical records
Because they’re so important, your clinical records for each patient need to:
·  provide client  identifiers such as their name, date of birth, and ethnicity
·  provide your name, a legible signature (if on paper) and the date and time of each
consultation/visit
·  be written at the time of the consultation/visit or shortly afterwards and have any
later records dated and countersigned
·  be written in English on a permanent electronic record or, if on paper, be legible and
in pen, not pencil
·  record any tests or communication that influenced your diagnosis or treatment
·  record any prescribed medications the patient is taking
·  provide clinical reasons to justify any consultation/visit or ongoing treatment
·  provide a provisional diagnosis and supporting rationale if there is a differential
diagnosis
·  identify a treatment plan and rehabilitation expectations, as discussed with the
patient
·  record any referrals made
·  show consistency between your appointment record and invoice dates
·  be stored securely for a minimum of 10 years after the final consultation/visit
·  be transported (physically or electronically) only when essential, taking all steps
necessary to protect that information. See Privacy.
·  withstand scrutiny on the treatment provided, in the event of peer review, audit
(medical or financial) or a medico-legal challenge.
What to avoid in your clinical records
Make sure you do not:
·  use ambiguous abbreviations
·  use offensive or humorous comments
·  alter notes or disguise additions.
Our recommendations for the initial consultation/visit
To help us make appropriate decisions, as swiftly as possible, we ask that in the initial
consultation/visit you record details of the:
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·
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  accident, how it occurred, and any mechanisms of injury
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·  injury symptoms and clinical significance
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·  reason for the presentation, or the main reason if the consultation/visit involves
more than one condition
·  history and examination findings, including important negatives
·  relevant past history including medications
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·  initial working diagnosis
·  initial advice you’ve given the patient, e.g. about work fitness or injury-related
restrictions.
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·  treatment undertaken and tests and investigations required
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·  management and follow up plan
Our recommendations for follow-up consultations/ visits
Your records for any follow-up consultations or visits should demonstrate that your
treatment meets the legislative requirements of being necessary and appropriate. We ask
that you detail:
·  the patients’ progress
·  your evaluation of the effectiveness of previous treatment
·  new aspects of history and examination, and the results of any new tests or
investigations
·  any restated or revised diagnosis
·  any subsequent advice given to the patient
·  any treatment provided
·  the reason for any change to an earlier treatment plan
·  any reports or communications relating to this injury.
Peer reviews
To ensure that we have the best possible information, we may sometimes approach peers
in your clinical area for independent advice. These may be medical advisors employed by
ACC or external advisors nominated by your professional body.
Provider monitoring, audit and fraud control
ACC’s quality assurance practices
ACC requires assurance that suppliers/providers are providing services that match ACC’s
requirements, and that the invoices you submit are valid and correct.
The legal basis for any monitoring is set out in:
·  Any service contracts agreed between providers and ACC, and/or
·  IPRC (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003, which
cover invoicing and payments under the AC Act 2001.
ACC guides providers towards best-practice behaviour and contract compliance to help
improve client services and relationships.
The assistance we offer includes:
·  working with providers in an educative and supportive way
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·  monitoring activity in accordance with ACC’s performance and monitoring
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framework and tracking providers whose invoicing patterns cause concern
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·  helping to develop, negotiate and implement improvement plans for providers
·  managing and resolving provider issues that impact on client outcomes.
The performance and monitoring framework outlines ACC’s approach to monitoring
provider performance and outcomes achieved through contracted and regulated services.
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How an audit works
An audit provides an independent and objective review of how suppliers /providers are
delivering services and can include all aspects of provider practice.
Audit details
ACC carries out a wide range of quality assurance and provider support initiatives
including random reviews of Supplier performance and practice. Audits are designed to
examine the strength of your practice control environment by looking at the arrangements
for purchasing, implementing and monitoring ACC-related work.
Supplier/provider audits formally examine how well you or your organisation:
·  complies with a service contract
·  can validate service provision
·  have provided services that match fees or contributions invoiced for
·  keep clinical notes
·  have provided appropriate treatment.
An audit may also include an assessment of compliance with applicable laws, regulations,
policies and clinical appropriateness. These audits are completed in compliance with audit
standards and all relevant legislation including the Privacy Act.
How ACC investigates and controls fraud
ACC defines fraud as:
“Any person who commits an act or omission that is dishonest and without claim of right
and for the purpose of obtaining a pecuniary advantage (money) or other valuable
consideration (e.g. an entitlement) for oneself or any other person, commits fraud.”
ACC has zero tolerance of fraud and the remedies that we consider when we detect fraud
include:
·  formal warnings
·  recovering money unlawfully or inappropriately obtained
·  billing restrictions
·  complaints to professional bodies
·  prosecution
·  penalties under legislation
·  civil court action.
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Investigating fraud
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ACC has an Investigation Unit that’s responsible for implementing our counter-fraud
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strategy. Investigators and intelligence staff are based throughout New Zealand. The team
uses a variety of detection and investigation methods, including reviews, surveys and
interviews.
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Examples of client fraud
·  Working while receiving weekly compensation without advising ACC.
·  Misrepresenting an accident and/or injury.
·  Misrepresenting incapacity to gain entitlements.
·  Making false declarations.
·  Altering documents to gain entitlements.

Examples of provider fraud
·  Claiming for treatments and services not provided.
·  Claiming times in excess of the time spent with a client, i.e. hourly billing when
should be direct billing.
·  Over-servicing for financial gain.
·  Forging billing schedules and documents.
·  Making false statements.
Reporting fraud
If you think someone is being dishonest, please contact the Investigation Unit on 0508 222
37283 or by email at [email address] or by following the ‘Reporting Fraud’ link at
www.acc.co.nz.
You may provide information anonymously.
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4.
Provider registration
Registering to become an ACC provider
Why become a registered ACC provider
Registration with ACC enables you to:
·  lodge claims for cover on your patients’ behalf
·  provide treatment for ACC clients within your scope of practice
·  invoice us for the services you provide to our clients
·  order stationery such as ACC claim forms
·  receive important communications.
Who can register
Any treatment provider who wants to be paid for services given to ACC clients needs to
register with ACC. Registration is open to all those identified under the AC Act 2001 as
treatment providers. This table shows the vocations that qualify, noting the groups that are
identified under the Act as ‘Registered Health Professionals’ and under the IPRC (Liability
to Pay or Contribute to Cost of Treatment) Regulations 2003 as ‘Specified Treatment
Providers’.
Specified
Treatment
Registered Health
Vocational classification
Treatment
Provider
Professional
Provider
Acupuncturist



Audiologist


Chiropractor



Clinical dental technician


Counsellor


Dental technician


Dentist




oni
Medical laboratory technologist



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Medical practitioner



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Medical radiation technologist


Midwife


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Nurse



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Nurse practitioner



Occupational therapist



Optometrist



Osteopath



Pharmacist


Physiotherapist



Podiatrist



Speech therapist



Note: Acupuncturists must be members of either New Zealand Register of Acupuncturists
or New Zealand Acupuncture Standards Authority at the time of delivering treatment.
ACC’s registration requirements
The qualification, registration and certification requirements that treatment providers must
meet, differ slightly between groups. For details for all the different invoicing arrangements
see Invoicing and payments.
Registered health professionals
Providers categorised as ‘registered health professionals’ are asked to demonstrate
qualifications in a way that directly reflects the registration and professional standards
required of them (and their peers) by the HPCA Act 2003.
Registered health professionals can include those holding interim practising certificates but
only when they are acting in accordance with any conditions of their certification, as stated
in the HPCA Act.
Nurses and nurse practitioners
Under the AC Act 2001, nurses and nurse practitioners are those who are registered as
such in terms of the HPCA Act and hold current annual practising certificates. These
categories do not therefore include enrolled nurses or nurse assistants.
Specified Treatment Providers

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‘Specified Treatment Providers’ are designated in the Cost of Treatment regulations. Their
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registration process is similar to that followed by registered health professionals.
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Specified Treatment Providers have special arrangements for invoicing and payment that
include the option of hourly rates or fixed rates per treatment. This reflects the way they
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provide treatment. For details see Invoicing and payment – Specified Treatment Providers.
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Counsellors
Counsellors work with ACC in a slightly different way. Reflecting these differences, they
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have a separate registration process. See Counsellor registration.
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Registering to provide contracted services
While some services can be provided under Regulations, others can only be provided
under contract. If you’re interested in registering as an ACC health provider, and want to
take up a contract, your key initial contact will be the Health Procurement and Contracting
team. This team negotiates and manages ACC contracting opportunities.
ACC’s contracted services govern client assessment, planning and
rehabilitation/treatment. We contract directly with rehabilitation and treatment providers to
enable our clients to receive a wide range of services. That service range is summarised
on our website under For Providers > Contracts and performance > All contracts.
For more information about applying for a contract you can:
contact the Health Procurement and Contracting team on 0800 400 503 or by emailing
[email address].
Visit our website at For Providers > Contracts and performance > How to apply for a
contract with ACC.
Individual registration
How to register as an individual treatment provider
If the organisation (vendor) for which you work has a contract with ACC you may not be
required to go through a registration process for yourself. For example, clinics or practices
holding Accident and Medical contracts or Rural General Practice Services contracts
register in a different way.
If you do need to register as an individual, you’ll need to supply:
·  a completed ACC024 Application for ACC Health Provider Registration form
·  a copy of your current annual practising certificate
·  your bank account details, either on a pre-printed bank deposit slip or via bank
verification.
For more information and registration forms visit our website at For Providers > Set up and
work with ACC > Register with ACC.
Alternatively, you can call the Provider Helpline on 0800 222 070 or email
[email address] and we can fax, post or email the relevant application form to you.

Once you’ve completed the form and attached all additional information required, please
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send it to:
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ACC Provider Registrations
PO Box 30823
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Lower Hutt 5040
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Alternatively, you can fax your form to 04 560 5213 or email scanned images of the signed
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form to [email address].
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The Health Practitioner Index (HPI)
The HPI is a Ministry of Health initiative that ACC supports. The HPI is a new identification
system that replaces the:
·  ACC provider number with an HPI person number
·  ACC vendor number with an HPI organisation number
·  ACC facility number with an HPI facility number.
ACC will register you with your HPI – Common Person Number (HPI – CPN). If this is not
possible, you will be allocated your own ACC provider number. We may contact you
directly to change from an ACC number to an HPI number. Individual providers may
already be using HPI – CPN, issued by their Registration Authorities.
Receiving your registration number
We’ll let you know in writing that we’ve accepted your application for registration, and
confirm your provider number within five working days of receiving it.
ACC uses provider numbers to identify who has provided treatment, track payments and
monitor treatment provider performance. Your provider number is therefore specific to you
and must not be shared with other health professionals. Please use it whenever you can in
communications and transactions with us.
If you’re employed at more than one practice, you may need a separate provider number
for each practice. This is due to restrictions with the electronic schedule and the invoice
payment systems used by some practices. Please contact the ACC Provider Registration
team on 04 560 5211, to find the best solution.
Keeping your details up-to-date
It’s important we hold up-to-date contact details for you and ask that you contact us if
you’ve changed your name, postal or email address, or phone or fax number. You can
update your details with us by phoning the Provider Helpline on 0800 222 070 or emailing
[email address] (please make sure you include your provider number in the
email).
We’ll update your records, send you confirmation of the change, and give your new details
directly to our printing and distribution partners, so they have the correct details in their
databases when you order stationery.
All bank account changes require either a pre-printed bank deposit slip or bank

verification. We can also accept faxed or emailed copies if they are received via a
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previously verified email address or fax number.
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To check the details we currently have recorded for you, please get in touch with the
Provider Helpline on 0800 222 070 or email [email address]
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Counsellor registration
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Who can be an ACC counsellor
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ACC accepts applications from suitably qualified and experienced counsellors, including
social workers, psychotherapists, psychologists and psychiatrists.
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Benefits of being an ACC counsellor
Counsellors registered with ACC can lodge ACC45 Injury Claim forms on behalf of clients,
which can make it faster and easier for clients to receive our services.
We’ll pay for your counselling services at published rates in accordance with the IPRC
(Liability to Pay or Contribute to Cost of Treatment) Regulations 2003 or updates. The
rates differ slightly according to whether treatment is given by a counsellor or a psychiatrist
(a medical practitioner).
See also Payment for Counsellors.
Counselling services purchased by ACC
ACC purchases counselling services for clients with:
·  sensitive claims
·  mental injuries from physical injuries or a workplace event.
ACC also has a Sensitive Claims Unit that specialises in helping people to recover and
rehabilitate from mental and physical trauma caused by criminal acts such as sexual
violation, indecent assault and unlawful sexual connection. Counselling services are key to
the recovery of these clients.
We also help people to recover from mental injury that is the direct result of a covered
physical injury or traumatic work related event.
For more information, see Mental injuries, sensitive claims and counselling
If you have any questions about our counselling work, please contact the Provider
Registration team on 04 560 5211 or email [email address].
Required qualifications, skills and experience
To be registered as an ACC-approved counsellor, psychologist, psychotherapist or
psychiatrist, you need some specific qualifications, skills and experience.
The requirements include:
·  membership of an appropriate professional body
·  qualifications that reflect your nominated area of expertise
·  previous and ongoing supervision arrangements

·  cultural competency
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·  proof of relevant ongoing training or experience in sexual abuse or physical injury
counselling.
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You will need to include other supporting documents:
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·  A completed application form
·  Two case studies
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·  Consent for a police check
·  A copy of your current annual practising certificate
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If you belong to another profession you’ll need to provide additional items, including
certified copies of your academic and qualifications. You’ll also need to arrange for your
supervisor to provide details about you, and about their own membership of an appropriate
professional body.
You can get more information on the required qualifications by:
·  phoning the ACC Provider Registrations team on 04 560 5211
·  emailing [email address]
·  reading the FSCR01 Counsellor Registration Information fact sheet.
Applying for registration
To find out about how to apply to become an ACC-approved counsellor, we recommend
that you:
·  visit our website at For Providers > Set up and work with ACC > Register with ACC
·  read the information sheet FSCR01 Counsellor Registration Information, which
explains the factors that may prevent your registration, such as a criminal record.
How we assess your application
All applications are reviewed by an external evaluation panel made up of nominated
representatives from various New Zealand counselling bodies.
The panel will assess your qualifications and experience against the ACC criteria and
make its recommendation to us, which will determine the final decision.
The application process includes a police check to find out if New Zealand Police holds
any information about you. This includes details of criminal convictions, except those
covered by section 7 of the Criminal Records (Clean Slate) Act 2004.
Letting you know
We aim to advise you of our decision within six weeks of receiving your completed
application.

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5.
Lodging claims
Lodging a claim with ACC or an Accredited Employer
Forms used to lodge claims
There are five main forms used to lodge claims and most can be lodged electronically:
ACC45 Injury Claim form
The ACC45 injury claim form is the primary form used to lodge a claim for cover, and
should be used wherever possible. This is because it has a unique number for security
reasons, which we also use to monitor claims, and provides sufficient prompts within the
form to ensure all of the necessary information is provided. See Completing the claim
form, for more information. If your patient requires further time off work, you’ll also need to
complete an ACC18 Medical Certificate.
ACC2152 Treatment Injury Claim form
Use this form in addition to the ACC45 when lodging a treatment injury claim. For more
information, see Treatment injury.
ACC18 Medical Certificate
Use the ACC18 Medical Certificate if you’re a medical practitioner or a nurse practitioner
and you need to describe a person’s ability to work. This is the only certificate we accept
for compensating clients for time off work. For more information see, Medical certificates
(ACC18) An ACC18 can also be used to request ACC to add a new injury to an already
existing claim.
ACC42 Dental Injury Claim form
The ACC42 Dental Injury Claim form  is a specialised form of the ACC45 Injury Claim form
that dentists use to provide more specific details about clients’ dental injuries.
ACC32 Request for Additional Treatment form
The ACC32 form can be used for several different purposes (refer to ACC32) – such as
when your patient’s injury is covered and you:
·  anticipate that you’ll need prior ACC approval for additional treatment funding
·  want to add or change a diagnosis
·  want additional splinting costs.

·  this form can also be used when the client requires initial time off work.
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Ordering new forms
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The easiest way to lodge a form is electronically, however, if you don’t have access to a
computer, printed forms can be requested.
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To order new forms, reply-paid envelopes and other ACC supplies:
·  phone the Stationery order Line on 0800 802 444
·  key in your ACC provider number, or press 0 to speak to an operator.
The claims lodgement process
When you lodge a claim using the Injury Claim forms you’re asking us to cover a patient’s
personal injury.
Please complete the form with your patient and send it to ACC either as a paper form or
electronically. For more information on electronic lodgement:
·  visit our website at For Providers > Set up and work with ACC > Work electronically
with ACC > eLodgement
·  see Working electronically with ACC.
Each ACC45 Injury Claim form has a unique secure reference number that identifies the
patient’s claim once it’s been lodged. The form is used for many kinds of injuries and
conditions and enables you to provide important information that can help start the
rehabilitation, treatment and/or entitlements process.
Notes:
Only treatment providers defined by legislation can lodge claims on behalf of patients. See
Who can register for a list of accepted providers, and visit our website at For providers >
Lodge and manage claims for more information.
Only medical practitioners and nurse practitioners can certify incapacity for work. For more
information, see Medical certificates (ACC18).
Lodging a claim with an Accredited Employer (AE) is slightly different. For more
information, see Lodging Accredited Employer claims.
The processes for lodging specific claims can differ. See the links under For providers >
Lodge a claim > How do I lodge a claim with ACC? and Treatment cover for details. on
how to lodge:
·  claims for mental injury caused by sexual abuse
·  claims for treatment injury
·  claims for work-related gradual processes, disease or infections
·  late lodgement claims.
If you’re not sure about how to lodge a claim with ACC we encourage you to check out the
information on our website, or give us a call. This will make sure everything goes smoothly

for you and your patient. If you have a question about lodging a claim, or a claim already
submitted, please get in touch with the Provider Helpline on 0800 222 070 or email
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[email address].
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Completing the claim form
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There is information about how to complete, sign and lodge a claim on our website under
For providers > Lodge a claim > How do I lodge a claim with ACC? See also Where to
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Things to note when completing the form and before you submit it:
If you want check whether a claim has already been submitted
If you need help in finding out about a claim already submitted, call the Provider Helpline
on 0800 222 070 or email [email address] with the patient and injury details. You
can also check on a claim’s status through the eLodgement system.
If your patient has claimed for their injury before
Quote the ACC45 number for their original claim. The number will be on the referral form,
or the first ACC45 Injury Claim form.
Check the client’s personal details (Part A) and employer details (Part B) and, if
necessary, update them.
Include previous surnames if they’ve changed within the previous few years.
If your patient is in paid employment
Employer’s names and addresses must be included for all claims where your patient is in
paid employment regardless of whether the injury is work related.
If you can’t find a Read Code that matches your diagnosis
If you can’t enter a Read Code on the ACC45 Injury Claim form because there is no code
that matches your diagnosis, provide a written description. For more information, see
Managing Read Codes
If you think your patient needs help beyond ACC’s contribution to treatment costs
For example if you think your patient needs further treatment, personal support or weekly
compensation there are several places on the ACC45 Injury Claim form where you can
specify a patient’s additional needs.
You can also give them your professional assessment of these needs and encourage
them to contact the Client/Patient helpline on 0800 101 996 as soon as possible. In most
cases they can apply for entitlements over the phone. However, entitlements aren’t
granted until cover is accepted, so it’s still essential that you lodge the ACC45 Injury Claim
forms promptly.
If your patient presents with a sexual abuse injury

·  It’s important you also ask them whether they want mail from ACC or providers to
be sent to a different address from the one on your records.
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Before submitting the form
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·  add NHI numbers if you know them
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·  be sure to go over the Patient Declaration and Consent section on the back of the
ACC45 Injury Claim form with the patient, to ensure they understand what they are
signing.
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Managing Read Codes
Read Codes are a hierarchical coding system for injury types with each level giving a more
specific diagnosis.
Each Read Code has five characters. If a code only has 4 numbers it will end in a dot,
which becomes its fifth character. For the most accurate injury diagnosis, you should
ensure that each Read Code includes the dot, if necessary.
The full Read Code directory is available via Read Code browser software or the
eLodgement service. The abridged ACC53 Read Code Quick Reference Guide covers the
most used Codes.
When completing an ACC45 Injury Claim form, you’ll need to record the Read Codes that
best correspond to your diagnosis of your patient’s injury. For multiple injuries, record the
Read Codes for each injury in the order of severity/complexity.
If there’s no Read Code to match your diagnosis, use Code Z (unspecified condition) and
provide an accurate written diagnosis. An ACC staff member will complete the Read Code
field, and may contact you to clarify and confirm your diagnosis.
Where to send the claim forms
If you’re sending claims using eLodgement, do so regularly during the day. Most claim
forms can be sent electronically.
For more information visit our website at:
·  For Providers > Lodge and manage claims > Lodge a claim electronically
·  For Providers > Set up and work with ACC > Work electronically with ACC
If you’re sending claims by post or fax, visit our website at Contact Us > How to contact
ACC > Write to us and send it by post or fax for a list of offices that deal with specific or
general claims.
Claim forms and documentation for AEs must be sent directly to employers.
What happens next
For details on how we process a lodged claim, visit our website at For Providers > Lodge
and manage claims > Lodge a claim > What happens after you have lodged a claim?
When cover is accepted, we advise the client by letter. If you want to find out whether
cover has been accepted, call the Provider Helpline on 0800 222 070 and quote the
ACC45 claim number or email [email address]. You can also check via the

eLodgement system.
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It’s important we have all the information needed to make a decision. If we don’t have
enough information the claim can be put on hold, or worst case declined pending further
information. We don’t usually pay for claims with insufficient information to make a
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Invoicing
For information on invoicing ACC and AEs:
see Invoicing ACC or AEs or visit our website at For Providers > Invoicing and payment

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Lodging Accredited Employer claims
About Accredited Employers (AEs)
An AE is a business that has signed a ‘Partnership Programme’ contract with ACC. This
allows it to deal directly with staff work place claims and health providers on behalf of
ACC.
AEs pay lower ACC levies than other employers and are expected to provide the same
cost contributions and quality of service as ACC. Some AEs also choose, at their
discretion, to refund co-payments for their employees. They manage their own:
·  workplace health and safety
·  employee injuries, including rehabilitation
·  employee workplace (but not non-workplace) injury claims.
Over a quarter of New Zealand’s full-time employees work for AEs. If your patient isn’t
sure whether they work for an AE, you can use the Accredited Employers search tool
(you’ll need your ACC provider number) or phone the Provider Helpline on 0800 222 070.
Third party administrators
An AE may, subject to ACC’s approval, contract a ‘third party administrator’ (TPA) to
deliver injury and claim management services to its injured employees. TPAs include
Gallagher Bassett, WellNZ and WorkAon.
Note:
·  TPAs can only act as payment agents and day-to-day points of contact.
·  AEs remain responsible for managing their injured employees claims and injuries.
How to lodge an AE claim
Send all documentation for your AE patients (i.e. the initial ACC45 Injury Claim form,
treatment and rehabilitation plans, and invoices) to the AE or their nominated TPA, rather
than ACC.
For more information, see:
For Providers > Lodge and manage claims > Lodge a claim for employer of Accredited
Employer
Accredited Employers and the ACC Partnership Programme: Treatment Providers’ Most
Frequently Asked Questions.

