Sector Services

Teams

Sector Support

Sector Support Wellington
Sector Support - Dunedin
Sector Support - Wanganui

Agreements
The Agreement Administration Team is based in Dunedin, and is responsible for creating new Agreements and Variations to Agreement, including the printing and approval of Agreement documentation. The Agreement Administration Team is also responsible for collecting Performance Reporting data from providers.

Agreements are currently created by Sector Services on the Funders behalf. These Agreements are predominantly based on standard templates. However, Funders and Providers can mutually agree to vary the some Agreement terms, including service fees.
The Agreement supports various relationships between parties, including:

Funder to Provider
Funder to Agents
Provider to Practitioner

Agreements are generally established for a fixed term and are renewed periodically. Changes to an Agreement are made through creation of an Agreement Variation, which must be signed by both parties. Agreement Variations record the changes to the services being provided, which may include an extension of term, a price increase or an amendment to the list of agreed services. The Agreement combined with the changes defined in the Agreement Variation effectively forms the new Agreement.

Variations to existing Agreements go through the same review and approval process as newly created Agreements.

Variations to Agreements results in the creation of a new Agreement document, which outlines the changes made to the original and to subsequent variations, and replaces the original with a new version.

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

Contact Centres
The Contact Centres are organised into teams at Wanganui and Wellington, which specialise in different claim and/or query types. The Contact Centres’ purpose is to handle telephone, email, postal and fax enquiries from the sector and the public relating predominantly to entitlements, registrations, claims and payments.

The queries include but are not limited to:

Artificial Aids - Queries relating to subsidy balances and supplier payments
Bulk Funded Payments – Provider secondary care payments queries(e.g. hospitals, District Health Boards)
Carer Support – Claims and entitlements queries
Community Services Card - Health care centres and/or Providers fax requests for patient Community Services Card numbers to Sector Services, and Sector Services faxes responses back
District Health Board support – Ad hoc report requests and Primary Health Organisation payment enquiries
Entitlements – Client entitlements and residential care claims enquiries
General Medical Services – services and claims enquiries
High Use Health Cards - High Use Health Card applications enquiries
Immunisation – General Practitioner claims
National Health Index - Lookup and confirmation of National Health Index numbers, creation of new National Health Index numbers, and the merging of duplicate entries in the National Health Index system
National Travel Assistance – Client eligibility for travel assistance, and client and service provider claim enquiries
Pharmacy – Pharmacy payment and agreement enquiries, and enquiries relating to the PHARMAC Pharmaceutical Schedule
Primary Care – Maternity, Pharmacy, Rural Practice Bonus, Practitioner Register enquiries
Primary Care Providers – Maternity, Dental, Contact Lens and Minor Benefit claim enquiries
Primary Health Organisations - Registration and maintenance requests
Special Authority - Special Authority applications
Work Request Support – Support for Health Payment application change requests

Processing and Payments
The Processing and Payments teams are located at Dunedin, Wanganui and Wellington which specialise in different claim and/or query types. The Processing and Payments Teams purpose is to process registers, claims, invoices and refund requests by:

Capturing and validating them against the Providers Agreement or against the health care users Entitlement, and against the business rules specified for each claim type
Generating Buyer Created Tax Invoices or Remittance Advices
Making payments on the Funder’s behalf.

Submission can be via:

Paper or paper based forms
Electronic files on diskette or Compact Disc
HL7 files
Electronic messages
Browser based or other file uploads.

Capture by Sector Services staff may involve the following:

Entering data from forms
Loading files from diskette or Compact Disc by selecting the file from the application file load menus or dialogs and setting load parameters.

Claims and claim data are validated against:

Registers - such as National Health Index, Health Practitioner Index, Special Authority or Dental Enrolment
Entitlements – such as remaining balance for artificial aids
Historic claims – such as Pharmacy partial dispensing claims
Other criteria specific to each claim type.

Validation is performed for a variety of reasons, including the prevention of duplicate claiming and to ensure the accuracy of clinical data.

Information Services

Contact Details

Business Purpose
Information Services is a Specialist Support Group designed to ensure that Sector Services can provide business critical support and information to both our own operations and to our external stakeholders.

Information Services main objectives are to:

Provide efficient and timely supply of payments, agreements and financial reports to stakeholders with improved accuracy, consistency, audit-ability;
Deliver improved operational support and comprehensive analysis to maintain accurate and timely solutions for internal and external stakeholders; and
Provide accurate and timely reporting on Sector Service’s business functions.

07/08 Strategic and Business Focus
System Improvement

Provide skilled resource to support existing systems
Provide quality assurance of system change
Contribute to systems upgrade to meet future needs

Operating Efficiency

Mitigate operational risk
Meet and monitor internal and external Key Performance Indicators
Maintaining professional standards in specialist areas (best practice)

Staff Capability

Cross skill
Succession plan
Strengthen capability in professional areas

Stakeholder Satisfaction

Setting and maintaining expectations with key stakeholders
Provide capability to manage sector change
Proactively communicate issues and risks to stakeholders

Information Services Teams
Finance Team
Payments Consolidation Project

Centralising complete payment process to Wellington
Consolidating the payment run function and financial functions to one FMIS system
Review of business process
Recommendations for improved process
Document process
Accountabilities for finance team

Operations Support Team
Centralisation of Operations Support Helpdesk

Single point of contact for operations support
Reduction of administration overheads by duplication of tasks
Availability of resource for improving service levels

Service Catalogue

Documenting services provided by the Operations Support team

Contacts
79 Taranaki Street
PO Box 1043
Wellington 6140
Ph: 04 381 5366

Page last updated: 2 September 2009