Sector Services

About Us

Business Purpose
Sector Services is a business unit within the Information Directorate of the Ministry of Health. Sector Services is responsible for providing strategic advice on the impact of sector changes on payment processes, and for the administration of the core health payment processes, including:

Agreements Administration – creation and administration of funding agreements between health funding organisations and health providers
Entitlements Administration – capture and tracking health care users’ health care entitlement and usage. Entitlement is established via criteria assessments, which includes Needs Assessments performed by agency organisations within the health sector
Claims, Invoice and Register Processing – receipt, validation and calculation of claims, invoices and registers, and the capture of clinical data from claims.
Payments Processing – manage the payment of funds on behalf of the Ministry and District Health Boards
Customer Service Management – handling queries and service requests from Funders, Providers and health care users
Analysis and Reporting – provision of contract, clinical, performance analysis and financial reporting to Funders and health Providers, and to the National Health Information and Data collections

Sector Services contributes to the success of the Ministry of Health, District Health Boards and the wider health sector by:

providing high quality nation-wide services at competitive cost,
being responsive to changing customer needs,
adding value to every service provided,
proffering advice based on sector expertise and promoting improvement of sector performance and efficiencies
providing timely operational information on services it provides,
operating a culture of continual improvement.

Our Vision
Sector Services delivers high quality, nationally consistent support services to contribute to Healthy New Zealanders.

Our Mission
To be the provider of choice, delivering vital services in support of achieving improved Health Outcomes for all New Zealanders.

Teams

Information Services:
Information Services provide business support services including: payments of health claims, provision of standard reports relating to payment and other health data; support of business systems. Information Services staff are located in Dunedin, Wellington and Wanganui.

Sector Support:
Sector Support provide claims management, agreement administration and contact centre capabilities. They process and administer claims and provide support to claimants to enable efficient and effective management of the claiming process. Sector Support staff are located in Dunedin, Wellington and Wanganui.

For additional information on the teams click the link below
Teams – this link will take you directly to the Teams pages

Offices
Sector Services has three offices throughout New Zealand. Click on the city below for the contact details.

Wellington Contact details – this link will take you directly to the Contacts pages
Wanganui Contact Details - this link will take you directly to the Contacts pages
Dunedin Contact Details - this link will take you directly to the Contacts pages

Sector Services Relationships and Services
Sector Services provides a number of services to health sector participants. The diagram below provides a summary of the main customers and services.

Figure 1: Sector Services Services Summary

Funders
Funders include the following:

Ministry Directorates, such as the Health and Disability National Services or the Sector Accountability and Funding
District Health Boards
PHARMAC
Other government agencies, such as the Ministry of Social Development.

Sector Services provides the following services for Funders:

Creation and maintenance of funding agreements, pricing schedules and payment rules
Validation of stipulated agency criteria for various entitlements
Validation of provider claims and invoices against funding agreements and entitlements
Payment processing
Financial reporting
Capturing and reporting agreement performance indicators
Regular and ad hoc reporting of data captured throughout the claims validation process

Providers
Providers include the following:

Individual Health Care Providers, such as nurses, midwifes, occupational therapists, physiotherapists, general practitioners, radiologists, and specialist doctors such as surgeons, obstetricians, gynaecologists, and radiologists
Provider organisations, such as District Health Boards, Primary Health Organisations, Community based providers, Non-Government Organisations, medical practices, laboratories, pharmacies, home care services and hospitals.

Sector Services provides the following services for Providers:

Maintenance and distribution of services catalogues
Preparation of payment schedules
Maintenance and distribution of entitlements payment schedules
Receipt, capture, validation and processing of entitlements, registers, claims and invoices
Payment processing
Query and request management.

Health Care Users
Health Care Users include:

Members of the public receiving primary health care services
Members of the public who are eligible for special services, such as home or frail care support.

Sector Services provides the following services to Health Care Users:

Maintenance of entitlement details and balances
Creation and distribution of claims forms
Receipt, capture and processing of claims and invoices
Payment processing
Query and request management.

Ministry of Social Development
The Ministry of Social Development supply an incremental extract to Sector Services containing the identity of new Community Service Card holders and their dependents, and SuperGold card holders with Community Services Card entitlements, the type of card issued, and the period for which the card is valid.

At the time of claims and register processing, Sector Services use this information to determine the level of government subsidy and relevant patient contribution for services provided to those eligible for Community Services Card entitlements.

Where a card has been issued, but is not available at the time of provision of the service, service recipients are charged the standard rate, and are required to present their invoice to The Ministry of Social Development to claim for a refund.

On a regular basis, The Ministry of Social Development provide Sector Services with a patient file and an invoice for the amount of reimbursement. The reimbursement is determined by calculating the difference between the patient contribution paid and the patient contribution that an eligible Community Services Card holder would have otherwise been entitled. Sector Services determine the applicable Funder for each patient in the file provided, and make payments from the respective Funder accounts to The Ministry of Social Development for the value of these cardholder reimbursements.

Inland Revenue Department
Sector Services provides the Inland Revenue Department with the facility to recover outstanding tax liabilities from Providers by netting regular payments directly from Provider payments.
Sector Services is required to comply with New Zealand Taxation Rules, including the generation of Buyer Created Tax Invoices and accounting for Goods and Services Tax.

Medsafe
Sector Services provides Medsafe with data on specific medicines of interest.

Ministry of Justice
Sector Services provides the Ministry of Justice with payment services for forensic pathology.

New Zealand Health Information Services
Sector Services provides the New Zealand Health Information Services with claim, payment and clinical data for loading into the national data warehouse. The data includes data for the following data marts or collections:

Pharmacy
Laboratory Claims
Immunisations
General Medical Services
Maternity
Primary Health Organisation Enrolment.

PHARMAC
Sector Services provides the following services to PHARMAC:

Applying the subsidy of pharmaceutical claims according to the PHARMAC pricing schedule
Reporting on pharmaceutical claims and payments
Processing of entitlements for pharmaceuticals requiring a special authority to prescribe
Special Authority audits.

Professional Registration Bodies
Professional registration bodies include:

Dental Council of New Zealand.
Dieticians Council of New Zealand
Medical Council of New Zealand
Midwifery Council of New Zealand
Nursing Council of New Zealand
Optometrist and Dispensing Opticians Board
Podiatrists Board of New Zealand.

Sector Services validates agreements and claims against Annual Practicing Certificates provided by registration bodies.

Page last updated: 8 October 2009