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6.
Treatment
Acute treatment
Definitions: acute treatment and acute admission
The AC Act 2001 describes acute treatment as:
·  the first visit to a treatment provider to get treatment for an ACC-covered personal
injury
·  if, in the treatment provider’s judgement, the need is urgent (given the likely clinical
effect on the client of any delay in treatment):
  any subsequent visit to that treatment provider for the covered injury
  any referral by that treatment provider to any other treatment provider, for the
covered injury.
The Act describes acute admission as an admission to a publicly funded or agreed facility
within seven days of the decision being made to admit, unless otherwise specified in the
Regulations. See 'Accident Services - A guide for DHB and ACC Staff' (see also
Glossary).
Deciding if acute treatment/ admission is needed
You need to be appropriately qualified to decide whether an injury needs acute treatment.
Otherwise you’ll need to refer the client to a treatment provider who is qualified. The
referred visit to another treatment provider is also regarded as acute treatment. The
applicable qualification is described in the Claim lodgement framework.
If you determine that the client’s injury is outside the scope of a primary care provider and
acute specialist assessment/treatment, and/or acute hospital admission is required you
must ensure the treatment is provided by:
·  a publicly funded provider, or
·  a provider that is not publicly funded, if:
ACC agrees beforehand ( prior approval),
  or
for reasons of clinical safety, treatment by a publicly funded provider is no
practicable.
Funding public health acute services (PHAS)
PHAS are funded by a bulk payment from ACC to the Crown. The Crown then funds the
Ministry of Health to purchase these services from DHB’s on behalf of ACC. You can find
more details in the publication 'Accident Services - A guide for DHB and ACC Staff'.

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Referring on for other acute services
Radiology
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For X-ray referrals we recommend you complete your practice radiology referral form and
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to need acute treatment outside of the scope of a primary care provider in addition to
radiology for their injury, refer them to the nearest public hospital.
High Tech Imaging (HTI)
Acute HTI such as MRIs and CT scans for ACC clients are provided as part of PHAS. If
your patient needs HTI as part of their acute treatment, please refer them to the nearest
DHB.
Non-acute MRIs are funded separately by ACC under contract. For more information on
how to access this service, phone the Provider Helpline on 0800 222 070 or email
[email address].
Surgery and specialist treatment
Acute specialist and surgical treatment is provided under PHAS. If your patient needs
these services, refer them to the nearest DHB.
Elective surgery and specialist treatment are paid for by ACC through both Regulations
and contract. If you are considering elective surgery and/or specialist treatment, ACC case
owners supported by medical advisors will be able to confirm cover and coordinate
services for clients and providers.
Nursing Services
Nursing Services
Nursing services can be provided in two different ways to ACC patients who have a
covered injury:
·  under the Cost of Treatment Regulations (see How ACC pays)
·  Contracted Nursing Services (community based service delivery within the client’s
home,  a clinic or any other appropriate community location).
Contracted Nursing Services
These are services to patients whose nursing needs cannot be met by their Primary Care
Team. This could be due to;
1)  The patient has reduced mobility
2)  The patient has little or no natural support making it unsafe or impractical for them
to attend a medical centre
3)  The injury related needs of ACC serious injury clients
4)  The patient needs care outside of normal practice hours

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5)  Complex injuries – i.e.; ulcers, wounds with heavy exudate, large bacterial burden,
pressure wounds, skin grafts etc.
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6)  Specialised treatment need – i.e.; stoma care, compression therapy, NPWT etc
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7)  Where the patient has a history of leg ulcers, slow healing wounds, immuno-
compromised, heart disease, diabetes etc.
8)  The patient is a student with a complex wound and cannot be managed by their
primary health care team or school nurse.  The supplier can provide services at the
school, home or clinic
9)  Where the patient has made a full or partial return to work and their individual
rehabilitation plan states the treatment is to occur at the workplace.  This requires
prior approval from ACC.
Please note however, that eligibility for entry to this service is not influenced by patient
preference or convenience.
Entry into this service is by referral only, including subsequent injuries.  Referrals can be
generated by:
·  Primary Health Care Team (e.g. GP, Nurse Practitioner or Practice Nurse)
·  Patient self referral (if the patient lives in a remote/rural area at least 50km or 30
minutes drive to the nearest medical centre which has a doctor in regular
attendance).
Your referral should include sufficient information to satisfy the nursing supplier that there
is a covered injury requiring nursing services input including:
·  the patients personal details
·  injury diagnosis
·  treatments to date
·  nursing needs
·  rationale for requiring services outside of what can be provided by the Primary
Health Care Team.
Requesting further treatment: Referring clients via the ACC32 form
Using the ACC32
The ACC32 form can be used for several different purposes by Specified Treatment
providers – such as when your patient’s injury is covered and you:
·  anticipate that you’ll need ACC prior approval for additional treatment funding or are
requesting additional splinting costs
·  want to add a diagnosis
·  want to change a diagnosis.
·  recommend another treatment provider in addition to completing another referral

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Further treatment and costs
Prior approval for further treatment
Prior approval is required from ACC when either:
·  it has been more than 12 months since the client last received treatment from a
specified treatment provider, or
·  a client first presents for management of an injury more than one year after the date
of that injury, or
·  the treatment trigger number for the covered injury has been (or is about to be)
reached and your client requires more treatment.
Note: Each Read Code identifies the number of treatments (trigger numbers) you can
provide, before you need ACC prior approval to fund further treatment. Please note that
trigger points are a guide to expected recovery timeframes only and all decisions are
based on individual clinical need.
ACC will consider each request on a case by case basis and will advise whether ongoing
treatment has been approved or declined. No payments will be made until prior approval is
granted.
When completing an ACC32 request for prior approval of treatment it’s important to specify
the date of the injury(s), details of the covered injury(s) and the treatment given to date. If
this information isn’t available from the client, call the Provider Helpline on 0800 222 070
or email [email address].
Adding or changing a diagnosis
Adding a diagnosis
In the course of providing treatment for a covered injury, you might identify an additional
injury(s). We can only fund treatment for that additional injury site(s) if we have made a
cover decision.
Example: A client falls and sustains a shoulder injury. A claim has been lodged and
accepted for the shoulder injury. However, you find out that they also sustained a knee
injury in the fall, and you want to treat the knee under this claim.
Changing a diagnosis
We’ll consider a request to change a diagnosis if there has been:
·  an administrative error (i.e. a claim was lodged for the incorrect body site)
·  a change from an International Classification of Disease (ICD) code to a Read Code

·  an error in the original diagnosis.
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What treatment profile trigger applies if you are registered with ACC for more
than one treatment modality
If you choose to move between different treatment modalities in the management of your
client, the treatment profile trigger relating to the primary modality applies, regardless of
the type or combination of modalities used.
Example: A provider is registered with ACC as a physiotherapist and also as an
acupuncturist. The client’s injury is primarily treated with physiotherapy but the provider
also determines that acupuncture is required at the same presentation. Only the
physiotherapy treatment profile trigger would apply.
A dual registered provider cannot refer to themselves for their second modality without first
seeking prior approval by
·  completing an ACC32 form
·  supplying clinical records that demonstrate the need for the change in treatment
modality.
The treatment profile trigger number for each modality cannot be added up or used one
after the other for ongoing treatments. The services should be invoiced under the
provider’s primary vocational scope.
What to include in the ACC32
The information we need on the ACC32 will depend on what type of provider you are.
Please refer to your contract for details.
Physiotherapists:
If you’re a physiotherapist or hand therapists you’ll need to include both an ‘outcome
measure’ report and the client’s clinical notes with each ACC32 application.
Other Specified Treatment Provider groups:
Other Specified Treatment Providers only need to submit clinical records with ACC32
applications. The clinical records should be legible, current records of treatment given to
the dates of application (see What we recommend for all clinical records).
If the information you submit is incomplete, we’ll return the form straight away and ask for
the missing information.
If the treatment required is post-operative and within three months of the date of ACC-
funded surgery, please note this on the ACC32 along with the date of surgery.
Alternatively you can call the Provider Helpline on 0800 222 070 and obtain approval.
Outcome measures for physiotherapy

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Outcome measures are a tool for measuring the effects of physiotherapy interventions
over time. They give all parties a better understanding of the outcomes achieved from
purchasing physiotherapy services for clients. They also enable physiotherapists to reflect
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Physiotherapists are required to use an evidence-based outcome measure. We
recommend either:
·  the Patient Specific Functional Scale (PSFS) outcome measure, or
·  the Numeric Pain Rating Scale (NPRS).
However, an alternative standardised, evidence-based outcome measure can be used if
it’s more appropriate to a client’s condition.
For guidance on using evidence-based outcome measures see the ACC Guide to
Outcome Measure Reporting. This document focuses on the PSFS and NPRS because of
their widespread acceptance among physiotherapists and other clinicians.
Please record a validated outcome measure for all ACC clients:
·  at initial consultation/visit
·  after six treatments
·  on discharge.
When patients are referred by other types of provider
Approval for treatment is discipline specific and using the ACC32 to refer a client to a
different provider type is not the same as using it to request ACC prior approval for further
treatment.
If a provider of another discipline recommends referral to your discipline on an ACC32 that
they have submitted to ACC, or uses an ACC32 to refer a client directly to you, you will still
need to determine if your treatments require prior approval and submit an ACC32 yourself.
Please attach the other provider’s referral letter or ACC32 form when you submit your
ACC32 request.
If a client has been referred to you by another provider of the same discipline as yourself,
you’ll need to confirm how many treatments the client has received, and complete another
ACC32 if the treatment profile triggers have been reached.
Our decision process
Once you’ve completed the ACC32 form, and included all relevant information, please
send it to your nearest Medical Fees Unit. We aim to either issue a decision or advise you
of any delay within five working days of receiving the documents.
The requests are assessed by clinical advisors as necessary and we’ll write to both you
and the client with our decision. If we decline the request, we’ll also try to contact the client
to talk them through our decision.
What to do if you disagree with our decision

If we decline your request for funding additional treatment, you can seek clarification from
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an ACC clinical advisor. The client can also formally dispute the decision, asall decisions
are issued with review rights, which means the client can have the decisions
independently reviewed. A request for review needs to be submitted within three months of
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the date of our decision, although this can be extended if a situation beyond their control
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Criteria for approving requests
If we approve your request for treatment, we’ll fund up to six treatments in addition to the
treatment profile trigger as long as you invoice ACC in the order that the services are
delivered.
If it’s a request for a serious injury client we can approve more than six treatments if it’s
clinically justified. Please ensure that you include all supporting information.

Criteria for declining requests
We’re unable to approve ACC32 treatment requests if:
·  There’s no causal link
There needs to be a clear link between the client’s ongoing condition and the covered
injury in order to receive funding. This link must be supported by medical evidence, as a
condition may be similar to, but not caused by an injury.
·  It’s not injury related
If the request is for a condition not related to their injury then we’re not able to cover it.
·  It’s not considered necessary or appropriate
If clinical records show there hasn’t been any significant improvement as a result of
treatment, further requests for treatment can’t be justified.
·  The injury site doesn’t match the covered injury
We can only approve requests for covered injuries. If you’re unsure about whether your
patient’s injury is covered please contact the Provider Helpline on 0800 222 070.
·  The surgery wasn’t funded by ACC
If we haven’t funded the surgery then we’re unable to fund post-operative rehabilitation
treatment.
·  It’s a gradual process injury
Unless it’s a covered, work-related gradual process condition we’re unable to fund
treatment.
·  It’s for treatment plus cover, or cover only
Cover and entitlement are two different decisions. If you submit an ACC32 to add an
injury, we need supporting clinical information. We may or may not approve cover while
determining treatment.

·  It’s a new claim
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If as a result of a patient assessment you believe that their current condition doesn’t relate
to the initial accident, you should inform the patient and not submit an ACC32.
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If during your assessment you find there has been a clear new event causing personal
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injury, your patient may want to submit a new ACC45 Injury Claim form.
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Work-related gradual process, disease or infection
Cover under legislation
ACC covers a range of gradually-arising processes, diseases or infections if:
-  it involves a personal injury as defined in Section 26 of the AC Act 2001, and
-  there is a causal link between the injury and the person’s employment.
Eligibility criteria
To be eligible for this cover, clients must meet either of two criteria:
1.  The client’s work environment shows that:
·  there is a particular property or characteristic in a work task or the work
environment that can be identified as having caused the condition
·  the property or characteristic is not materially present outside the person’s work
environment
·  those performing the work task or employed in that work environment are at
significantly greater risk of developing the condition.
The more common musculoskeletal injuries that can develop over an extended period of
time through work are epicondylitis (lateral or medial), tenosynovitis (e.g. de Quervain’s),
prepatella bursitis and rotator cuff syndrome. Claims for these need to satisfy the three-
part test above which reflects section 30 of the AC Act 2001.
If your patient has noise-induced hearing loss
Patients with noise-induced hearing loss may be covered if they have been exposed to
hazardous noise levels while working in New Zealand and meet the above criteria. In
addition, the amount of occupational noise-induced hearing loss (i.e. ‘net of age’
corrections and an allowance for other otological conditions) must be at least 6%.
2.  The injury is on the list of occupational diseases and their causative agents described
in Schedule 2 of the AC Act 2001. Common Schedule 2 diseases include occupational
asthma, allergic contact dermatitis, mesothelioma, leptospirosis and lead poisoning.
This list enables an injured person to be granted ACC cover more quickly and easily
than the above criteria.
A person will be covered for a listed disease if evidence shows that they have the disease
and were exposed to contributing factors while working in New Zealand. If it’s unclear that
the disease is linked to employment, ACC must establish that the Schedule 2 disease is
not work-related.
Lodging a gradual process injury claim

Work-related gradual process injury claims can only be lodged by medical practitioners.
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Any other provider who believes a person has a gradual process disease or injury should
refer them to a GP for an ACC45 Injury Claim form as quickly as possible. Any treatments
given for the injury (e.g. by a physiotherapist) before the patient has seen a GP or medical
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specialist won’t qualify for payment.
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When we receive the ACC45 Injury Claim form we send three questionnaires to the
patient. The patient must fill in their sections and ensure that their employer and GP fill in
theirs. All the questionnaires must be returned to ACC so that a cover decisions can be
made. As the patient will only be able to receive their entitlement (e.g. weekly
compensation for incapacity) once we have accepted their claim it’s important that you fill
in your questionnaire promptly.
For more information on gradual process claims, see Work-related gradual process,
disease or infection.
Notes:
We may ask for a copy of your clinical notes
As we require evidence of actual damage, including a specific diagnosis of the gradual
process injury, disease or infection, we may ask for a copy of your clinical notes and
require test results. Providing details of the patient’s clinical history and your examination
findings at the time you lodge the claim, will speed up the cover decision process for them.
If the cause is work task or place related
If you’re documenting aspects of work task or place cause (to help establish plausible
consequence, an absence of non-work factors, and epidemiological evidence), please give
details of where the causative agent is present. This means accurately identifying the
specific property or characteristic in the task or workplace that has caused, or contributed
to, the person’s condition. We may also request a worksite assessment to clarify these
factors.
You might also need to get information on the person’s non-work activities.
Treatment injury
How ACC defines treatment injury
Treatment injury is defined in the AC Act as:
‘An injury caused as a result of seeking or receiving treatment from a registered health
professional’.
Before July 2005, medical misadventure legislation covered these injuries. Claims lodged
before this date continue to be managed under the previous legislation.
What treatment injury covers
If a patient is injured as a result of treatment, they may be able to make a claim and get
help through ACC. However, we don’t cover all treatment that doesn’t turn out as
expected, so we encourage you and your patient to contact us before lodging a claim to

discuss whether a treatment injury has occurred.
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Treatment needs to be provided by a covered registered professional
The covered registered health professionals are:
·  chiropractor
·  medical practitioner – doctor, surgeon, anaesthetist, etc.
·  optometrist
·  clinical dental technician
·  medical radiation technologist
·  pharmacist
·  dental technician
·  midwife
·  physiotherapist
·  dentist
·  nurse
·  nurse practitioner
·  podiatrist
·  medical laboratory technologist
·  occupational therapist
Several other provider groups qualify as ACC treatment providers but their treatment
cannot be the subject of a “treatment injury” claim.
However, patients who receive injuries from these treatment providers may still be covered
under the wider ACC personal injury claim provisions. Such as treatment provided by an:
·  acupuncturist
·  counsellor
·  speech therapist
·  audiologist
·  osteopath
Lodging a treatment injury claim
Treatment injury claims are lodged on the ACC45 Injury Claim form, or ACC42 Dental
Injury Claim form along with an ACC2152 Treatment Injury Claim form.
The ACC2152 is available on the For Providers section of our website. Payment for the
consultation when the ACC45/42 is submitted is made separately.
For more information on treatment injuries and how to lodge claims, visit our website at
For providers > Lodge a claim > Lodge a claim for treatment injury, or phone the
Treatment Injury Centre on 0800 735 566.
Notes:

