Sector Services

Claims, Provider Payments & Entitlements

Contact Lens subsidy

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The claim has been received but not been fully paid - the variance report is showing error messages - what do these messages mean?
Are the fitting fees and corresponding claim codes GST inclusive or exclusive?
Replacing lost or damaged lenses. Does Sector Services meet two thirds of the cost, or the total costs?

Does the client or does Sector Services fund the cost of a check up by an Opthamologist?
Can we either do away with the - copy of invoice - requirement for silsoft and patch lenses, or can another process can be agreed to?
Does Sector Services fund the provision of disposable Contact Lenses?

What is the Contact Lens subsidy?
This is available to Optometrists and Dispensing Opticians under the Section 88 notice who fit or supply patients who, for medical reasons, cannot wear glasses.

I have not been paid for an entire Contact Lens claim, what should I do?
Contact the Sector Services Contact Centre (0800 252 464) to find out whether the claim has been received and if so whether payment has been stopped due to an error with the claim or a processing problem.

If the claim has not been received it will need to be resubmitted to Sector Services via the usual routes – if the claim is now over six months old it will need special approval from the Ministry of Health before Sector Services can process it.

The claim has been received, but not been paid, why would this be?
If the contract number is not valid or if the payee number is not correct a payment may be stopped or may be directed to the wrong account. In most cases these claims can be amended by Sector Services, once we are advised the correct information is provided, and put on the next payment run.

The claim has been received but not been fully paid - the variance report is showing error messages - what do these messages mean?

Error 0513 - Invalid Provider (Registration) Number
The Provider number given has expired or is not in Sector Services' database. Please check your records and contact the Sector Services Contact Centre with the correct details so that adjustments can be made. If the Provider number is correct then Sector Services will need to check that the Optician's Registration No is still valid and covers the dates of service of the claim.

Error 0520 - Invalid service for contract
The Contract number given has expired or is not in Sector Services' database. Please check your records and contact the Sector Services Contact Centre with the correct details so that adjustments can be made. If the Contract number is correct then Sector Services will need to check that the Optician's Registration No is still valid and covers the dates of service of the claim.

Are the fitting fees and corresponding claim codes GST inclusive or exclusive?
The fees are the same as those set out in the previous contract, the only difference is that these are GST inclusive.

For the replacement of lost or damaged lenses, does Sector Services meet two thirds of the cost or the total costs of the lenses?
Sector Services will meet two thirds of the cost of the replacement lenses when the lenses have been damaged or lost (use claim code S2). In all other cases, Sector Services will meet the total supply cost of the lens, as evidenced by a copy of the lens supplier's invoice (use claim code S1).

Does the client or does Sector Services fund the cost of a check up by an Opthamologist?
If no lenses were fitted and it was only an eye examination then the client pays.

Can we either do away with the - copy of invoice - requirement for silsoft and patch lenses, or can another process be agreed to?
You can send us a copy of the bulk supply invoice and indicate on this how many lenses you are claiming for.

Does Sector Services fund the provision of disposable Contact Lenses?
Sector Services does fund this as long as the following criteria are adhered to –

disposable lenses are a clinically appropriate selection for the client.
disposable lenses are as cost effective as permanent lenses.

When will my claims be paid?
Payment will be made within 20 working days of receiving a valid claim.

Where do I send my Contact Lens claim forms?
Your claim 'schedule B' form should be sent to:
Sector Services
P O Box 1026
Wellington 6140

Please ensure to attach a copy of the Contact Lens Supplier's invoice to each claim form.

I have run out of claim forms, where can I get some more?
Claim forms are available free through Wickcliffe Press on 0800 259 138, you will need to provide your payee number.

Please note: you should not rely solely on the answers provided here; the contracts applicable to each provider and all relevant legislation must be consulted to determine the full rights & liabilities applicable to any service provider or funder.

Page last updated: 2 October 2008