Who can complete the ACC45 and ACC2152 forms
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The best person to complete the forms may be the registered health professional involved
in the treatment that caused the injury.
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The forms can also be completed if you’re a treatment provider who wasn’t involved in the
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treatment injury (e.g. if you’re helping a patient) so long as you have enough information.
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If you don’t have enough information you should only complete the ACC45 Injury Claim
form and:
·  tick the ‘Treatment Injury Box’
·  provide the place of treatment
·  provide the name(s) of the person(s) involved in the treatment that caused injury
·  provide any relevant clinical information
We’ll contact the health professional who provided the treatment for more information.
If you’re helping a patient to compete a claim form, you don’t need to ascertain the cause
of the injury being treated. We understand you may not have access to this information
(e.g. for older injuries, or when records are incomplete).
Who can’t complete the form
Some health professionals can’t lodge a treatment injury claim even if they were involved
in the treatment that caused the injury. These include:
·  clinical dental technicians
·  dental technicians
·  medical radiation therapists
·  midwives
·  pharmacists
What to say to your patients
If possible you should let your patient know that we’ll assess the claim and may ask for
more information about the injury and the events that led to it, including from other
treatment providers involved. This means that it could take a few weeks or more to reach a
decision on their claim.
Note: Legislation gives up to nine months to make a decision after a treatment injury claim
has been lodged. However we aim to determine cover as quickly as possible.
Eligibility criteria for clients
A patient may qualify for cover if they are injured as a result of treatment by a registered
health professional and the treatment, not the patient’s health condition or some other
factor, is the cause of the injury.
The treatment from which injuries may stem includes:
·  the treatment itself, either given or directed by the health professional
·  a lack of treatment that should have been provided.
Under special conditions, we’ll consider a claim for someone who was part of an approved
clinical trial, and they suffered complications. We’re unable to accept claims that result

from trials that are mainly for the benefit of the maker or distributor of the item being
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tested.
Assessing treatment injury claims
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ACC’s Treatment Injury Centre assesses all treatment injury claims. It also assesses
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claims for any potential risk of harm to the public.
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The Centre starts the claim assessment process as soon as the ACC45 Injury Claim form,
along with an ACC2152 Treatment Injury Claim form and/or supporting medical records
are received. If only an ACC45 Injury Claim form is received, we’ll need to obtain the
ACC2152 and other records before processing the claim.
Each claim is allocated to one of the Centre’s clinical advisors who have clinical
experience in nursing, midwifery, pharmacy, physiotherapy and medicine. Their role is to
make cover decisions on whether to accept claims by assessing the individual facts of the
claim and applying the legislative criteria.
Once a cover decision is made, the Centre informs the client and advises them to let their
health professional know about it (it doesn’t contact the health professional directly). For
an accepted claim, we either pay the relevant invoices (if no further help is needed) or
transfer the claim to be managed by the client’s local branch (if the client still needs help).
Assessing potential public harm
The Treatment Injury Centre analyses treatment injury data to assess the potential risk of
harm to the public.
The results are shared through monthly treatment injury case studies in Well Said (our
electronic provider newsletter), and at presentations to clinical meetings, conferences and
seminars. Notifications are also made monthly to authorities such as the Director General
of Health, Medsafe and, in some circumstances, registration councils or boards.
Mental injuries, sensitive claims and counselling
Definition of mental injury
A mental injury is defined as a ‘clinically significant behavioural, cognitive, or psychological
dysfunction”. ACC covers the effects of the mental injury from the event, rather than the
event itself.
Client eligibility
ACC funds counselling under regulations for:
·  mental injuries arising from physical injuries or a work place event
·  sensitive claims, i.e. mental injuries arising from certain criminal acts listed in
Schedule 3 of the AC Act 2001.
When a person’s mental injury has been caused by sexual abuse, they can lodge their
claim through either a medical practitioner or an ACC-registered counsellor.
Mental injury caused by physical injury & work related mental injury
In making a cover decision for a person who has a mental injury caused by a physical

injury or through a traumatic event at work, we need at least two medical reports:
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·  a report from the person’s treating practitioner
·  a comprehensive assessment by a registered psychiatrist or clinical psychologist,
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After receiving the treating medical practitioner’s report, we may make a referral to obtain
an assessment from a psychiatrist or a clinical psychologist. The assessment is designed
to help us understand more about the injury’s clinical significance, and the casual link to
the event. We may also seek appropriate treatment recommendations.
Exception
The only exception to this process is when a treating practitioner advises that there is no
clinically significant mental condition.
In this case we may decline the claim without a psychiatric report as long as we have
confirmation from an ACC medical advisor that it’s appropriate to do so. The decision will
depend on the facts of each situation. For example, when the advice is from a GP, a claim
will likely only be declined if they have recent and regular contact with the client.
Treatment options
The recommended treatment options outlined in the psychiatric report can include referral
to a counsellor, psychotherapist, psychiatrist or psychologist for treatment or counselling.
We can contribute to the funding of treatment if the provider is registered with us to provide
counselling services under Regulations or Contract. We’re unable to fund services for non-
registered providers.
For a full list of ACC-registered counsellors call the Provider Helpline on 0800 222 070.
To find out more about registering as an ACC counsellor see, Counsellor registration, or
contact the Provider Registrations team on 04 560 5211 or by emailing
[email address].
Sensitive claims injuries
A sensitive claim is a mental and/or physical injury caused by a sexual abuse crime such
as sexual violation, indecent assault and unlawful sexual connection.
Because these claims are confidential and personal in nature we have a special Sensitive
Claims Unit to help people with these injuries. The claims can often be complicated, and
ACC staff may need to gather more information than what’s collected on an ACC45 Injury
Claim form. As a result it can take longer to determine cover for these claims, the
legislation makes allowances for this.
Sexual abuse crimes considered by ACC are listed in Schedule 3 of the AC Act 2001.
ACC staff may refer to the ‘event’ as a ‘Schedule 3 event’. You can find the Schedule 3 list
on our website under For providers > Lodge a claim > Lodge a sensitive claim, and under
the right hand page heading ‘Related information’ click on ‘Sensitive claims’. Alternatively
you can access this information at: Lodge a Sensitive Claim

If you have any questions about a claim like this or wish to direct a patient to ACC for
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confidential advice, phone the Sensitive Claims Unit on 0800 735 566.
Crisis care and early intervention
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If your patient is distressed and there are serious concerns for their safety, contact the
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Crisis Assessment and Treatment Team (CATT) at your regional DHB. Each DHB has its
own team, and details are available on all DHB websites.
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The CATT teams provide 24-hour, seven-day assessment and short-term treatment
services for people experiencing a serious mental health crises who have urgent safety
issues.
ACC also funds early medical and forensic assessment and follow-up treatment through
the Sexual Abuse Assessment and Treatment Service (SAATS). This service is delivered
by DSAC (Doctors for Sexual Abuse Care) doctors and nurses under the local DHB.
DSAC doctors and nurses are specifically trained in managing sexual assault cases. You
can refer patients to the SAATS by contacting the local DHB or Police.
Lodging a sensitive claim
Only medical practitioners and ACC-approved counsellors can lodge sensitive claims.
GPs and counsellors can get help with lodging sensitive claims in two ACC guides:
ACC1149 GPs’ Guide to Completing the ACC45 Injury Claims Form For a Sensitive Claim
ACC1363 Counsellors’ Guide to Completing the ACC45 Injury Claims Form For a
Sensitive Claim.
You’ll find them on the ‘Forms & Fact Sheets’ side bar on our website at For Providers >
Lodge a claim.
Counselling under Regulations
If your patient needs counselling support
If you are a counsellor and believe your patient needs counselling support please
complete and send an ACC2922 Sensitive claims support sessions - Service Provider
Notification along with the ACC45 Injury Claim form.
As soon as a claim is lodged a client is eligible to 16 hours of support sessions with a
counsellor. For further information on support sessions and how these work visit our
website at Support Session: Theraputic Assessment and Recovery Support for Sensitive
Claims. Once we receive more information the client can proceed to a cover assessment
and be eligible for other entitlements.
For more information on sensitive claims processes visit our website at For Providers >
Lodge and manage claims > Lodge a sensitive claim.
Please note there will be changes to the support sessions process at the end of November
2014. Refer to our website at Sensitive Claims Service Redesign to find out more or
contact ACC’s Specialised Treatment Category by emailing
[email address].

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Lodging a sensitive claim – continued
Notes:
When describing a criminal act
Important: When lodging a sensitive claim, describe the criminal act and/or the relevant
section listed in Schedule 3. The cover decision process is likely to be delayed if you use
simplified wording such as ‘sexual abuse’, failure to describe the criminal act or give
unclear details of a mental injury diagnosis.
When providing a preliminary mental injury diagnosis
·  If you’re unsure about identifying a preliminary mental injury diagnosis, or are not
qualified to provide one, please use clinically relevant terms to the best of your
ability.
·  If in doubt, over-describe the symptoms, as this is likely to provide the most useful
information to help us determine cover. Use a DSM-IV diagnosis, an ICD code, a
Read Code or any other relevant diagnostic classification tool.
·  At the various stages of seeing the patient, you should always check whether their
contact details need updating.

Ensuring client safety and privacy
Given the nature of these claims, ask your patient for a safe address, which may be
different than the one you have on record for them.
This is particularly important for clients aged between 13 and 16 we prefer a
caregiver/guardian and/or family/whānau to be involved if possible.
Who can sign the ACC45 Injury Claim form
Only the patient or their legal representative can sign the ACC45 Injury Claim form.
If your patient is under 16, their parent or guardian must sign for them.
If any other person signs, or there’s no signature we won’t be able to register the claim and
will return the form to you.
Before sending us the form
To avoid any delays it’s really important to double-check that all mandatory sections have
been completed (e.g. whether the patient is working).
Dealing with challenging behaviour

Dealing with an aggressive patient
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Patient violence against providers is uncommon in New Zealand. However, some
providers may find themselves on the receiving end of verbal abuse and on rare occasions
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physical assault.  Dealing with an aggressive or violent patient can be a huge challenge for
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In most cases patients are keen to get back to everyday life or work. Others, owing to
injury or debilitation, take out their frustrations on treatment providers and may blame the
broader accident compensation and rehabilitation system.
There may or may not be a direct connection between a patient’s behaviour and their
presenting condition. Abusive or threatening behaviour can also stem from compensation
issues such as entitlement, eligibility for treatment or investigation, the legitimisation of a
claim, and issues of cooperation in rehabilitation.
How we can help
It’s important that you let us know about any violent and/or aggressive patients who are
also our clients. We can help you to assess the situation and determine whether other
known factors are contributing to the hostility.
If mental injury is a factor
If a patient has developed a mental illness post injury and this appears to contribute
significantly to their aggression or violence, we can help by providing psychiatric
evaluations and therapy or psychologist referrals. In these cases our staff can be crucial in
working with you to rehabilitate the patient and help with your patient relationship.
If pain is a factor
If chronic pain resulting from an injury is central to a patient’s frustration and escalating
hostility, we can offer pain management options. This type of support could help you with
returning your patient to everyday life and work. For more information, see Managing pain.
We also train our client service staff to deal with difficult or hostile clients, so they can
support you in getting information from these patients. ACC staff usually hold interviews in
rooms that offer some protection and security for participants.
Preventing or handling attacks
Sudden, violent attacks are rare; most incidents are preceded by mounting tension,
frustration or escalating threats. To help you recognise the warning signs and take
appropriate action practical guides are available through many professional bodies,
including the New Zealand Medical Association and the Royal New Zealand College of
General Practitioners. Working and communicating with a patient, their family/whānau,
associated staff and other providers, can go a long way to reducing or eliminating a
patient’s hostility.
For example, there are steps that you can take before a patient arrives, when they make
appointments, when they are on your premises, while the consultation/visit is underway,
and if they become violent.
Here are some essential points to remember and develop in assessing the risks of and

managing these situations:
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Anticipate
Make sure you and your colleagues are always aware that you could
encounter an aggressive or violent patient, and have mechanisms in place
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Detect
Detecting high-risk patients early and implementing harm-reduction
measures can stop threatening behaviour escalating into full-blown
violence.
Analyse
Try to identify the factors that promote or encourage aggressive or violent
tendencies in a patient. A careful analysis of patient, practice and provider
features may identify the cause of the problem and enable management
strategies that benefit you and your patients.
Team
Take a team approach to planning and managing aggressive or violent
patients.
Support
Contact appropriate support if a patient becomes aggressive or threatens
violence, eg the Police, ACC, the New Zealand Medical Association, the
Medical Council of New Zealand, or other provider bodies.
Prevent and
Effective prevention and appropriate action are crucial when dealing with
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violent and aggressive patients.

Pharmaceuticals
ACC’s definition
Pharmaceuticals are described in the Act as:
·  prescription medicines, restricted medicines or pharmacy-only medicines, as listed
in Parts 1, 2 and 3 of Schedule 1 of the Medicines Regulations 1984
·  controlled drugs as defined in the Misuse of Drugs Act 1975.
Helping with costs
ACC may be able to contribute to prescription costs for clients who are prescribed
medication to help them recover and rehabilitate after injury.
To be eligible for assistance clients will need to complete the ACC249 Request for
Reimbursement of Pharmaceutical Costs.
It comes with an Information Sheet explaining what reimbursement we offer, and what we
need to be able to reimburse costs, E.g. the types of receipts and invoices that will need to
be sent with the form.

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How we decide to reimburse
ACC will consider helping with the cost of pharmaceuticals if a claim has been accepted
and the item prescribed:
·  is reasonably required to help the client’s treatment or rehabilitation based on their
injury and clinical information
·  is prescribed within the scope of practice of the prescribing provider
·  is classified as a prescription medicine, restricted medicine, pharmacy-only
medicine or controlled drug
·  follows best practice prescribing protocols
·  follows best practice rehabilitation pathways.
We’ll also consider the availability of similar pharmaceuticals and generic alternatives
listed in the Pharmaceutical Schedule (www.pharmac.govt.nz).
If there isn’t enough information to support a reimbursement request, we may ask for more
information.
What we’re unable to reimburse
We are not able to reimburse any:
·  administration charges added by the prescriber or dispensing pharmacy
·  the cost of substances that are not considered pharmaceuticals such as herbal
remedies and complementary medications.
How we contribute to costs
We pay for clients’ pharmaceuticals in several ways.
By contract
If the contract includes providing pharmaceuticals, we will pay the contracted price. Clients
should not be charged pharmaceutical costs if the contract price covers pharmaceuticals.
By reimbursement
We reimburse clients or pharmacies:
for co-payments on community pharmaceuticals
a contribution towards part-charges for partly subsidised community pharmaceuticals
a contribution towards pharmaceuticals that aren’t on the Pharmaceutical Schedule or that
don’t meet its subsidy criteria, as long as we have pre-approved them.

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Via Public Health Acute Services (PHAS)
The bulk amount that we pay to the Crown via the PHAS agreement covers
pharmaceuticals that are:
-  required by clients during acute hospital admissions or emergency department
visits
-  given as part of the treatment associated with a client’s outpatient follow-ups for
up to six weeks from discharge or treatment
-  used during treatment given by medical practitioners less than seven days after
referral by other medical practitioners
-  listed on the Pharmaceutical Schedule, meet its subsidy criteria and are used in
the community.
Pharmacies, clients and other providers do not need to invoice ACC for these
pharmaceutical costs as they are already paid for under the PHAS agreement.
When you’re prescribing medicines
When prescribing medicines please record:
·  the ACC45 Injury Claim form number against each item
·  a Ministry of Health identifier for all medical illness scripts to distinguish between
accident and medical cases.
When to seek prior approval
Prior-approval is needed for all non-subsidised pharmaceuticals.
If a client needs non-subsidised pharmaceuticals, that are not already covered by the
PHAS time period or under another ACC contract, we may be able to partially reimburse
the costs.
You’ll need to seek funding approval from us before prescribing the pharmaceuticals. If
you prescribe them without our prior approval, we ask that you let the client know that we
may not be able to contribute to the cost.
Requesting funding for non-subsidised pharmaceuticals
To apply for prior approval, complete the forms listed below with your patient.
We’ll need to know how the non-subsidised medication will help treat the injury and why
other subsidised medication is unsuitable. This type of approval is for a limited time only.
Initially you need to complete the ACC1171 Request for funding from ACC for non-
subsidised pharmaceuticals. You can seek a further contribution to costs by completing
the ACC1172 Evaluation of Pharmaceutical Use.

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Things to note when prescribing
When prescribing, please ensure that you:
·  prescribe subsidised pharmaceuticals that meet the Pharmaceutical Schedule
criteria for community pharmaceutical use.
Note: Non-subsidised pharmaceuticals should be rarely prescribed
·  always apply for Pharmac special authority when this is available – our clients
qualify for this
·  code prescriptions as A4 – all our clients are eligible people in New Zealand,
including non-residents whose injuries are covered by ACC.
Note: You’ll need to change the code on the script if it’s computer generated and
you’ve categorised the client as non-resident in your practice management system
·  prescribe generic names rather than brand name, e.g. diclofenac tablets, not
Voltaren tablets. If this means your client needs a new generic brand, you may
need to support their changeover. Information sheets are available from Pharmac at
http://www.pharmac.govt.nz/patients/AboutPHARMAC/infosheets
·  support patient adherence –use the tool at
http://guidance.nice.org.uk/CG76/QuickRefGuide/pdf/English.
·  prescribe small quantities when trialling new medicines
·  Report adverse reactions to the Centre for Adverse Reactions Monitoring, PO Box
913, Dunedin 9054.
·  More information, updates forms and guidelines can be found on: ACC Website

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Work and rehabilitation
ACC’s definition of rehabilitation
Rehabilitation is the term we use to cover the overall process of helping clients return to
work or, if they weren’t working at the time of their injury, to independence in their daily
lives as much as possible.
Rehabilitation can involve combinations of:
·  treatment for the effects of an injury
·  specialised inpatient rehabilitation
·  support to maintain employment
·  support to obtain employment
·  education support
·  support to regain independence
·  support in everyday living activities.
It’s a dynamic process in which we involve treatment providers and help make connections
to other providers. It recognises that one clinician or organisation can seldom meet a
client’s total needs in isolation.
Our rehabilitation framework
Our clients’ circumstances vary greatly according to injury, health, work and other factors.
We have created a range of pathways to make it easier to tailor the best support for each
person and help them achieve the results that will be the most benefit to them.
Together, the pathways fit into an overall rehabilitation framework. The table below
summarises the core concepts as developed in conjunction with stakeholders and staff:
Intent
Rehabilitation framework principles
An inclusive relationship of  Rehabilitation is based on listening to, and understanding,
support
the person in the context of their personal circumstances and
community.
A service approach based
ACC works with the person and their family, employer and
on client need
provider to plan and deliver the agreed rehabilitation tailored
to the individual.
ACC acts as a partner and  We mobilise existing support and provide any additional
facilitates the expertise of
support and services needed to help people return to
others
productive lives.

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Rehabilitation and you
Your involvement in helping our clients rehabilitate
As a treatment provider you may become involved with our clients at various stages of
their rehabilitation.
You might initiate rehabilitation yourself by treating an injury, or make a referral to elective
surgery or other specialists.
The client might also need social and vocational rehabilitation services. Through your
understanding of their needs, you can help us to identify where support in their
environment could help them.
Managing pain
At all stages of rehabilitation you should consider whether there are any pain-related
disability factors that could inhibit the client’s progress. We have a number of pain
management services to which you can refer clients, or you can let us know your concerns
so we can consider the best option.
For more information see:
For Providers > All contracts > Pain management services - a brief summary of each
service
ACC4467 Pain management quick reference guide to our services.
Vocational rehabilitation
‘Vocational rehabilitation’ aims to help clients maintain or obtain employment, or regain or
acquire vocational independence. The range of tools and programmes spans:
·  helping clients to rehabilitate at work e.g. via the stay at work service
·  helping clients to rehabilitate who have to consider different work
·  retraining clients when necessary to help them to find different work
When clients have some capacity to work and are at low risk of re-injury, we can work with
employers to arrange alternative work duties or hours.
Clients might need ongoing help to return to work, including return to work monitoring, an
Employment Maintenance or graduated return to work programme, work trials, agreed
recovery initiatives such as lifestyle changes, help with workplace access, or adaptation
and other equipment to enable their independence.

ACC, or sometimes another contracted provider, may ask you to verify that a client is
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medically fit for vocational rehabilitation programmes.
If a client’s return to work isn’t progressing as expected, discuss it with us. There may be
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Assessing a client’s work capacity – overview
As part of a client’s rehabilitation, we’ll ask an appropriately skilled treatment provider to
assess their capacity to work. We might also ask them to assess any medical grounds on
which we can compensate the client while they’re unable to work.
Stay at Work (SAW) providers
The provider will seek to understand the constraints, demands and risks of the client’s
workplace and how those factors fit within their rehabilitation needs. If you’re a Stay at
Work (SAW) service provider you’ll be involved in outlining a plan for modifying the work
tasks and gradually increasing the hours a client works as their recovery progresses.
Stay at Work (SAW) service
SAW service providers visit clients and employers at the workplace, review the work tasks
and environment, and develop return-to-work plans.
A good early intervention is the SAW level 1 service, in which a SAW service provider
helps clients and employers develop suitable return-to-work plans, including possible
short-term modifications to the employee’s work tasks.
The SAW level 2-4 services are longer term, cover more complex needs and require
progress reports from providers. Levels 3 and 4 are multidisciplinary programmes that
include both functional and vocational rehabilitation components and monitoring of the
client’s return to work.
SAW providers
SAW providers come from a range of backgrounds. They are registered or certified
members of their chosen fields, have ergonomic and health and safety expertise and are
skilled in working with injured people in the workplace.
Assessing a client’s disability duration – resources
Tools to help you assess the duration of incapacity include:
·  Treatment profiles for some primary care professions
·  the ACC14191 Return to Work Guide first published in May 2006.
These help to summarise current best practice for common injuries and provide a starting
point for how to manage a client’s rehabilitation at work or their return to work with ‘time off
work’ certification.
They should be used when possible. If you’d like paper copies, please phone the
Stationery Order Line on 0800 802 444, option 0.

Factors that influence disability duration
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The duration of a disability can be affected by factors such as dominant versus non-
dominant arm, work requirements (use of wrist, forearm), conservative versus surgical
treatment, and compliance with the rehabilitation programme.
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There is a minimum recovery time that most people will need to return to work at the same
performance level as before the injuries. Clients may be fit to return to work in a shorter
timeframe, particularly if there are suitable selected or modified duties, or other support.
Likewise there is the time ientified when most people are likely to be able to return to work,
subject to good health care and no significant complications and/or co-morbid medical
conditions.
There is a time at which additional review and evaluation should occur to determine when
(and if) a person may be able to return to work and whether there are specific factors,
including psychosocial, that need to be addressed.
Definitions for degree of work
For details on work types see For Providers > Work Type Details Sheets. The work types
are listed at the bottom of that page.
Work type
Definition
Sedentary
Exerting up to 4.5 kilograms (kg) of force occasionally and/or a negligible
amount of force frequently or constantly to lift, carry, push, pull or
otherwise move objects, including the human body.Involves sitting most
of the time, but may involve walking or standing for brief periods.
Light
Exerting up to 9kg of force occasionally and/or up to 4.5kg of force
frequently, and/or negligible amount of force constantly to move objects.
Physical demand requirements exceed those for sedentary work.
Usually requires walking or standing to a significant degree. However, if
the use of any arm and/or leg controls requires exertion of forces greater
than those for sedentary work, and the worker sits most of the time, the
job is rated light work.
Medium
Exerting up to 22.5kg of force occasionally and/or up to 9kg of force
frequently and/or up to 4.5kg of force constantly to move objects.
Heavy
Exerting up to 45kg of force occasionally and/or up to 22.5kg of force
frequently and/or up to 9kg of force constantly to move objects.
Very heavy
Exerting over 45kg of force occasionally and/or over 22.5kg of force
frequently and/or over 9kg of force constantly to move objects.

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Frequency scale for degree of work example
This table gives an example of how often the degree of work can apply to a client when
their work type work capacity and disability duration are being assessed.
Frequency
% of an 8-hour day
Example
Occasional
0-33
One lift every 30 minutes
Frequent
34-66
One lift every two minutes
Constant
67-100
One lift every 15 seconds

Medical certificates (ACC18)
Why medical certificates are important
Medical certificates (ACC18s) must be firmly grounded in your clinical assessment as they
verify that clients are entitled to ongoing ACC weekly compensation while they’re off work
recovering.
You can also use an ACC18 to:
·  alert us early that a client might need extra rehabilitation support so we can look at
the options
·  recommend home help, personal care, a second opinion or an assessment for the
client.
·  change a diagnosis or add an additional diagnosis.
We encourage you to use the spaces provided on the form, as well as other
communication methods, to give us your views on a client’s needs. If you’re unsure about
specifics, please still pass on any general concerns to our case managers.
Discussing confidentialities
If you’d like to talk to us about matters that you’re not comfortable writing onto a client’s
ACC18, please tick the option ‘I would like to discuss this with the client’s case manager’.
In complex cases it can be in the client’s interest for you to meet our staff, rehabilitation
experts, the client, their family and others in a case conference facilitated by ACC.
How medical certificates work
When clients need time off work to recover from their injuries, the medical certificates
validate this and specify specific tasks, or exposures, they should avoid while recovering.

They also allow us to provide workers with compensation for lost income while they’re off
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work. Please emphasise to clients that the sooner they send us their ACC18s, the sooner
we can process their applications for compensation.
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Only a medical practitioner (e.g. GP, Specialist or Emergency Department Doctor) or
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Nurse Practitioner can complete an ACC18 Medical Certificate.
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The practitioner records the client’s incapacity details on either the:
·  ACC45 Injury Claim form if this is the client’s first visit. This can be used to certify
incapacity for up to 14 days.
·  ACC18 Medical Certificate if an ACC45 has already been lodged. The ACC18
provides a detailed description of how the client’s injury affects their capacity for
work and their prospects for rehabilitation.
The certificate must show:
·  that the client’s examination was done in person, not by phone or based on third
party reports
·  your clinical assessment following the examination – this should be in line with the
relevant treatment profile
·  your diagnosis, comments and recommendations to meet the overarching needs of
care. The care must be necessary, appropriate and of the required quality.
How to fill in an ACC18 Medical Certificate
Give a confirmed diagnosis
After you’ve examined the client, enter a Read Code and/or a diagnosis (preferably both)
on the form. You can also use the ACC18 to change a diagnosis. If you do, we’ll need a
new Read Code along with the supporting clinical evidence or rationale for the change.
Get work information
Find out:
·  the type of work the client does and the tasks involved
·  key facts about their work history (tasks, skills)
·  what their work environment is like
·  any problems or injuries they had before the accident
·  any concerns or fears they have about returning to work
·  what tasks they can still do
An ACC18 can help you to gather this information. It provides you with an early opportunity
to advise us about possible risk factors in the client’s work that could affect their
rehabilitation.
Indicate a client’s capacity for work
If the client can’t do the job they had before their accident, they may still have other work
options, so it’s important to indicate whether they have a capacity for work.
Marking that they have some capacity (i.e. are fit for selected part-time or alternative work)
enables us to negotiate with all parties for the client to return to other available duties
within the medical limitations imposed by the injury. This doesn’t mean that we’ll stop their

weekly compensation payments. When negotiating a partial return to work we’ll need to
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ensure that payment levels are appropriate and in line with the client’s entitlement.
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If the client doesn’t think there are light duties available, contact us so that we can discuss
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this with their employer and look at alternatives.
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Determining fitness for work
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To be fully unfit for work the client must be unable to:
·  travel to and from work, and
·  be at the workplace, and
·  do specified tasks at the workplace.
If you identify only one or two of these points we can look at ways to help the client to
overcome their barriers. It’s important that we know their functional limitations, eg if they
can’t lift more than10kg, lift above shoulder height or stretch etc.
Important: The client must sign the ACC18 to say that it accurately reflects their activity
restrictions.
Specify the time off work
Time off work is usually certified from when the client first presents with an injury until the
next scheduled consultation/visit, usually two weeks or less.
If they have a severe or chronic condition, you may need to certify for a longer period,
usually a maximum of 13 weeks. However, in some cases, such as if the client has a
serious injury; they may need medical certificates at intervals of more than 13 weeks, e.g.
six- or 12-monthly intervals. The case manager will let you know if the client meets the
criteria.
A client can have a medical certificate for more than 13 weeks (up to a maximum of 12
months) if:
·  their functional restrictions have stabilised and are likely to remain unchanged, and
·  these restrictions mean they can’t perform any work, and
·  their eligibility for long-term entitlements is not in doubt.
Highlight next steps towards a return to work
Estimate when you expect the client to be fit for normal work. This helps us to negotiate
with their employer and develop appropriate rehabilitation and return-to-work programmes.
The  client’s  return  to work  should  always  focus first  on  their  pre-injury  employment  role,
tasks and hours. If the client can’t do their usual tasks or hours, options include part-time
work, vocational rehabilitation services, and temporary alternative duties.
Send in the ACC18 form
Electronically by eACC18: You can send us the form by post or electronically (eACC18)
through BPAC (the Best Practice Advocacy Centre) which is accessed through a BPAC
module in your PMS.
See the certification page on our external website for more information.

If you’re using the eACC18, the form is sent to us as soon as you press the ‘Submit’
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button.
Before you submit it, print a copy for the client to give to their employer.
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You can also give them a copy to keep. The client must also sign the consent section,
declaring that the information they have given is true and correct, and authorising us to
collect all relevant information. We recommend that for audit purposes, you keep a signed
copy of the eACC18 in paper or image form.
Manually by post: Give the paper form to the client to post to us. Emphasise to them that
the sooner they send us the form, the sooner we can process the application and begin
compensation payments.
Sustained return to work
Helping your patients return to work
The benefits of early return to work are recognised by health professionals and employers.
Modern practice supports safe and sustainable work that quickly integrates people back
into their workplace and their normal lives.
Informed work fitness certification is vital to opening the doors to the range of vocational
rehabilitation assistance ACC can deliver to your patients.
Returning to work after an injury has to be sustainable if it’s to be successful. To establish
your patient’s work capacity there’s a few things you can do:
1.  Get in touch with their employer to:
·  understand the specific demands of the job
·  identify any barriers to returning to work
·  troubleshooting the barriers.
2.  Let us know if barriers are indentified.
3.  Call the case owner looking after your patient if you’re unable to make contact with the
employer.
There’s a lot of good information on supporting and coordinating an effective return to work
in the ACC2360 Return to Work Guide, which was developed by both ACC and treatment
providers. It includes best practice information and practical help for managing
rehabilitation and supporting your decisions.
Understanding the demands of your patient’s job
The first step in helping you assess your patient’s ability to return to work involves
identifying your patient’s work tasks. These might include things like sitting, standing,
climbing a ladder, lifting heavy loads, or working on a keyboard most of the day.
‘Work type detail sheets’ are available to help you. They specify tasks for various work
categories and can be found on our website by scrolling to the bottom this page: For

Providers > Work type detail sheets.
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Check if the client can complete any of the employer’s minimum requirements. Observing
directly is the most accurate way to do this.
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How to identify return-to-work barriers
A number of barriers can affect your patient’s fitness to return to full, partial or graduated
work activities. A vocational/occupational provider may need to be involved. They’ll consult
with you and any rehabilitation providers involved in your patient’s care on the following:
Disability and physical impairment
Residual impairments can stop a client returning to work fully. It’s important to diagnose
these and seek the help of providers with appropriate expertise to manage the
rehabilitation.
Injury factors
Injury factors include safety, biomechanical, cognitive, perceptual and functional
limitations. Pain itself is not a contraindication to activity and work. If you identify specific
safety concerns they may apply to only part of the job. Identifying the part(s) of the job the
client can still do is an important starting point for returning them to work part time, or using
a graduated approach.
Individual factors
Individual factors include the client’s beliefs about their injury and symptoms, e.g. their fear
of pain from movement. A client may believe that pain intensity signals significant damage
to the body and that all activity and work must be avoided until the problem is completely
fixed. This means they often respond to the anticipation of pain, which engenders a ‘fear-
and-avoidance cycle’.
In these cases you should consider prescribing appropriate pharmaceuticals as part of
your response, and to ensure they’re being used correctly.
Workplace factors
Workplace factors include job satisfaction, work organisation issues, and relationships with
managers and co-workers. An employer’s willingness and/or ability to offer temporary
modifications to work tasks are critical.
To see an example of how to complete a return-to-work plan with your patient, see
Appendix 3 of the ACC2360 Return to Work Guide.
Advising us of barriers preventing return to work
When your patient has ongoing restrictions or specific limitations, please let us know so we
can get in touch with their employer to arrange duties and a phased return to work as
appropriate.

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A phased programme may involve:
·  selected or alternative duties, so that the tasks they can still do become the
temporary focus of their work
·  a graduated return to work, where they undertake full or selected duties for part of
the day and steadily increases them over a few weeks. With this option it’s
important to keep to the usual work starting time.
·  an employment maintenance programme, which provides an individual return-to-
work plan containing physical and vocational rehabilitation targets
·  part time work, which is considered a temporary last resort and only used in
exceptional circumstances, e.g. significant fatigue or serious medication side-
effects. See Lifestyle substitution.
Our main focus is to return your patient to a full day of selected duties and activity rather
than a limited day of full duties.
Dealing with return-to-work barriers
Fear of pain from movement
If there are no specific safety concerns, your patient’s activity levels should be based on
time rather than pain. They should be given clear guidelines on steadily increasing their
activity level to avoid the risk of ‘disuse or inactivity syndrome’ developing from a long-term
withdrawal from activity. Reassurance, motivation and encouragement can often help to
counter this problem.
Lifestyle substitution
A graduated return to work may not advance beyond, for example a four-hour day, but it
enables your patient to experience the benefits of work while avoiding the lifestyle
pressures associated with working longer hours.
To change this pattern, ask them to work a full day followed by a short day, then steadily
move towards every day being a full day.
Workplace barriers
An ergonomic review of the workplace, organisation and processes might be needed.
These might not have caused the injury but could be barriers to a full and sustainable
return to work. Health professionals who specialise in the work environment will usually
conduct these reviews.
Please watch carefully for other return-to-work barriers. Anecdotal evidence indicates that
highly motivated people (such as the self-employed) return to work more quickly than other
groups of workers. However, a few may need close monitoring to ensure they temporarily
modify their workloads and do not end up prolonging their recovery.

Support is important within the first few days, as this is when most return-to-work problems
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occur. Many concerns can be resolved by contacting your patient’s ACC case manager
and/or their employer (manager or supervisor). If this fails, you might consider a referral to
a health professional specialising in the work environment.
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Referral and rehabilitation services
Other health professionals involved
A number of health professionals specialise in the work environment including:
·  occupational health nurses
·  occupational physicians
·  occupational physiotherapists
·  occupational therapists
·  vocational rehabilitation providers.
Your patient’s problems will indicate which provider is the most appropriate. Please
contact their case manager to discuss any referral, as you might need prior ACC approval.
Vocational rehabilitation services
Some of our most common assessment, service and/or rehabilitation programmes
available to ACC clients are described in the table below. In almost all cases these are
provided by contracted providers. The provider criteria in the table gives an indication of
the contract type.
Service
Purpose
Provider criteria
Initial Occupational
Assesses a client’s education,
Occupational assessor
Assessment
training and work experience and
identifies suitable work types.
Initial Medical
Assesses a client’s medical and
Medical assessor
Assessment
injury-related conditions, and any
non-injury-related barriers to ensure
they can medically sustain
rehabilitation with safety.
Stay at Work 1 and Stay
Evaluates and reviews a worksite,
Rehabilitation
at Work 2
then implements a supervised
professional
increase of hours with the client via a
documented plan, including
troubleshooting.
Stay at Work 3 and Stay
Evaluates a client’s worksite and
Rehabilitation
at Work 4
involves the key work contact to
professional
identify changes needed to make the
environment safe or for the client to

return to work. It is a multidisciplinary
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service where functional rehabilitation
is provided alongside monitoring of
the client’s return to work.
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Clinical Review of Fitness  Allows certifying practitioners and
Medical Practitioner
claims managers to request an expert
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for Work
medical view of a client’s fitness for
with Vocational training
work. The service helps clients return
to work quickly and safely following
injury. The CRFW provider consults
with all parties to ensure agreement
on fitness for work.
Work Readiness
Helps clients to become work ready
Vocational practitioner
Programme
when, even after all practicable
rehabilitation has been completed,
they aren’t expected to return to their
pre-injury job or can’t maintain their
current job due to injury-related
factors.

Social Rehabilitation Services
Some of our most common assessment, service and/or social rehabilitation programmes
available to ACC clients are described in the table below. In almost all cases these are
provided by contracted providers. The provider criteria in the table gives an indication of
the contract type.
Service
Purpose
Provider criteria
Equipment
Provides equipment, aids and
Contracted providers
appliance based on the client’s
assessed needs to support their
rehabilitation.
Home and Community
Provides high quality, flexible support  Contracted providers
Support Services
service in the client’s home and
or personal carer
community to support rehabilitation
and help them return to an ‘everyday
life’. Some services include home
help, attendant care and/or childcare.
Housing modifications
Provides project management and
Contracted consultants
advice for housing modifications
approved by ACC, such as the
removal of structural barriers or
addition of fixed features that are
based on the client’s assessed injury
related needs.

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Inpatient non-acute
This contract is for clients who, as a
DHBs and some Trust
rehabilitation
result of personal injury, require fast-
Hospitals
stream inpatient rehabilitation in a
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Social Rehabilitation
To recommend to ACC the most
Contracted providers
Assessments
appropriate and cost-effective
combination of social rehabilitation
services to enable the claimant to
achieve the expected outcome in the
most rapid and durable manner.
Specialised Rehabilitation Services
Some of our most common assessment, service and/or specialised rehabilitation
programmes available to ACC clients are described in the table below. In almost all cases
these are provided by contracted providers. The provider criteria in the table gives an
indication of the contract type.
Service
Purpose
Provider criteria
Concussion services
An interdisciplinary traumatic brain
Multidisciplinary
injury (TBI) service. The service aims  providers
to prevent long-term consequences,
such as post-concussion syndrome
(PCS), by identifying clients at risk of
PCS and giving them effective
interventions and education.
Spinal cord active
Non acute impatient rehabilitation
Multidisciplinary
rehabilitation and/or
services for clients who have
providers
reassessment
sustained a Spinal Cord Injury (SCI)
to assist them to return to acute
participation in their home, work,
leisure and community in a planned
and timely manner. Reassessments
support clients to maintain their
health and wellbeing and prevent
secondary complications through
regular and routine reassessment.
Visual impairment
Provides clients who are visually
Multidisciplinary
services
impaired as a result of their injury the  providers
support they need to regain the skills
they need in everyday life.
Education support
Aims to meet the short and long term  Education support
injury-related learning support needs  workers
of children and young people
attending early childhood education

centres, primary and secondary
nt
institutions and the long-term injury-
related learning support needs of
students in tertiary education.
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Traumatic Brain Injury
Supports clients who have sustained  Multidisciplinary
Residential
a moderate-severe TBI to return to
providers
Rehabilitation (TBI RR)
active and meaningful participation in
Services
their community. If appropriate
supports clients return to work in a
planned, timely, supported and
sustainable manner.
Child and adolescent
Specialist inpatient, community
Multidisciplinary
rehabilitation services
rehabilitation and follow-up services
providers
(CARS)
for children and young people aged
0-16. It aims to enable these children
to achieve and maintain their optimal
level of functioning, participate in
developmentally appropriate
activities, prevent further injury and
provide advice on appropriate
rehabilitation planning.
Training for
Trains and coaches a client as they
Multidisciplinary
Independence
adapt to the impact of their injury and  providers
helps maximise their participation in
home and community activities.
Residential Support
Provides slow stream rehabilitation or  Contracted or
Services
a ‘home for life’ environment for
designated provider
clients who have suffered a serious
injury.
Pain Management Services
Some of our most common pain management services available to ACC clients are
described in the table below. In almost all cases these are provided by contracted
providers. The provider criteria in the table gives an indication of the contract type.
Service
Purpose
Provider criteria
Pain Management
Uses psychological
Clinical
Psychological Service
assessments and interventions
Psychologist/psychiatrist
to help clients cope and adapt to
their injuries.
Pain Disability
Targets psychosocial risk
Medical Practitioner, Clinical
Prevention (PDP)
factors for pain and disability for  Psychologist or Health
Programme
clients who have additional
Psychologist

mental health-related issues,
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such as depression.
Progressive Goal
Activity mobilisation programme  Physiotherapist, Occupational
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Attainment
which is tailored to meet the
Therapist, Registered Nurse,
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Programme (PGAP)
rehabilitation needs of clients
Osteopath, or Chiropractor
who are struggling with the
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challenges of a wide range of

persistent pain conditions.
Functional
Provides and individualised
Registered Physiotherapists
Reactivation
exercise programme that
and/or Occupational Therapist
Programme (FRP)
incorporates education in pain
management and the practical
applications of self-management
principles.
Comprehensive Pain
A comprehensive, fully
Multidisciplinary providers
Assessment (CPA)
integrated, and independent
clinical assessment. The
emphasis is on determining
functional goals for the client’s
rehabilitation.
The CPA consists of three
separate clinical assessments
(medical, functional and
psychological) followed by a
team discussion. The team
produces a combined
‘formulation’ with
recommendations.
Activity Focus
For clients who have a
Multidisciplinary providers
Programme (AFP)
persistent pain-related disability
with significant functional
problems which are due to an
injury. The purpose of this
programme is to help clients
adopt a self-management
approach to independent
functioning both at work and
home, despite pain.
Multi-disciplinary
A three-week residential
Multidisciplinary providers
Persistent Pain
programme that primarily
(MDPP) Programme
focuses on helping modify the
client’s response to pain, rather

than removing the pain stimulus.
Interventional Pain
Provides specialised
Contracted specialised
Management
assessments and treatment for
medical practitioners

clients who have an accepted
nt
claim for cover for a personal
injury. Pain is a complex
phenomenon and best treated
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using an integrated approach.
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IPM procedures should be
undertaken within the wider
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context of the client’s
rehabilitation (i.e. it is not
appropriate for a client to be
receiving IPM procedures in
isolation, with no concurrent
rehabilitation).

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7.
Invoicing and payments
Our legislation and policies
Payment criteria
ACC pays providers for the costs of treating clients’ personal injuries that are covered by
the scheme.
It is important to note that legislation and policies specify that the treatment provided must
be for the purpose of restoring the client’s health to the maximum extent practicable. That
means it needs to be:
·  necessary and appropriate
·  of the quality required
·  given at the appropriate time and place, with only the necessary number of
treatments
·  given prior approval, if required
·  provided by an appropriately qualified treatment provider holding a current annual
practising certificate
·  clearly documented.
In deciding whether the points above apply to a client’s treatment, the legislation also says
ACC must take into account the:
·  nature and severity of the injury
·  generally accepted treatment for the injury in New Zealand
·  other treatment options available in New Zealand for such an injury
·  New Zealand cost of both the generally accepted treatment and the other options,
compared with the likely benefit to the client of the treatment.
Your provider responsibilities are significant. In the course of making payments to you, we
may at times need to query and verify aspects of your treatment or approach. This is to
ensure that treatment meets the criteria including ‘necessary’, ‘appropriate’ and ‘of the
quality required’, and that all providers are supporting the treatment given with auditable
clinical records. For more information on monitoring, see Audits, fraud control and
monitoring.

Invoicing
You can invoice ACC:
mentsy
·  under the IPRC (Liability to Pay or Contribute to Cost of Treatment) Regulations
2003, and amendments (Regulations)
·  through a contract arrangement (see your particular contract for details of the
invoicing process)
·  by agreement with ACC against a purchase order
ng and pai
Note: If you’re providing services under an ACC contract, you need to follow the invoicing
c
or payment arrangements in the contract, as these will supersede the Regulations.
oi
Inv
For more information, visit our website at For providers > How to invoice ACC, or phone
the Provider Helpline on 0800 222 070 or email [email address].
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See also, Electronic invoicing: eSchedules.
Invoicing under Regulations –key points
The Regulations referred to are the IPRC (Liability to Pay or Contribute to Cost of
Treatment) Regulations 2003.
ACC and Accredited Employers (AEs) pay, or contribute to, costs at the rates and/or
amounts specified in these Regulations or later amendments. These contributions are
towards basic consultation costs and additional costs for specific treatment and procedure
types. For details of the contributions please see the Schedule
The Regulations allow invoicing for:
·  a consultation/visit relating to an injury or condition covered by ACC. The price for
the consultation includes any procedures not specified in the Regulations.
·  a treatment or procedure carried out during the consultation/visit if an amount for it
is specified in the Schedule. The amount we pay includes the cost of the most
effective treatment materials for the client’s injury. Procedures that don’t have a
specified price in the schedule are included in the price for the consultation and
can’t be invoiced separately.
You can only invoice us for payments if your client is eligible for the service you provide.
Our policy is to recover any money paid through incorrect invoicing.
For more details about inclusions and exclusions for invoicing treatments and procedures
see, Consultation/Visit and procedures costs and codes.
Invoicing ACC and AEs
ACC
We pay you once we have accepted a claim and received your invoice for services,
usually on an ACC40 schedule (for medical practitioners) or ACC47 schedule (for other
treatment providers), or electronically through your Practice Management System (PMS).
Accredited Employers
If your patient works for an Accredited Employer you’ll need to send your invoices directly
to the AE. If you have any queries about invoice payments, prior approval or injury

management when treating an employee of an AE, please discuss these with the
employer’s contact person or their nominated Third Party Administrator. For more
information see Lodging Accredited Employer claims.
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Consultations/Visits
Definition of a consultation/ visit
For ACC to pay for a consultation/visit, it must be a necessary and appropriate face-to-
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face assessment, treatment or service relating to a covered injury.
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This includes providing injury-related advice, completing prescriptions, making referrals,
issuing any certificate to ACC and all relevant documentation that may result from the
consultation/visit. It does not include insubstantial medical services for which clients
wouldn’t normally pay, e.g. phone consultations or informal encounters.
For billing purposes, a consultation/ visit also includes:
·  removing sutures
·  removing a non-embedded foreign body from an eye, mouth, auditory canal or other
site (excluding rectum or vagina) without incision
·  dressing minor single burns or abrasions
·  re-dressing wounds that don’t need significant dressings
·  checking a plaster cast
·  removing casts or splinting
·  removing packing of the nose, an abscess or haematoma
·  cleaning of and minor dressings for (e.g.  small gauze or non-stick dressings) small
burns or abrasions
·  cleaning of and minor dressings for (e.g.  plaster strips) small, open wounds
·  managing minor sprains that don’t need significant splinting.
For more details about inclusions and exclusions for invoicing consultations/visits, see
Consultation/Visit and procedures costs and codes.
When appointments are missed
You can invoice us for missed appointments or cancellations only if:
·  we made the appointment and agreed to pay a non-attendance fee as part of
arranging it
·  your contract with us covers payments for non-attendance by clients.
Paying for more than one consultation/ visit per day
Generally, we only pay for one consultation/visit per day per client, for all provider types.
However, we consider each case individually and if clinically justified we may pay for a
second consultation/visit.
Criteria for more than one payment
Paying for two consultations/visits in one day may be clinically justified if:

·  you need to reassess the client for a second time later in the day, e.g.  if you need
to change a dressing or check a client whose condition may deteriorate or be likely
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to deteriorate
·  the client initiates the second consultation/visit because of concerns about their
condition
·  the client is treated for one injury then leaves the consultation/visit and has a
second, separate accident that day.
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We’re unable to pay for more than one consultation/visit in a day when:
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·  a client is referred for X-ray and returns for a consultation/visit afterwards to discuss
the outcome
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·  more than one covered injury is managed at the same presentation.
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If you have any queries, please call the Provider Helpline on 0800 222 070 or email
[email address].
Make sure you let us know why a second consultation/visit was necessary
To help us make quick decisions on invoices for additional same-day consultations/visits,
please explain why they were necessary. If you use manual invoices or a bulk billing
schedule, note your reasons on the invoice. If you invoice electronically, phone the
Provider Helpline on 0800 222 070 or email [email address].
Medical practitioners’ treatment costs
Medical practitioners’ costs that we cover
We pay for two aspects of a medical practitioner’s treatment costs:
·  A consultation/visit fee for a covered injury or condition.
Note: The rate we pay depends on the client’s age and is specified in the
Regulations. We pay a slightly higher rate for clients under six years old than we do
for all other clients.
·  Specific treatment or procedures a client receives during a consultation/visit.
Note: The treatment or procedure must be listed under the heading ‘Medical
Practitioners’ and Nurses’ costs’. We pay the amount stated in the Schedule to the
Regulations.
How to invoice when different injuries need different treatments
If a client has more than one injury and needs procedures for more than one injury at the
same consultation/visit, the fees we pay are scaled.

We pay:
·  the full amount stated in the Schedule for the most expensive treatment or
procedure the client receives
·  50% of the amount stated in the Schedule for any other treatment or procedure the
client receives.
Example 1: An adult client needs three treatments or procedures for more than one injury.

Example 1
Regulated amount $
Invoice shows $
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Treatment/Procedure A
$34.83
@ 50% = $17.52
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Treatment/Procedure B
$75.44 (highest-cost
@ 100% = $75.44
procedure overall)
Treatment/Procedure C
$40.35
@ 50% = $20.18
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Consultation/Visit
$35.48
$35.48
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Invoice Total
$148.62
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Note: This example is based on indicative rates and isn’t intended to reflect any amounts
specified in the latest Regulations or Schedule.
How to invoice when the same injury needs different treatments
If a client receives a basic treatment or procedure that is then expanded on during the
same consultation/visit, we pay only the most expensive procedure.
If you need help clarifying whether the rules for dual treatments apply, contact the Provider
Helpline on 0800 222 070 or email [email address]. We also recommend using
the list of treatments and procedures from the Schedule in the Regulations to find the most
appropriate category.
Nurses’ treatment costs
‘Nurse’ defined for invoicing
For ACC purposes a ‘nurse’ means a registered nurse, including a nurse practitioner, but
not an enrolled nurse or nurse assistant.
Nurses’ costs that we cover
We pay for two aspects of a nurse’s treatment costs:
·  a consultation/visit fee for a covered injury or condition
Note: The rate we pay depends on whether you are a Registered Nurse or a Nurse
Practitioner. If it’s a combined consultation together with a GP the amount also
depends on the client’s age.
·  specific treatment or procedure a client receives during a consultation/visit.
Note: The treatment or procedure must be listed under the heading ‘Medical
Practitioners’ and Nurses’ costs’. We pay the amount stated in the Schedule to the
Regulations.
These payments apply to nurses, or providers of nursing services, who don’t have
contracts with ACC. Nurses and Nurse Practitioners wanting to claim under the
Regulations need to be registered with us as individual treatment providers.
How to invoice when different injuries need different treatments

If a client has more than one injury and needs two or more treatments or procedures at the
same consultation/visit, the fees we pay are scaled. See Example 1 in the table above. We
pay:
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·  the full amount stated in the Schedule for the most expensive treatment or
procedure the client receives
·  50% of the amount stated in the Schedule for any other treatment or procedure the
client receives.
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How to invoice when the same injury needs different treatments
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If a client receives a basic treatment or procedure that is then expanded on during the
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same consultation/visit, we’ll pay only the most expensive procedure.
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If you need help clarifying whether the rules for dual treatments apply, contact the Provider
Helpline on 0800 222 070 or email [email address]. We also recommend using
the list of treatments and procedures from the Schedule in the Regulations to find the most
appropriate category.
Joint medical practitioner and nurse treatment costs
Joint treatment costs that we cover
If both a nurse and a medical practitioner treat a client during the same consultation/visit
and each one makes relevant clinical notes, we pay for both aspects of the treatment
costs:
·  a joint consultation/visit fee for a covered injury or condition
Note: The rate we pay depends on the client’s age and is specified in the
Regulations. We pay a slightly higher rate for clients under six years old than we do
for all other clients.
·  a specific treatment or procedure a client receives during a consultation/visit.
Note: The treatment or procedure must be listed under the heading ‘Medical
Practitioners’ and Nurses’ costs’. We pay the amount stated in the Schedule to the
Regulations.
When you invoice for a joint consultation/visit use only the medical practitioner’s provider
number.
Note that when we pay for a joint consultation/visit we don’t pay:
·  more than once for the same treatment
·  the individual consultation costs specified for a registered nurse, nurse practitioner
or a medical practitioner.
Invoicing for joint work on multiple treatments and procedures
If a client has more than one injury and needs two or more treatments or procedures from
a nurse and a medical practitioner working together at the same consultation/visit, we pay
for:
·  the full amount stated in the Schedule for the most expensive treatment or

procedure the client receives
·  50% of the amount stated in the Schedule for any other treatment or procedure the
client receives.
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Example 2: An adult client needs three treatments or procedures for more than one injury.
At a joint consultation/visit a nurse and medical practitioner work together on each
treatment or procedure.
Example 2
Regulated
Invoice shows $  Provider Type
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amount $
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Treatment/Procedure A   $34.83
@ 50% =
Nurse
$17.42
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Treatment/Procedure B   $75.44 (highest-
@ 100% =
Medical practitioner
cost procedure)
$75.44
Treatment/Procedure C  40.35
@ 50% =
Nurse
$20.18
Joint Consultation/Visit  $38.79
$38.79
Medical Practitioner
Invoice Total
$151.83

Note: This example is based on indicative rates and isn’t intended to reflect any amounts
specified in the latest Regulations or Schedule.
Invoicing for joint work when the same injury needs different treatments
If at a joint consultation/visit a client receives a basic treatment or procedure that is then
expanded on during the same consultation/visit, we pay only the higher amount for the
more comprehensive service.
If you need help clarifying whether the criteria for dual treatments apply, contact the
Provider Helpline on 0800 222 070 or email [email address]. We also recommend
using the list of treatments and procedures from the Schedule in the Regulations to find
the most appropriate category.
Working separately on multiple treatments or procedures
When a nurse and a medical practitioner work separately to provide more than one
treatment or procedure for a client for more than one injury during a joint consultation/visit,
we pay:
The nurse
The medical practitioner
The  full  amount  specified  in  the  Schedule  for  The  full  amount  stated  in  the  Schedule
the  most  expensive  treatment/procedure
for
the
most
expensive
the client is given by the nurse.
treatment/procedure  the  client  is
given by the practitioner.
50%  of the amount  stated in  the  Schedule for

each  other  treatment/procedure  given  by  50%  of  the  amount  stated  in  the
the nurse.
Schedule
for
each
other
treatment/procedure  given  by  the
practitioner.
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Example 3: An adult client needs several treatments or procedures for more than one
injury. At a joint consultation/visit a nurse and medical practitioner work separately on each
treatment or procedure. We pay:
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Example 3
Regulated
Invoice shows $
Provider number
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amount $
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Treatment/Procedure by
$34.83
@ 100% = $34.83
Nurse
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Treatment/Procedure by
$32.16
@ 50% = $16.08
Nurse
nurse A
Treatment/Procedure by
$113.09
@ 100% = $113.09
Medical
medical practitioner B
practitioner
Treatment/Procedure by
$68.59
@ 50% = $34.30
Medical
medical practitioner B
practitioner
Joint Consultation/Visit
$38.79
$38.79
Medical
practitioner
Invoice Total
$237.09
Note: This example is based on indicative rates and isn’t intended to reflect any amounts
specified in the latest Regulations or Schedule.
Specified treatment providers
Defining specified treatment providers
Specified treatment providers are acupuncturists, chiropractors, occupational therapists,
osteopaths, physiotherapists, podiatrists and speech therapists, as listed in Regulation 3 of
the IPRC (Liability to Pay or Contribute to Cost of Treatment) Regulations 2003.
Rule for invoicing
Specified treatment providers can provide services to our clients either under contract or
under the Regulations.
Invoicing under contract
Providers invoicing for services given under contract should follow the invoicing
requirements specified in the contract.
The following applies to invoicing and payment under the Regulations.
Invoicing under the Regulations
All specified treatment providers invoicing under the Regulations must choose whether

they want to be paid per hour or per treatment.
When you start invoicing under one approach we take that as your chosen option. To
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change your invoicing option, please write with your reasons to ACC Provider
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Registrations, PO Box 30823, Lower Hutt, 5040 or email [email address].
Our policy is to allow one option change without the need for internal ACC approval. Any
further changes are referred by Provider Registrations to ACC’s Health Procurement and
Contracting Unit for approval.
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When you request a change to your invoicing option you won’t be eligible to receive any
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back payments for services. Your new invoicing option will be effective from the date of
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receipt of the change request.
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The Regulations specify the rates for invoices per hour or per consultation. For more
information visit our website at For Providers > Invoicing and payment or contact the
Provider Helpline by phoning 0800 222 070 or email [email address].
Invoicing per hour
If you provide ‘direct treatment’ for less than one hour, we calculate the payment in
increments of five minutes, e.g. if your treatment takes 28 minutes, we pay for 30 minutes
of the hourly rate (i.e. half the hourly rate).
Direct treatment
You provide ‘direct treatment’ when you directly apply your expertise to a client’s
treatment. Direct treatment includes:
·  assessing and/or reviewing a client’s injuries
·  developing a treatment plan with the client
·  applying direct hands-on treatment.
It doesn’t include the “hands off” element of treatments such as acupuncture when the
provider is not physically attending to the client.
When attending to multiple clients you cannot invoice concurrently. Instead, calculate the
total time spent in direct contact with each. You cannot invoice for more than one hours
treatment in any hour.
If you’re invoicing on the hourly rate we pay the appropriate proportion of the rate that
applies for direct treatment.
Part-hour payments
Hourly Rate
Hourly Rate
Minutes
$(GST excl)
$(GST incl)
5
4.73
5.44
10
9.46
10.88
15
14.19
16.32

20
18.92
21.76
25
23.65
27.20
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30
28.38
32.64
35
33.11
38.07
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40
37.84
43.51
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45
42.57
48.95
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50
47.30
54.39
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Part-hour payments
55
52.03
59.83
60
56.76
65.27
Please note: these prices are as per Regulations effective 01/04/2014 and may have been
updated since. For current prices see ACC1523 on our homepage.
In all cases your clinical records must support and document your direct treatment. If it’s
clinically justified, you can claim for a block of direct treatments of more than an hour’s
duration, as long as you document it in your clinical records.
Please note that we’ll follow up any invoicing patterns outside of expected norms for that
discipline. For more information on provider monitoring and other quality assurance
functions, see Audits, fraud control and monitoring.
Invoicing on the hourly rate for more than one client
If you treat more than one client in an hour, we pay only up to 60 minutes in total.
Example: You treat six clients in a group for an hour.
·  You can invoice us for six individual clients for 10 minutes each (i.e. invoice us for a
total of one hour of your time).
·  You can’t invoice us for an hour for each client (i.e. invoice us for a total of six hours
for one hour of your time).
Please note: Your records still need to demonstrate that your clinical input is necessary
and appropriate. See Supporting quality.
You can invoice us in five minute increments for accuracy – that is for 5, 10, 15, 20, 25, 30,
35, 40, 45, 50, 55 or 60 minutes of treatment.
Example: You treat a client from 10:00am to 10:30am (30 minutes), and another from
10:15am to 11:00am (45 minutes).
·  We’ll pay for the hour between 10:00am and 11:00am, but not for 75 minutes of
treatment time.
However, if your second client’s 45-minute slot begins at 10:20am (so finishes at 11:05am)

we’ll pay for one hour and five minutes.
You can’t invoice us for the overlap of the clients’ treatment during the hour, but you can
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invoice us for the five minutes beyond the hour.
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Limitations to invoicing per treatment
If treatment profiles and their trigger numbers apply to your treatment, you can’t combine
the number of treatments for different injuries (i.e. the sum of different Read Codes) to give
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an aggregated number of treatments. You can only provide treatments up to the highest
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individual trigger number before you need to provide an ACC32 Request for prior approval
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of treatments.
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Example 4: A client has a mountain bike accident and sustains multiple injuries:
Example 4
Injury
Trigger number of treatment profiles
S50
Sprain shoulder
12
SE31.
Contusion elbow
12
S5400
Sprain knee joint
14
The injury with the most treatments before you need to get ACC approval for additional
treatment is the S5400 sprain knee joint. You can invoice us for up to 14 treatments in this
example, but not the sum of the treatment trigger numbers for all the injuries, which would
be 38 treatments.
Similarly, if you are dual registered (i.e. as a chiropractor and acupuncturist) you can’t
combine the number of treatments under both provider types to give an aggregated
number of treatments. You can only provide treatments up to the highest individual trigger
number before you need to provide an ACC32 Request for prior approval of treatments.
Examples: A chiropractor can provide up to a trigger of 18 treatments, whereas an
acupuncturist can provide up to 16 treatments before prior approval is required. You can
invoice us for up to 18 treatments in this example, but not the sum of the treatment trigger
numbers for all the injuries, which would be 34 treatments.
If none of the injuries have a treatment profile with a treatment trigger, then you can
provide 6 treatments before requesting approval for additional treatments.
If you anticipate that the trigger number is likely to be exceeded, complete an ACC32
Request for Prior Approval of Treatment. For more information, see Further treatment:
Referring clients via the ACC32 form.

Payment for counsellors
How to invoice
The Regulations specify counsellors’ invoicing and payment arrangements. They require

you to provide treatment face to face.
Exception
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There is one exception. You can provide and invoice for one session of counselling
provided in another way (eg by phone) if the client urgently needs it for mental injury
caused by certain criminal acts outlined in section 21 of the AC Act 2001. See also, Mental
injuries, sensitive claims and counselling.
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ACC will pay either the:
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·  hourly rate fixed in the Regulations for treatment provided by a counsellor who’s a
medical practitioner, or
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·  hourly rate fixed in the Regulations for treatment provided by a counsellor.
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Actual rates may be adjusted from time to time. You can get the latest rates from us by
phoning the Provider Helpline on 0800 222 070 or emailing [email address].
Different invoicing and payment arrangements may apply to counsellors who deliver
treatment or services under contracts with ACC.
Invoicing for services given under contract or Regulations
If you’re providing services under an ACC contract, you need to follow the invoicing or
payment arrangements in the contract; these will supersede the Regulations.
Services and reports
Invoicing for imaging services
You’ll find a list of imaging services and fixed rates for treatments and procedures in the
Schedule to the IPRC (Liability to Pay or Contribute to Cost of Treatment) Regulations
2003. The Schedule covers a wide range of radiological procedures used in everyday
practice, including mammography, ultrasound and special procedures such as myelogram
and arthrogram.
High-tech imaging
The Schedule doesn’t cover more high-technology items such as MRI scans. You can only
access them – and have us pay for them if you’re working under contract for these
services. See also Further treatment: Referring clients via the ACC32 form - Types of
acute referrals.
Invoicing for supplying reports and records
If we ask you to provide a report, you can invoice us for a report fee at the rate quoted in
our request letter. You need to cite the purchase order number and the appropriate report
code, e.g.  STPR for specified treatment providers and MEDR for medical practitioners.
The standards we expect in your reports are the same as those of your professional
organisation, i.e. they must be honest, impartial, unbiased, clear and relevant. They will
serve your patients’ interests best if they focus on verifiable clinical evidence wherever
possible.

We sometimes ask for copies of existing clinical notes and typically pay the expenses for
providing this information at identified rates. You can get the latest rates from your local
Supplier Manager or by phoning the Provider Helpline on 0800 222 070 or emailing
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[email address]
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Important: Under section 309(4) of the AC Act 2001 you’re required to provide us with any
information we ask for if the client has authorised us to make the request and you have
notice of that authorisation. Clients give us this authority when they sign their ACC45 Injury
Claim forms.
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It is an offence not to supply the information without a reasonable excuse, as we use it to
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make decisions about entitlements and to detect fraud.
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If a patient asks for their own medical records, you must supply them free of charge –
unless the patient has requested the same information within the past 12 months, or the
information includes video recordings, X-rays and CAT scans.
Invoicing correctly
Procedures for invoicing ACC
How you invoice ACC will depend on the conditions of your contract, purchase order or the
Regulations. If you are:
·  contracted to ACC, follow the invoicing process in the contract
·  seeking payment for services that we’ve asked you to provide, make sure you have
a seven-digit purchase order number from us and include it on your invoice to the
requesting unit. It will be processed by our Accounts Payable team.
·  invoicing under the Regulations, see For providers > Invoicing and payment > How
to invoice ACC.
A claim needs to be lodged prior to an invoice being submitted. When invoicing, please be
aware of the following:
·  only one consultation per day/per client can be invoiced to ACC
·  where there are exceptional circumstances and a client returns for a second
consultation on the same day, full details of this (including the relevant clinical
records) should be provided to ACC for consideration
·  where multiple injuries are being managed at the same consultation, you can only
invoice ACC for the most significant injury
·  where you choose to utilise elements of more than one treatment modality eg
chiropractic and acupuncture, at the same consultation (or on the same day), you
can only invoice ACC once under one provider ID
·  all invoices need to be complete and accurate
·  at times ACC will request copies of clinical records. Failure to provide these could
result in non-payment.
Ensure the following information is correct for every line:
·  ACC Claim number or ACC45 number or both
·  READ code
·  Full client name (no abbreviations or incorrect spelling)

·  Date of injury
·  Date of service
·  Date of birth
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Completing and sending a bulk-billing schedule
ACC prefers that all providers invoice electronically, but still enables the manual process.
(see Electronic invoicing: eSchedules)
The ‘bulk-billing’ process applies to all invoices from treatment providers. It enables you to
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send several invoices at once on either an ACC40 schedule (for medical practitioners) or
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an ACC47 schedule (for other treatment providers).
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Every schedule must show your GST number.
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Directions for bulk-billing are on our website at For providers > Invoicing and payment >
How to invoice ACC > Manual bulk-billing.
Where to send your schedule
Please send your schedule to the Medical Fees unit for your area, see Key ACC contacts
for treatment providers.
If you have any queries about the process, or about a specific payment, phone the
Provider Helpline on 0800 22 070 or email [email address].

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8.
Working electronically with ACC
Digital certificates
How to get a digital certificate
The forms you need to use to apply for eLodgement, eSchedules, eLookup and digital
certificates are listed in step 6 of What you need to use eLodgement.
For more information:
·  see Apply for a digital certificate on our website
·  visit HealthLink’s website www.healthlink.net, HealthLink creates, distributes and
supports digital certificates.
Receiving and connecting your digital certificate
Digital certificates are approved and administered by the Zealand Health and Disability
Sector Registration Authority (NZHSRA).
Before issuing your digital certificate the NZHSRA will send you a test email (if you have
an email address). Once you’ve replied to this email your digital certificate will be couriered
to you from HealthLink on a CD-ROM.
Call HealthLink on 0800 288 887 to get the installation password which you need to install
your digital certificate. HealthLink can also talk you through the installation if you need
help.
The ACC eBusiness team will contact you to schedule a phone training session, which will
take approximately 30 minutes. They’ll also monitor your progress to ensure everything is
running smoothly.
1
Electronic claims lodgement: eLodgement

About eLodgement
2
Any provider who submits ACC45 Injury Claim forms can use eLodgement.
th ACC
You can learn about the benefits of using eLodgement at For providers > Set up and work
wi
with ACC > Work electronically with ACC > eLodgement.
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3 al
What you need to use eLodgement
To start using eLodgement you need:
tronic
ec
1.  A personal computer (PC or Mac). We recommend:
4
·  a 200MHz processor in a Pentium or similar PC
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·  32Mb RAM
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·  a 500Mb hard disk
·  a 32-bit operating system, i.e. Windows 98, Mac OSX or later versions.
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2.  A  digital  certificate  -  a  software  application  that  creates  your  unique digital  signature.
Issued on CD-ROM and stored on your computer, your digital certificate authenticates
the  origin  of  data  and  secures  data  as  it  travels  between  you  and  ACC.  Your  digital
certificate  is  free,  renewed  annually  and  issued  by  ACC.  For  more  information  see
Digital certificates.
3.  A  compatible Practice Management  System (PMS).  Your PMS  will generate ACC45s
complete with data you normally use and prompt you for any additional data needed.
To find out about PMSs:
·  see our online list of PMS systems that support eLodgement
·  phone our eBusiness team on 0800 222 994, option 1
·  email [email address].
If you don’t have a PMS you can still take advantage of the system by using our
eLodgement website.
4.  A compatible communications link, eg an internet broadband or dial-up connection, or
HealthLink Online.
5.  A compatible web browser (eg Internet Explorer 6.0+, Mozilla Firefox 1.0+, Apple Safari
1.0+).  The  browser  should  support  128-bit  SSL,  1024-bit  digital  certificates.  This
specification  is  the  minimum  recommended  for  adequate  performance,  and  it  will
depend on your system’s power.
6.  To register by completing three forms:
·  HealthSecure Organisation Registration
·  HealthSecure User Registration
·  ACC23L Organisation Application for eBusiness
The forms include addresses to send them to.
You might also like to read our Security Policy for Electronic Business document.
Electronic invoicing: eSchedules

Who can use eSchedules
You can use eSchedules if you submit invoices to us for payment under business rules
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specified in a contract, purchase order or the Regulations.
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You can use the service to send us your ACC40 or ACC47 schedules (invoices)
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electronically, either from your PMS or through our eForm web page.

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The benefits of eSchedule
eScheduling offers you the benefits of:
·  faster payments, normally within seven working days, as electronic invoices have
priority
·  easy online tracking to check the progress of your schedules and payments and the
registration of an ACC45 Injury Claim form, 24 hours a day
·  online remittance advices
·  time and paper savings through streamlined processes
·  quality information between systems
·  easy checking of whether a claim is for an Accredited Employer(AE) and, if so,
quick access to the AE’s name and address
·  schedule payments being processed within five days, if the information is complete
and accurate
·  partial payments for incomplete schedules, rather than having them held for
payment in their entirety
·  the ability to diagnose any invoicing and payment problems quickly and easily
·  not having to submit printed schedules or copies of referral forms and approval
letters.
Note: Make sure you keep copies of referrals and approval letters as we may need to see
them to validate your invoices.
What you need to use eSchedules
Setting up eSchedule is the same as setting up eLodgement – although you’ll also need to
complete an ACC23 Application for Electronic Medical Fees Schedules for each provider
in your practice.
If any providers aren’t registered with us, they’ll need to complete the ACC24 Application
for ACC Health Provider Registration form which includes a section on electronic claiming.
The team will advise you in writing when your request has been approved, usually within a
week of your application being submitted.

How to send eSchedules
To send an eSchedule:
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1.  Check that your billing schedule is correct:
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·  send separate schedules for nurses and medical practitioner, unless your practice
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holds an Accident and Medical contract, or a Rural General Practice Services
contract
·  ensure you use the correct service codes to avoid payment delays
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·  check that your claim numbers are correct and in the required format. Use ACC45
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numbers where possible, but be careful not to use zero in place of the letter ‘O’ or
vice versa. Enter alpha and numeric data only (i.e. not symbols such as / or –)
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·  if you’re providing services on an hourly rate, list the service duration(s).
2.  Before you send your first eSchedule, check that your ACC provider number is loaded
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correctly  in  your  system.  There  should  be  no  gaps  between  the  alpha  character  and
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3.  Check with your software vendor that system flags are correctly set for you to send live
claims  (otherwise  your  electronic  claims  will  go  into  an  ACC  test  system  that  can’t
make payments).
4.  Send real schedules only.
5.  The day after you send your first batch of schedules,  phone the Provider Helpline on
0800  222  070  to  check  that  they  have  arrived.  Your  PMS  should  receive
acknowledgement,  but  acknowledged  schedules  can  still  be  rejected  for  various
reasons.  The  eBusiness  team  will  let  you  know  if  you  need  to  fix  your  system  or
resubmit the schedules.
Note: If at any other time you want to check your payment schedules you can use
eLookup, our eForm web page, or phone the Provider Helpline quoting your ACC
provider number and each schedule number you’re querying.
6.  ACC  pays  the  amount  owing  into  the  bank  account  you  provided  and  sends  you  a
payment advice letter confirming the amount.
Late invoicing
If you send us an invoice 12 months or more after providing the service, you’ll need to give
us extra information to show that we’re still liable to pay for the service.
Querying payment delays
Where we have enough information we usually decide on cover for a claim within 24
hours. However, some claims (e.g.  sensitive claims) can take a little longer because we
need to get additional information. In these cases delays in payment are unfortunately
inevitable. Payments can also be delayed if we’ve asked a client to visit another treatment
provider for a second opinion.
The bulk billing payment advice and the Schedule Payment Status Query on our eForm
web page will show you which payments have been withheld and why. You can also
phone the Provider Helpline on 0800 222 070 to discuss late payments or email

[email address], or if you think a claim has been accepted for payment but you
haven’t been paid.
Electronic claims queries: eLookup
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Who can use eLookup
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Currently radiologists, DHBs and any organisation using ACC’s eSchedule service can
have access to eLookup.
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The benefits of eLookup
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With eLookup you can query:
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the status of an ACC45 claim number to check if the claim:
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·  has been accepted or declined by ACC
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·  has come from an AE. If it has you’ll receive the name and address of the AE
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the current payment status of any schedule you’ve sent us, including:
·  whether a schedule has been paid
·  how much was paid
·  the reason for a payment being put on hold or declined.
What you need to use eLookup
All you need to access eLookup is a PC with an internet connection and a Health Secure
digital certificate.
If you’re already using a digital certificate for other health sector transactions such as
eLodgement, it’s likely to be a Health Secure digital certificate which you can use for
eLookup.
To check if you have the right digital certificate phone our eBusiness Team on 0800 222
994 option 1, or email [email address].
If you need to apply for a Health Secure digital certificate complete the forms:
HealthSecure Organisation Registration
HealthSecure User Registration.
The forms include addresses to send them to.
Frequently asked questions on working electronically
Q: Why are claim numbers important?
A:
The ACC system checks that claims belong to the people who are being claimed
for.
If the ACC database and your database have different details for a client (name and
date of birth), the discrepancy will be flagged so all involved can make sure they’re

sharing the correct details.
Q: If we eLodge, do we still need to send printed copies to ACC?
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A:
No, we only need the electronic copy. However, you must keep a signed copy in
paper or image form that shows your patient has authorised you to lodge the claim
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on their behalf.
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Q: Does the treatment provider who generates an ACC45 during a consultation or visit
have to send it to ACC straight away?
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A:
No. If you have a network of practice computers, a practice administrator can pick
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up the ACC45 on their computer, check that the information is complete and submit
it to ACC. This should be done once a day. However, all ACC45 claim forms should
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be lodged on the day of the consultation/visit.
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Q: Do all treatment providers need a computer?
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A:
No, you can complete ACC45s by hand and give them to your administrative staff
for input that day to minimise the time required on a computer.
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Q: We already send invoices to ACC electronically – how will lodging the ACC45 claim
form electronically affect our billing?
A:
The eLodgement system allows you to lodge your ACC45s electronically without
affecting your electronic invoicing. The process of invoicing ACC won’t change.
However, you’ll find that you can invoice us a lot faster when eLodging your
ACC45s as we’ll have details of your patients’ claims in our system at the time you
submit your invoices.
Q: Will the information I send electronically be secure?
A:
Yes. The digital certificate protects the information you transmit by letting ACC
know that it was you or your organisation that sent the data. Your computer system
also encrypts (or ‘scrambles’) the data with your digital certificate to protect it as it
travels from you to ACC.
Q: Does every treatment provider need a digital certificate?
A:
No. You only need a digital certificate on the computer(s) that sends the data online
to ACC. If you’re using the ACC eLodgement website to capture and submit your
data, you’ll need a digital certificate to do this too.

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9.
Glossary
Introduction
Glossary covers definitions relating to the Regulations
This glossary covers terms used by treatment providers working under ACC’s legislation.
Accordingly, most of the terms relate to the AC Act 2001 and associated ACC-specific
Regulations, such as the IPRC (Liability to Pay or Contribute to Cost of Treatment)
Regulations 2003.
Definitions specific to contracts are not covered
Providers working under ACC contracts will find some of the definitions do not apply to, or
are modified by the terms of, specific ACC service contracts.
If definitions in this Glossary differ from terms and definitions in service specifications (, eg
consultation/visit for providers working under the ACC Rural General Practice Services
contract), then the contract version applies.
Other definitions
You might also find the general Glossary of ACC terms helpful.
Definitions
Term
Meaning
ACC18 Medical
This certificate is completed by a medical practitioner or nurse
Certificate
practitioner to describe how an injury has affected a patient’s capacity
for work when they can’t continue in their normal employment for a
time because of their injury; or to confirm that they are now able to
return to their normal work.
We publish guidelines on how to complete the form and resources
that help medical and nurse practitioners to determine their
recommendations for time off work.
This certificate can also be used to update/add a diagnosis.
It is ACC’s preference that Medical certificates are submitted
electronically.

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Term
Meaning
ACC32 Request
This form is completed by a Specified Treatment Provider:
for Prior
Approval of
·  to alter or add a diagnosis
Treatment form
·  when they believe a client needs additional treatment beyond
the treatment profile trigger numbers
·  when a client needs to resume treatment after more than 12
months have passed.
·  When the client presents for treatment for the first time for an
injury that is more than 12 months old
ACC45 Injury
This form is used to lodge a new injury and to determine ACC cover
Claim form
on a person’s claim. It is completed by both the client, who provides a
signed ‘patient authority and consent’, and the initial treatment
provider.
ACC705 Referral  This form is used by a hospital to provide ACC with information about
for Support
a clients’ needs when the hospital’s clinical team has identified that
Services on
the client will need home support services on discharge.
Discharge
An ACC staff member acknowledges receipt by faxing back the form
with details of action taken.
ACC706 Early
This form is used by a hospital to refer to ACC when the clinical team
Notification of
has identified that a patient has complex needs post discharge and
Complex Case
will require a range of support services.
The form is faxed to ACC as soon as possible so that ACC’s client
service staff can liaise with DHB staff to arrange for the required
supports before the client is discharged. ACC staff fax back the form
to acknowledge receipt.
ACC1171
This form is used to request pharmaceutical funding approval and
Request for
should be completed by a provider and submitted to ACC before they
Funding from
prescribe a non-subsidised pharmaceutical for a client.
ACC for Non-
Subsidised
ACC may contribute towards the cost of partly and non-subsidised
Pharmaceuticals  pharmaceuticals. Approvals are for a limited time. Other related forms
and checklists are detailed on.
ACC2152
This form is used by a treatment provider (always together with a new
Treatment Injury  ACC45 form) when lodging a claim for injuries caused by treatment
Claim form
from a registered health professional.
Accident
The AC Act 2001 (and subsequent amendments) prescribes the ways
Compensation
in which ACC provides and pays for, or contributes to, the costs of

Act 2001
comprehensive, no-fault cover and entitlements for all New Zealand
citizens, residents and temporary visitors who sustain personal
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(the AC Act
injuries in New Zealand.
2001)
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Term
Meaning
Accredited
This is an employer who has signed a contract with ACC taking
Employer (AE)
responsibility for the management and costs of their employees’ work-
related injuries and illnesses and gradual process diseases for a
specific period of time in exchange for a levy reduction.
Acute admission  This is an admission to a publicly funded hospital within seven days of
a medical practitioner’s decision to admit the person to hospital,
unless otherwise specified in the Regulations. An acute admission
may be from an emergency department, outpatient department or a
GP/private specialist.
Acute treatment
Acute treatment, in relation to a client, means:
(a) the first visit to a treatment provider for treatment for a personal
injury for which the client has cover, and
(b) if, in the treatment provider’s reasonable clinical judgement, the
need for the treatment is urgent (given the likely clinical effect on
the client of any delay in treatment):
(i)  any subsequent visit to that treatment provider for the
injury referred to in (a), and
(ii)  any referral by that treatment provider to any other
appropriate treatment provider for the injury referred to
in (a).
AC Act 2001, Part 1, Section 7
Advocacy
This service provides independent advocacy that is free to patients
service
and funded by the Health and Disability Commissioner. It can help
and support people to know their rights and the actions they can take
if they have concerns about any health or disability service, including
ACC.
Ancillary services  These are services that are ‘ancillary’ to a client’s rehabilitation (i.e.
the client needs them to be able to access or receive their
rehabilitation).
They include emergency transport, non-emergency transport to and
from treatment, accommodation in relation to treatment, and payment
to enable a client to be escorted to and from treatment (,e.g. if the
client is a child).
The AC Act 2001 also classifies pharmaceuticals and laboratory tests
as ancillary services. Some ancillary services are funded through an
agreement with the Ministry of Health (,e.g.  community-
pharmaceutical, and laboratory tests).

The eligibility for many ancillary services is determined by ACC’s
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client service staff, taking into consideration the context of the request
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and the claim.
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Term
Meaning
Annual practicing  This is a certificate issued annually to a medical practitioner and other
certificate
health practitioners under the HPCA Act 2003 which allows them to
practise their professions in New Zealand. The certificate is intended
to ensure that health practitioners are competent and fit to practise.
Capacity for work  This describes a person’s ability to perform work duties, based on
their education, experience or training (or any combination of these)
in relation to the consequences of their personal injury.
Client
An ACC client is a person who has sustained a personal injury and
has had their claim for ACC cover approved under the AC Act 2001 or
an earlier Act.
Client consent
A person’s consent is required when an ACC claim is lodged on their
behalf. This authorises the treatment provider to lodge the claim and
ACC to collect and disclose certain information.
Clinical advisor
ACC clinical advisors are qualified health professionals. They range
from medical practitioners to specialist practitioners, nurses,
pharmacists, physiotherapists and other allied health professionals.
Their role is to provide advice on claim cover and entitlement and in
respect to treatment injury claims, the clinical advisor determines
cover.
Code of Rights
All people who use a health or disability service have the protection of
the ‘Code of Health and Disability Services Consumers’ Rights’. An
independent Commissioner promotes and protects these rights under
legislation. More details can be found at www.hdc.org.nz.

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Term
Meaning
Consultation/Visit  A consultation/visit, as defined by the Regulations, means an
assessment in person (face to face), and a necessary and
appropriate service performed, or treatment provided, by a provider
for an injury or condition covered by ACC. It includes providing claim-
related advice, completing a prescription or referral, and issuing any
certificate to ACC as a result of the consultation/visit.
A consultation/visit does not include:
·  medical services where no substantial service is given by the
provider and for which the patient would not reasonably be
expected to pay
·  any telephone consultation
·  any informal encounter.
A number of minor treatments/procedures are also included in a
consultation/visit for billing purposes under the Regulations. For
examples of these, see:
Section 11 – Consultation/Visit and procedure costs and codes:
Guide to invoicing for medical practitioners and nurses.
Providers using hourly rates or variable fees should invoice ACC in a
way that shows the proportion of time spent directly treating the
client’s ACC-covered injury or condition. (See also ‘Direct treatment’).
Co-payment
This is a fee that a treatment provider can charge a client over and
above ACC’s contribution to the treatment, unless the provider has
signed a contract with ACC that doesn’t permit them to charge co-
payments.
Criminal
ACC is unable to provide entitlements other than treatment for a client
disentitlement
who is injured in the course of committing an offence for which they
are subsequently charged, and then imprisoned or sentenced to
home detention for the offence.
Direct treatment
This means the amount of time a treatment provider directly applies
their expertise to a client’s treatment. It includes assessing and/or
reviewing their injury, developing a treatment plan with them and/or
applying direct hands-on treatment.
Discharge
This is a report prepared by a health care facility or service
summary
responsible for a person’s care when it discharges them from
inpatient, custodial or residential care.

It includes a statement on their health status immediately before
discharge, their prognosis, the nature, duration and objective of any
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continuing treatment, care or support needed, and the ACC claim
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number (the ACC45 number).
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Term
Meaning
Doctors for
DSAC is a professional organisation of doctors from many disciplines.
Sexual Abuse
Their prime focus is to educate and help medical practitioners
Care (DSAC)
maintain international best practice medical and forensic standards
when managing victims of sexual assault. For more information, see
www.dsac.org.nz.
Emergency
Emergency transport is transport needed to get urgent treatment for a
transport
client who has a personal injury.
It must be dispatched by an Emergency Ambulance Communications
Centre from a contracted provider within 24 hours of the client
sustaining the personal injury, or being found after sustaining the
injury (whichever is the later). Being ‘found’ relates to situations such
as an injured person being located by search and rescue. ACC pays
for emergency transport once cover for the claim has been approved.
Entitlement
A fundamental requirement of the ACC statutes is that people who
become clients with cover for personal injury can apply for
entitlements. The entitlements provided under the AC Act 2001
include:
(a) rehabilitation, comprising treatment, social rehabilitation and
vocational rehabilitation
(b) first week compensation
(c) weekly compensation
(d) lump sum compensation for permanent impairment or
independence allowance
(e) funeral grants, survivors' grants, weekly compensation for the
spouse (or partner), children and other dependants of a deceased
client, and child care payments.
If a client meets all the relevant statutory criteria, ACC has a legal
obligation to pay or contribute to the cost of entitlements. These are
often delivered by providers working under the Regulations or ACC
contracts.
Hāuora Māori –
All contracts between ACC and providers include an organisational
Cultural
quality standard, a Hāuora Māori clause, which takes into account the
Competency
practical application of the articles of the Treaty of Waitangi when
providing services, and commits providers to complying with ACC’s
Guidelines on Māori Cultural Competencies for Providers.

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Term
Meaning
Health
The HPCA Act supports the regulation of health practitioners in order
Practitioners
to protect the public where there is a risk of harm from the practice of
Competence
the profession.
Assurance Act
2003 (HPCA Act)  This legislative framework allows for consistent procedures and
terminology across the many professions regulated by the Act. The
HPCA Act includes mechanisms to ensure that practitioners are
competent and fit to practise their professions through their working
lives.
Home and
This service provides high quality, flexible home and community
Community
support services (personal care, child care, home support) for Clients
Support Services  in their own homes and community.  The service facilitates the
(HCSS)
achievement of clients’ goals and is flexible to fit with the clients
normal daily routine as far as practicable, and will be appropriately
matched to the client’s needs.
There are three service types:
1.  Initial Support Package: (ISP):  Allows DHBs to refer Clients with
low  complexity  and/or  short  term  home  support  needs  directly  to
the  Supplier.  Service  includes  service  set-up  and  up  to  a
maximum of 10 hours of support over a 2 week period
2.  Return To Independence (RTI):  ‘For Clients with a time limited
need for support whilst they recover from their injury. The Service
will assist Clients to achieve their pre-injury level of independence
within their everyday lives.
3.  Maximise Independence Service (MI):  For Clients  who have a
long term need for support to live their everyday lives.
Impairment
This is a general term for any loss, or abnormality, of the following
bodily structures or functions:
Psychological (relating to the mental state)
Physiological (relating to body function)
Anatomical (relating to body structure).
1
Incapacity
This describes an injured person's inability to work owing to personal
injury, or an injured person’s absence from work for necessary
treatment owing to personal injury. See ACC Act 2001.
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Term
Meaning
Independence
This is an entitlement for a client who, as a result of an ACC-covered
allowance
injury, has a permanent loss of bodily (physical and/or mental)
functions. The independence allowance compensates for significant
long-term impairment and is paid in addition to any other entitlements.
ACC requires a medical certificate from a medical practitioner
indicating that it is likely there is impairment, and that the condition is
stable, before any assessment for this entitlement can be carried out.
Individual
An IRP is the plan that ACC develops in consultation with a client and
rehabilitation
their family, employer and treatment provider. It outlines the
plan (IRP)
rehabilitation support needed to meet the timeframes and
rehabilitation goals.
Injury
IPRC was the previous name of the AC Act 2001 before the passing
Prevention,
of the Accident Compensation Amendment Act 2010. Many of the
Rehabilitation,
regulations that pertain to the AC Act 2001 are still referred to as the
and
IPRC Regulations.
Compensation
(IPRC)
Medical advisor
ACC medical advisors are medical doctors, often with specialist
qualifications. They are part of ACC’s clinical advisor group and their
role is to provide medical advice and guidance to case managers and
other ACC staff managing injury claims.
Medical Fees
MFP is ACC’s computer software system for provider contracting,
Processing
payments and service management.
(MFP)
The software
·  is used to process health providers invoices using bulk billing
and electronic schedules
·  can allow automatic approval and payment for goods or
services that ACC purchases in relation to client rehabilitation
or treatment
·  handles some areas of contract management.
Mental injury
ACC covers the treatment of mental injury that is shown to be ‘a
clinically significant behavioural, cognitive, or psychological
dysfunction’ and is the result of a covered personal injury (refer to
definition of personal injury)
A mental injury must be substantial enough to be observed, be
diagnosable with a specific diagnosis and require treatment.

Missed
You can’t invoice ACC for missed appointments or cancellations
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appointments
unless we made the appointment for the client and agreed to pay a
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non-attendance fee as part of arranging it.
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Term
Meaning
National Serious  This is a detailed support and rehabilitation plan developed with a
Injury Service:
client who has long-term or lifelong support needs due to a serious
Client
injury (i.e. spinal cord injury, moderate-severe traumatic brain injury,
Support/Service
multiple amputations or severe burns).
Plan
Each plan focuses on the client’s goals and identifies the supports
they need to achieve an ‘everyday life'. The outcomes aim to
maximise the client’s independence and community participation and,
if possible, sustainable employment.
Natural use of
This term means the normal use of teeth for eating, such as chewing
teeth
and biting, or using teeth to prise or tear food. Any injuries caused by
the natural use of teeth are excluded from cover under the AC Act
2001.
We will consider covering a claim for tooth damage that hasn’t been
caused by the natural use of teeth – such as a tooth damaged when a
person bites a foreign object while eating (, eg a piece of glass in a
bread roll).
Ordinarily
In general to be ‘ordinarily resident’ a client must:
resident
·  hold the required citizenship, permit, or visa of a New Zealand
resident or
·  be the spouse or dependant of an ordinarily resident person
and generally accompany them, and have a permanent place
of residence in New Zealand and
·  if overseas, have intended to return to New Zealand within six
months of leaving.
Other detailed conditions may apply.
Pain
Pain management services are designed to support a client’s broader
Management
rehabilitation goals and act as an enabler to allow a client to access
Services
further rehabilitation services that they can’t currently because of
ongoing or chronic pain conditions.

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Term
Meaning
Personal injury
Personal injury means a:
·  physical injury
·  mental injury resulting from a physical injury
·  mental injury resulting from sexual assault or abuse
·  mental injury caused by a traumatic work related event
·  person’s death.
Personal injury includes damage to:
·  dentures (other than wear and tear)
·  prostheses that replace a part of the human body (except for
hearing aids, spectacles and contact lenses).
Personal injury does not include hurt to emotions, stress or loss of
enjoyment.
Pharmaceuticals  Pharmaceuticals are classified by the AC Act 2001 as prescription
medicines, restricted medicines, pharmacy-only medicines and
controlled drugs specified in legislation controlling such substances.
ACC will only consider contributing to costs for pharmaceuticals within
this definition.
Physical injury
The category of ‘physical injury’ requires an actual diagnosis of the
injury and evidence that shows damage to the body. A diagnosis of
pain is insufficient for establishing a physical injury.
Provider claim
The ACC provider claim lodgement framework lists injuries by
lodgement
description and Read Code and specifies the provider groups that are
framework
able to lodge ACC45 Injury Claim forms for cover on each one.
The framework is designed to support claim lodgement by providers
who are appropriate for specific types of injury.

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Term
Meaning
Public Health
Services from DHBs needed by ACC clients are funded under PHAS.
Acute Services
ACC pays for these services through a bulk payment which is given,
(PHAS)
via the Treasury, to the Ministry of Health.
The IPRC (PHAS) Regulations 2002 relate to services provided by a
publicly funded provider (such as a DHB) to treat a client for a
covered personal injury, including services provided:
·  as part of an acute admission
·  as part of an initial emergency department presentation, and
any subsequent services given by the emergency department
within seven days of that presentation
·  for an outpatient by a medical practitioner within six weeks of
acute discharge or emergency department attendance
·  by a medical practitioner within seven days of the date on
which the client is referred for those services by another
medical practitioner
·  that are ancillary to any of the above services, such as travel
and accommodation for the client, and an escort or support
person, but excluding emergency transport
·  to aid treatment as above, such as consumables, diagnostic
imaging and equipment.
It also covers the costs of pharmaceuticals which are prescribed as
per the listings in all parts of The Pharmaceutical Schedule and for
community laboratory/diagnostic tests
Registered
A registered health professional is defined in the AC Act 2001 as:
health
professional
(a) a chiropractor, clinical dental technician, dental technician,
dentist, medical laboratory technologist, medical practitioner,
medical radiation technologist, midwife, nurse, nurse
practitioner, occupational therapist, optometrist, pharmacist,
physiotherapist, or podiatrist, and
(b) includes any person referred to in paragraph (a) who holds an
interim practising certificate but only when they are acting in
accordance with any conditions of such interim certificate, and
(c) includes a member of any occupational group included in the
definition of ‘registered health professional’ by Regulations made
under section 322 of the Act.
Rehabilitation
Rehabilitation is a process of active change and support to help a
person regain their health and independence, and therefore their
ability to participate in their usual activities as far as possible. It
comprises social rehabilitation, specialised rehabilitation, pain

management, vocational rehabilitation and treatment.
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Rehabilitation
These are rehabilitation goals, objectives or results that may stem
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outcomes
from the rehabilitation intervention and are agreed by the client with
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Term
Meaning
Review rights
A client has the right to have a decision made by ACC about their
claim independently reviewed within a specified timeframe. ACC is
required by its legislation to tell clients that they have the right to a
review and what the review timeframe is. Clients must be told early
enough to allow them the maximum amount of time to exercise the
right.
Scope of practice  This means a health service that is part of a health profession.
Scopes of practice for health professions covered by the HPCA Act
2003 are decided and published by the relevant registration authority
(e.g.  Medical Council of New Zealand). A practitioner must practise
within any conditions imposed by their registering authority.
Self-harm
ACC has to decide if a self-inflicted injury or suicide was the result of
wilful act, or from a covered or coverable mental injury. If not, we may
withhold entitlements other than treatment.
Sensitive claims
For clients who have been injured by specific sexual crimes, ACC
covers mental injuries as well as any physical injuries. These are
called ‘sensitive claims’ owing to the sensitive and confidential nature
of the injuries.
ACC’s national Sensitive Claims Unit specialises in managing these
claims.
Short-term Claim  ACC has four Short-term Claim Centres in Christchurch, Dunedin,
Centre
Hamilton, and Wellington. They typically manage claims involving
mild injuries, or injuries from which clients would usually make a
complete recovery within several months.
Significant
Significant dressings are specialised dressings, usually moderate to
dressings
high cost per application, or multi-layered dressings. This term does
not cover the application of simple gauze and tape, plaster strips or
strips of adhesive tape, and the use of non-stick dressings.
Social
Social rehabilitation helps clients to regain their independence in daily
rehabilitation
living activities, as much as possible. It includes home and community
services, equipment and for independence, training for independence,
modification of vehicles or home, and education support.
Provision of these services is based on the clients injury related
needs which are identified through an appropriate assessment
completed by a health professional.

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Term
Meaning
Specialised
Specialised rehabilitation helps clients achieve the best possible
rehabilitation
rehabilitation and community participation outcomes for clients who
have long-term or lifelong support needs owing to a significant injury,
e.g.  spinal cord injury or traumatic brain injury. Services include
residential rehabilitation for clients who have sustained a spinal cord
injury, TBI residential rehabilitation, child and adolescent
rehabilitation, transition services, training for independence,
community based rehabilitation, education support and services for
the blind.
Specified
STPs (also known as allied providers) are specified in the Regulations
Treatment
as: acupuncturist, chiropractor, occupational therapist, osteopath,
Providers (STPs)  physiotherapist, podiatrist, and speech therapist.
Supervision for
Clinical supervision plays a fundamental role in the successful
counselling
progress of counselling. ACC Regulations require a counsellor, as a
member of a professional body, to have effective, regular and
ongoing supervision that involves ACC, and can make available its
detailed written expectations.
Telephone
ACC pays for counselling only when it’s provided on a face to face
counselling
basis. However, in a single exception under the Regulations, we can
pay for one telephone counselling session for a client who has an
accepted sensitive claim, if they need it urgently.
Treatment
Treatment includes physical rehabilitation, cognitive rehabilitation,
and an examination to provide an ACC medical certificate and the
provision of it.
Treatment injury
This is a personal injury that has occurred as a result of treatment
provided by, or at the direction of, one or more registered health
professionals. The injury must be directly caused by the treatment,
and cannot be a necessary part or ordinary consequence of the
required treatment.
Treatment profile  Treatment profiles are a collection of injury profiles developed by a
group of independent practitioners that give providers standardised
expectations about treatment and incapacity. They are published by
ACC and distributed free of charge.
The information on each injury includes:
·  appropriate treatment
·  the probable duration of the incapacity

·  the probable duration of the treatment
·  the possible complications
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·  an illustration of the relevant injury site (for fractures).
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Term
Meaning
Treatment profile  This is the number of treatments for a specific diagnosis without
number
complications, which has been referred for treatment at an
appropriate stage in the healing process. These numbers provide a
consensus on acceptable treatment ranges.
Treatment profile  Trigger numbers indicate the number of treatments after which ACC
trigger number
would seek a review of the services that have been provided.
Treatment
The following are treatment providers under the AC Act 2001 and can
provider
lodge claims within their own scopes of practice.
·  Acupuncturists
·  Audiologists
·  Chiropractors
·  Counsellors
·  Dentists
·  Medical laboratory technologists
·  Nurses and nurse practitioners
·  Occupational therapists
·  Optometrists
·  Osteopaths
·  Physiotherapists
·  Podiatrists
·  Medical practitioners (only medical practitioners can give
clients a medical certificate for time off work)
·  Speech therapists.
See also, For Providers > Lodge and manage claims > Provider claim
lodgement framework.
Visitors
Overseas visitors injured in New Zealand are covered by ACC, so we
can help pay for suitable treatment here if we accept their claim.
However, we can’t reimburse visitors for loss of income or for
treatment costs in their home country.
Vocational
This means a client’s capacity, as determined by the AC Act 2001, to
independence
engage in work for which they are suited by reason of their
experience, education or training, or any combination of those things,
and to do so for 30 hours or more a week.
Vocational
Vocational rehabilitation helps a client to maintain or obtain
rehabilitation
employment, or regain or acquire vocational independence.
When helping to guide a client, the employment in question must be

suitable for them in terms of their capacity to function, and appropriate
for their levels of training and experience. Assessors are also
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Term
Meaning
Weekly
This entitlement compensates a client for loss of earnings, or loss of
compensation
potential earning capacity. A spouse, partner or dependant of a
deceased client may also be entitled to weekly compensation.
work-related
There are three key criteria for establishing cover for a personal injury
gradual process,  caused by work-related gradual process, disease or infection.
disease or
infection
1.  The person’s employment tasks or employment environment must
have  a  particular  property  or  characteristic  that  caused  or
contributed to the cause of the personal injury.
2.  The person’s non-work activities or environment must not hold that
same property or characteristic to any material extent.
3.  There  must  be  a  greater  risk  of  sustaining  this  type  of  personal
injury for people who do this particular employment task or work in
that environment, than for people who do not.
Any condition must meet all the criteria of the AC Act 2001, although
some occupational diseases are listed in Schedule 2 of the Act and
have a simplified cover process.

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10.  Consultation/Visit and procedure
costs and codes
Guide to invoicing for medical practitioners and nurses
Scope of this guide
This is a guide to invoicing under the IPRC (Liability to Pay or Contribute to Cost of
Treatment) Regulations 2003.
The guide should be read in conjunction with the ACC1520 Medical Practitioners' and
nurses' costs 2014.
Section 8 of this Handbook also has detailed information about invoicing under the
Regulations.
What a consultation/ visit covers
You can invoice ACC for a consultation/visit, which is defined as including:
·  a face to face examination and/or assessment
·  a necessary and appropriate service or treatment, performed by a provider, for an
injury or condition covered by ACC

·  any claim-related advice, prescription or referral, and the issue of certificates as
appropriate following the consultation/visit
·  managing conditions, including providing a small range of minor
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treatments/procedures, such as:
1.  removing sutures
and c
2.  removing a non-embedded foreign body from eye, mouth, auditory canal or other
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site (excluding rectum or vagina) without incision
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3.  re-dressing wounds that don’t require significant dressings
c
4.  performing a plaster check
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5.  removing casts/splinting
6.  removing packing of nose, or packed abscesses or haematomas
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7.  cleaning and minor dressings (eg small gauze or non-stick dressings) to small
burns or abrasions
8.  cleaning and minor dressings (eg plaster strips) to small, open wounds
9.  managing minor sprains that don’ involve significant splinting
10. completing clinical records.
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What a consultation/ visit does not include
1
A consultation/visit does not include:
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·  telephone consultations (except for a one-off phone counselling session if required)
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·  medical services where no substantial service is given by the provider and for which
2
the patient would not reasonably be expected to pay.
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All invoices for procedures, regardless of the number claimed, must be clinically justifiable.
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Understanding procedure codes
The procedure codes start with two letters:
·  the first letter is M which stands for ‘Management of’
·  the second letter is phonetic and covers the procedure code topic (e.g. B for burns and
D for dislocations).
The two letters are followed by a number that defines a sub-category within the code.
Summary of procedure codes
This table summarises the procedure codes, the injuries to which they refer and the
recommended maximum treatments per injury.
Procedure
Injury type
Recommended maximum treatments
Page
code
claimed per injury
reference
MB#
Burns and
4
121-122
abrasions
MD#
Dislocations
1
123-124
MF#
Fractures
1
125-130
(except MF7, MF9 – MF12 = 3)

MM#
Miscellaneous
1
131-133
odes
MW#
Open Wounds
1
134-135
MT#
Soft tissue injuries  1
136-138
and c
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(except MT3 = 2, and MT5 = 3)
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Burns and abrasions
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General invoicing criteria
Practitioners can invoice for treating burns and abrasions under the following eligibility
criteria.
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Eligible – all MB codes
Services that are eligible for invoicing include:
·  assessment
·  providing initial care and patient/caregiver education
·  treating significant skin damage
·  cleaning and debriding wound(s)
·  managing significant wound dressings
·  providing a significant amount of practitioner time
·  providing post-injury advice and patient education.
Not eligible – all MB codes
Services that are not eligible for invoicing include:
·  treating trivial and superficial burns or abrasions, at a first or subsequent
consultation/visit, and applying only a simple gauze or similar dressing. This is
covered as part of a consultation/visit
·  follow-up consultations/visits involving dressing removal, or re-dressing where
significant dressings are not used, wound inspection, and recommendations about
infection control. These are covered as part of a consultation/visit.
Invoicing criteria for each MB code

MB1 - Treatment of burns less than 4cm2 (, eg 2cm x 2cm)
Included
See Eligible – all MB codes.
odes
Excluded
See Not eligible – all MB codes.
and c
Procedures per injury
Recommend: maximum of four procedure claims per injury.
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MB2 - Treatment of burns greater than 4cm2 at a single site
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Included
See Eligible – all MB codes.
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Note: Claims in this category are usually few.
Excluded
See Not eligible – all MB codes.
Procedures per injury
Recommend: maximum of four procedure claims per injury.
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MB3 - Treatment of significant abrasions less than 4cm2 at a single site
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Included
See Eligible – all MB codes.
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Excluded
See Not eligible – all MB codes.
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Procedures per injury
Recommend: maximum of four procedure claims per injury.
MB4 - Treatment of significant abrasions greater than 4cm2 at a single site
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Included
See Eligible – all MB codes.
Excluded
See Not eligible – all MB codes.
Procedures per injury
Recommend: maximum of four procedure claims per injury.
MB5 - Significant burns or abrasions (not including fractures) at multiple sites
(greater than 4cm2), necessary wound cleaning, preparation, and dressing
Included
See Eligible – all MB codes.
Excluded
See Not eligible – all MB codes.
Note: If there are multiple wounds, but only one needs significant
time or dressing, only one claim would be made for the
significant wound under MB2 or MB4.
Procedures per injury
Recommend: maximum of four procedure claims per injury.
This section should be read in conjunction with the ACC2136 MB and MW Codes.
Note: To access the ACC2136 you can click on the link above or go to the ACC website
and select For Providers > Publications, and click on either ‘General practitioner resources’
or ‘Burns and scar management’.

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Dislocations
General invoicing criteria
Practitioners can invoice for treating confirmed dislocations on any of the five listed joints,
under the following eligibility criteria.
Note: There must be evidence of significant joint dysfunction (major effusion or
haemarthrosis and/or ligament laxity).
Eligible – all MD codes
Services that are eligible for invoicing include:
·  assessment
·  providing initial care and patient/caregiver education
·  referral for, review of and action on, an X-ray (if necessary)
·  use of appropriate anaesthetic technique (including local, intravenous, or regional
anaesthesia, or mild central sedation)
·  treating significant subluxation
·  providing post-injury advice and patient education
·  management using best-practice splinting techniques, which may include providing
a plaster cast. See also ACC579 Treatment profiles 2001 and ACC2373 Practical
Techniques in Injury Management. The ACC2373 isn’t available online but can be
obtained through your local Relationship & Performance Manager.

Not eligible – all MD codes
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Services that are not eligible for invoicing include:
·  minor joint trauma, including minor sprains not involving confirmed dislocations or
and c
significant subluxation, and where there is no evidence of serious subsequent joint
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dysfunction. These are covered as part of a consultation/visit or by a soft tissue
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injury procedure, whichever fits best
c
·  possible dislocations to joints not covered under the following five codes (MD1–5).
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In that case a ‘nearest equivalent’ treatment or procedure will be considered.
However, a soft tissue injury procedure may be appropriate
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·  treatment, including temporary splinting, before referral to a specialist centre. This is
covered under a soft tissue injury procedure
·  follow-up assessments, including removal of splinting. These are covered as part of
a consultation/visit
·  treatment of injury that does not require the use of best-practice splinting with
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significant dressing cost. This is covered as part of a consultation/visit.
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Invoicing criteria for each MD code
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MD1 - Dislocation of finger or toe, with splint or strapping
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Included
See Eligible – all MD codes.
Excluded
See Not eligible – all MD codes.
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Procedures per
Recommend: one procedure claim per injury.
injury
MD2 - Dislocation of thumb, closed reduction and immobilisation
Included
See Eligible – all MD codes.
Excluded
See Not eligible – all MD codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MD3 - Dislocation of elbow with radiological confirmation, closed reduction and
immobilisation
Included
See Eligible – all MD codes.
Excluded
See Not eligible – all MD codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MD4 - Dislocation of shoulder, closed reduction and collar and cuff immobilisation
Included
See Eligible – all MD codes.

Excluded
See Not eligible – all MD codes.
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Procedures per
Recommend: one procedure claim per injury.
c
injury
MD5 - Dislocation of patella, closed reduction and cast immobilisation
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Included
See Eligible – all MD codes.
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Excluded
See Not eligible – all MD codes.
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Procedures per
Recommend: one procedure claim per injury.
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Fractures
General invoicing criteria
Practitioners can invoice for treating diagnosed fractures under the following eligibility
criteria. If there is no diagnosis of a fracture, a soft tissue injury code (MT) may be
appropriate.
Note: Each service code includes tasks that can and can’t be invoiced for, on top of the
general invoicing eligibility criteria below that cover all codes.
Eligible – all MF codes
Services that are eligible for invoicing include:
·  assessment
·  providing initial care and patient/caregiver education
·  X-ray confirmation (or clinical certainty) of a fracture
·  applying best-practice soft tissue splinting, or plaster cast immobilisation, for more
than three weeks
·  providing post-injury advice and patient education
·  management that may include (where clinically appropriate):
-  the use of appropriate anaesthesia
-  fracture reduction.

Not eligible – all MF codes
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Services that are not eligible for invoicing include:
·  undisplaced  simple  fractures  that  do  not  need  plaster  cast  immobilisation.  These
and c
are covered as part of a simple soft tissue injury procedure
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·  plaster checks and removal. These are covered as part of a consultation/visit
c
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·  treatment,  including  providing  temporary  splinting  before  referral  to  a  specialist
centre. This is covered as part of a soft tissue injury procedure.
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For fractures that aren’t covered under these specific procedure codes, and where best
practice would suggest a plaster cast, a ‘nearest equivalent’ procedure will be considered.
In other cases, a soft tissue injury procedure may be appropriate. See also ACC579
Treatment profiles 2001 and ACC2373 Practical Techniques in Injury Management
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(available through your local Relationship & Performance Manager).
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Invoicing criteria for each MF code
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MF1 - Fractured finger or toe (proximal, middle or distal phalanx), closed reduction
and immobilisation
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Included
See Eligible – all MF codes.
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Excluded
Follow-up treatments are usually covered as part of a
consultation/visit as they do not require the same degree of
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assessment or significant new splinting.
See also Not eligible – all MF codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MF2 - Fractured finger or toe (proximal, middle or distal phalanx), requiring digital
anaesthetic
Included
See Eligible – all MF codes.
Excluded
Follow-up treatments are usually covered as part of a
consultation/visit as they do not require the same degree of
assessment or significant new splinting.
See also Not eligible – all MF codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MF3 - Fractured metatarsal: closed reduction (not requiring cast), closed reduction,
immobilisation by strapping
Included
See Eligible – all MF codes.

Excluded
Follow-up treatments are usually covered as part of a
consultation/visit as they do not require the same degree of
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assessment or significant new splinting.
See also Not eligible – all MF codes.
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Procedures per
Recommend: one procedure claim per injury.
injury
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MF4 - Fractured metacarpal(s) hand: with or without local anaesthetic,
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immobilisation by strapping
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Included
See Eligible – all MF codes.
Excluded
Follow-up treatments are usually covered as part of a
consultation/visit as they do not require the same degree of
assessment or significant new splinting.
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See also Not eligible – all MF codes.
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Procedures per
Recommend: one procedure claim per injury.
injury
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MF5 - Fractured carpal bone, including scaphoid: treatment by cast immobilisation,
not requiring reduction
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Included
See Eligible – all MF codes.
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Follow-up treatments that involve reapplying a plaster cast are also
eligible under this code.
Excluded
If a new plaster cast is not required, invoice for a soft tissue injury
procedure if it involves significant best-practice soft tissue strapping
or splinting. If it does not, invoice for a consultation/visit.
See also Not eligible – all MF codes.
Procedures per
Recommend: three procedure claims per injury if repeated plaster
injury
casts are needed.
MF6 - Fractured tarsal or metatarsal bones (excluding calcaneum or talus):
treatment by cast immobilisation
Included
See Eligible – all MF codes.
Excluded
If injury needs significant best-practice soft tissue splinting (rather
than a plaster cast), invoice for a soft tissue injury procedure. If it
does not, invoice for a consultation/visit.
See also Not eligible – all MF codes.
Procedures per
Recommend: three procedure claims per injury if repeated plaster
injury
casts are needed.

MF7 - Fractured calcaneum or talus: treatment by cast immobilisation
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Included
See Eligible – all MF codes.
Excluded
If injury needs significant best-practice soft tissue splinting (rather
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than a plaster cast), invoice for a soft tissue injury procedure. If it
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does not, invoice for a consultation/visit.
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See also Not eligible – all MF codes.
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Procedures per
Recommend: three procedure claims per injury if repeated plaster
injury
casts are needed.
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MF8 - Fractured clavicle
Included
See Eligible – all MF codes.
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Excluded
These follow-up treatments are usually covered as part of a
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consultation/visit as they do not need the same degree of
assessment, or any new splinting.
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See also Not eligible – all MF codes.
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Procedures per
Recommend: one procedure claim per injury.
injury
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MF9 - Fractured distal radius and ulna: cast immobilisation not requiring reduction
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Included
See Eligible – all MF codes.
Follow-up treatments that involve reapplying a plaster cast are also
eligible under this code.
Excluded
Follow-up visits involving plaster checks or removal of plaster. These
are covered as part of a consultation/visit.
See also Not eligible – all MF codes.
Procedures per
Recommend: three procedure claims per injury.
injury
MF10 - Fractured distal radius and ulna requiring closed reduction, involving
regional or other form of anaesthesia
Included
See Eligible – all MF codes.
Must involve use of appropriate anaesthetic (intra-fracture, arm block,
and/or intravenous sedation)
Excluded
Follow-up visits involving plaster checks or removal of plaster. These
are covered as part of a consultation/visit.
Follow-up visits involving reapplying a plaster cast. These are
invoiced under MF9.

See also Not eligible – all MF codes.
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Procedures per
Recommend: three procedure claims per injury.
injury
and c
MF11 - Fractured shaft radius and ulna: treatment by cast immobilisation
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Included
See Eligible – all MF codes.
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Follow-up treatments that involve reapplying a plaster cast are also
eligible under this code.
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Excluded
Follow-up visits involving plaster checks or removal of plaster. These
are covered as part of a consultation/visit.
See also Not eligible – all MF codes.
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Recommend: three procedure claims per injury.
injury
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MF12 - Fractured distal humerus (supracondylar or condylar): by cast
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Included
See Eligible – all MF codes.
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eligible under this code.
Excluded
Follow-up visits involving plaster checks or removal of plaster. These
are covered as part of a consultation/visit.
See also, Not eligible – all MF codes.
Procedures per
Recommend: three procedure claims per injury.
injury
MF13 - Fractured proximal or shaft humerus: immobilisation by collar and cuff or U-
slab
Included
See Eligible – all MF codes.
Involves immobilisation by collar and cuff, or U-slab.
Excluded
Follow-up visits involving fracture checks or removal of splinting.
These are covered as part of a consultation/visit.
See also Not eligible – all MF codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MF14 - Fractured shaft tibia and/or fibula: treatment by cast immobilisation with

reduction
odes
Included
See Eligible – all MF codes.
Follow-up treatments that involve reapplying a plaster cast are also
eligible under this code.
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Excluded
Follow-up visits involving plaster checks or removal of plaster. These
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are covered as part of a consultation/visit.
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See also Not eligible – all MF codes.
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Procedures per
Recommend: three procedure claims per injury.
injury
MF15 - Fractured distal tibia and/or fibula: treatment by cast immobilisation with
reduction
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Included
See Eligible – all MF codes.
Follow-up treatments that involve reapplying a plaster cast are also
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eligible under this code.
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Excluded
Follow-up visits involving plaster checks or removal of plaster. These
are covered as part of a consultation/visit.
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Procedures per
Recommend: three procedure claims per injury.
injury
MF16 - Fractured fibula (without tibial fracture): immobilisation with soft tissue
splinting, strapping, or cast
Included
See Eligible – all MF codes.
Covers either best-practice soft tissue splinting or strapping, or
plaster cast, if appropriate.
Follow-up treatments that involve reapplying appropriate splinting,
strapping or plaster cast are also eligible under this code.
Excluded
Follow-up visits involving fracture checks or removal of splinting.
These are covered as part of a consultation/visit.
See also Not eligible – all MF codes.
Procedures per
Recommend: one procedure claim per injury.
injury

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Miscellaneous
Invoicing criteria for each MM code
MM1 - Abscess or haematoma: drainage with incision (with or without local
anaesthetic agent)
Included
Incision and drainage of abscess or haematoma must involve a
significant opening of lesion, drainage, and packing of cavity.
Excluded
Simple needle aspiration without packing wound. This is covered as
part of a consultation/visit.
Wound check.
Re-packing cavity.
Removal of dressings.
Procedures per
Recommend: one procedure claim per injury.
injury
MM2 - Insertion of IV line to administer medications, electrolytes, or transfusions
Included
Insertion of an IV cannula and administration of IV fluids or antibiotic
infusion. This includes repeat infusions over a 24-hour period.

Note: This must be provided under a local or national guideline
odes
approved by ACC.
Excluded
Administration of medication into an existing IV cannula. These are
and c
covered as part of a consultation/visit.
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Procedures per
Recommend: one procedure claim per 24 hours. Normally no more
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injury
than three IV insertions would be required.
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MM3 – Nail: simple removal of
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Included
Removal of an adherent nail and significant dressing of the wound.
Excluded
Removal of non-adherent nail with wounds not requiring significant
dressing.
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Procedures per
Recommend: one procedure claim per injury.
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injury
on/V
MM4 – Nail: removal of or wedge resection, requiring the use of digital anaesthesia
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Included
Use of a digital anaesthesia, excision of wedge or whole nail,
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cauterisation of wound (if necessary) and the dressing of a nail bed
with significant dressings.
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Excluded
Simple nail removal.
Wound checks. These are covered as part of a consultation/visit.
Procedures per
Recommend: one procedure claim per injury.
injury
MM5 - Removal of embedded or impacted foreign body from cornea or conjunctiva
(with use of topical anaesthetic), or from auditory canal or nasal passages, or from
skin or subcutaneous tissue with incision, or from rectum or vagina
Included
Foreign body that is impacted or embedded and requires active
removal.
Excluded
Simple  flushing  or  syringing,  or  removal  using  forceps  or  similar
instrument  without  use  of  anaesthetic  or  incision.  These  are
covered as part of a consultation/visit.
Fluoroscein  check  of  cornea/conjunctiva  without  removing
embedded  foreign  body.  These  are  covered  as  part  of  a
consultation/visit.
Procedures per
Recommend: one procedure claim per injury.
injury
MM6 - Pinch skin graft

Included
Application of skin removed from separate site to cover open wound.
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Involves the dressing of donor and graft sites.
Excluded
Follow-up checks, and re-dressing. These are covered as part of a
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consultation/visit, unless the injury requires significant dressing, in
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which case it can be invoiced for.
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Procedures per
Recommend: one procedure claim per injury.
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injury
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MM7 - Dental anaesthetic
Included
Insertion of dental local anaesthetic using best-practice dental
treatments and procedures.
Excluded
Application of topical, oral or IV anaesthetic.
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Procedures per
Recommend: one procedure claim per injury.
injury
on/V
MM8 - Epistaxis: arrest during episode by nasal cavity packing with or without
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cautery
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Included
Application of first-aid measures, packing of nasal cavity using ribbon
gauze and best-practice ear nose and throat treatments and
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procedures, and advice given to the client after treatment or
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procedure.
Excluded
Simple first-aid epistaxis measures or simple cautery of nostril. This
is covered as part of a consultation/visit.
Removing the packing.
Procedures per
Recommend: one procedure claim per injury.
injury

Open wounds
General invoicing criteria
Eligible – all MW codes
You can invoice for treating open wounds under the following eligibility criteria, if the
wound has significant full-thickness skin damage.
Note: Each service code includes tasks that can and can’t be invoiced for, on top of the
general invoicing eligibility criteria below that cover all codes.
Services that are eligible for invoicing include:

·  assessment
·  providing initial care, advice, and patient/caregiver education
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·  cleaning and debriding wound(s)
·  closing wounds by active apposition of wound edges using appropriate wound
closure materials, including wound closure strips, surgical glue or equivalent
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adhesive and suture materials
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·  management by appropriate wound dressings
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·  providing post-injury advice and patient education.
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Not eligible – all MW codes
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Services that are not eligible for invoicing include:
·  treatment of trivial and superficial open wounds, at a first or subsequent
consultation/visit, that need no more than a minor clean, and no more than a simple
gauze, plaster strip or similar dressing. This is covered as part of a consultation/visit
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·  follow-up consultations/visits involving wound inspection, recommendations about
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infection control, dressing removal, or where re-dressings are not significant. These
are covered as part of a consultation/visit.
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Invoicing criteria for each MW code
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The general invoicing criteria cover all MW codes, but each code may have additional
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inclusions and exclusions. The details below show what can and can’t be invoiced for
under each code. MW codes are for procedures that occur within 7 days of the initial
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injury.
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MW1 - Closure of open wounds less than 2cm
Included
Any necessary care and treatment, including cleaning, and debriding,
exploration, administration of anaesthetic, and dressing. See also
Eligible – all MW codes.
Excluded
See Not eligible – all MW codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MW2 - Closure of open wound(s) of skin and subcutaneous tissue or mucous
membrane 2cm to 7cm long
Included
Any necessary care and treatment including cleaning, and debriding,
exploration, administration of anaesthetic, and dressing. See also
Eligible – all MW codes.
Excluded
See Not eligible – all MW codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MW3 - Closure of open wound(s) of skin and subcutaneous tissue or mucous
membrane greater than 7cm long

Included
Any necessary care and treatment including cleaning, and debriding,
exploration, administration of anaesthetic, and dressing. See also
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Eligible – all MW codes.
Excluded
See Not eligible – all MW codes.
and c
ts
Procedures per
Recommend: one procedure claim per injury.
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injury
c
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MW4 - Amputation of digit: including use of anaesthetic, debridement of bone and
soft tissue, closure of wound
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Included
Removal of the whole or part of a digit, requiring use of a local
anaesthetic, active excision and debridement of wound, attempted
stump closure using flap or equivalent technique, and appropriate
dressing of wound.
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See also Eligible – all MW codes.
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Excluded
Follow-up wound checks.
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Removal of dressings.
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See also Not eligible – all MW codes.
Procedures per
Recommend: one procedure claim per injury.
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injury
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This section should be read in conjunction with the ACC2136 MB and MW Codes.
Soft tissue injuries
General invoicing criteria
You can invoice for sprains or soft tissue injuries that need compression or other best-
practice splinting.
Note: Each service code includes tasks that can and can’t be invoiced for, on top of the
general invoicing eligibility criteria below that cover all codes.
Eligible – all MT codes
Services that are eligible for invoicing include:
·  assessment
·  providing initial care, advice, and patient education
·  referral for and review of x-ray (if necessary)
·  management by best-practice splinting (this may include providing a plaster cast)
·  providing post-injury advice and patient education.
Not eligible – all MT codes
Services that are not eligible for invoicing include:

·  minor soft tissue trauma, involving use of initial care and advice (such as rest, ice,
compression and elevation (RICE), and not requiring application of simple wound
compression which is covered as part of a consultation/visit.
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Invoicing criteria for each MT code
and c
The general invoicing criteria cover all MT codes, but each code may have additional
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inclusions and exclusions. The details below show what can and can’t be invoiced for
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under each code
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MT1 - Significant soft tissue injuries: managing simple sprain of
wrist/ankle/knee/elbow/or other soft tissue injury requiring crepe bandage or similar
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immobilisation not requiring formal strapping
Included
Splinting or compression dressings. Management of dislocations,
subluxations and minor fractures that do not need plaster cast
immobilisation.
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See also Eligible – all MT codes.
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Excluded
See Not eligible – all MT codes.
on/V
Procedures per
Recommend: one procedure claim per injury.
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injury
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MT2 - Soft tissue injury (other than splinting of dislocated or fractured digit), unless
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specified elsewhere
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Included
Limited best-practice application of plaster cast, padded splint or
specific strapping to significant soft tissue injury (such as strained or
ruptured Achilles tendon or serious ankle sprain) which needs more
than three weeks immobilisation. See also Eligible – all MT codes.
Excluded
Soft tissue injuries requiring less than three weeks splinting or
compression. These are invoiced under MT1.
See also Not eligible – all MT codes.
Procedures per
Recommend: one procedure claim per injury.
injury
MT3 - Aspiration of inflamed joint, tendon, bursa, or other subcutaneous tissue or
space (with or without injection)
Included
Significant soft tissue inflammation requiring either aspiration or
injection of steroid, or both.
See also Eligible – all MT codes.
Excluded
See Not eligible – all MT codes.
Procedures per
Recommend: two procedure claims per injury.
injury

MT4 - Extensor tendon, primary repair
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Included
Primary repair of significantly damaged extensor tendon, requiring
use of local anaesthetic and surgical repair using best-practice
techniques. Dressing of wound, splinting of limb or digit, and
and c
providing post-operative advice. See also Eligible – all MT codes.
ts
Excluded
Follow-up checks, including removal of dressings. These are
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covered as part of a consultation/visit.
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See also Not eligible – all MT codes.
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Procedures per
Recommend: one procedure claim per injury.
injury
MT5 - Ruptured tendon Achilles: management by plaster immobilisation
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Included
Rupture of Achilles tendon requiring plaster cast immobilisation for
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more than three weeks. Repeat applications of plaster cast. See also
Eligible – all MT codes.
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Excluded
Soft tissue splinting of strained or ruptured Achilles tendon for more
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than three weeks. These are invoiced under MT2.
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Soft tissue splinting or other care to strained Achilles tendon. These
are invoiced under MT1.
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Follow-up checks, removal of plaster cast without re-applying the
cast.
See also Not eligible – all MT codes.
Procedures per
Recommend: three procedure claims per injury.
injury

odes
and c
ts
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t and procisi
on/V
tati
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