Sector Services

Claims, Provider Payments & Entitlements etc

Immunisation (IMMS)

FAQs
What is the Immunisation subsidy?
Can I submit an Immunisation claim and a General Medical Service (GMS) claim for the same patient and same date of service?
How can I submit my claims to Sector Services?
What is the GMS & IMMS HL7 Specification?
What is a PMS vendor?
How long will it take for my Immunisation claim to be paid?

What should I do if Sector Services has received my claim but the whole file has been rejected?
Some items within the claim file have rejected with errors. What do these errors mean?
I don’t understand the ‘indications’ that Sector Services staff refer to on the phone. What do these mean?
I don’t understand the vaccine code combinations that Sector Services staff refers to on the phone. What do these mean?
How should booster doses of the HepB Paed vaccine (where the original Indication is 9 – HepB Carrier Mother) be claimed?
What is an alternative vaccine?

Are NHI numbers required for every patient within a claim file?
How do I submit a claim where a locum doctor has provided the service?
How do I receive payment for claims that are over 6 months old?
If I have ongoing computer problems, can I obtain approval from my DHB to claim manually for a specified period of time or do I need to obtain approval each time I submit claims?
If I immunise a patient with more than one vaccine in a single visit, can I claim a separate fee for each vaccine?
Can I submit claims where a Nurse Vaccinator has provided the service?

If a patient receives a standard immunisation vaccine in addition to a pre/post splenectomy vaccine on the same day, am I entitled to an extra fee?
How often is the National Immunisation Schedule updated?
Where can I find more general information about Immunisation?
When does the National Immunisation Schedule 2008 apply from?
Is the pneumococcal conjugate vaccine only available to children at special risk?
What are the rules for the Human Papilloma Virus (HPV) vaccine?

Where do I send my manual claim forms?
How do I contact Sector Services?
I have run out of claim forms - how do I order more?

What is the Immunisation subsidy?
This subsidy is for General Practitioners who administer vaccines to eligible patients and submit claims to Sector Services under the Section 88 Advice Notice for General Practitioners, PHO agreement or other approved agreement for Immunisation services. If a claim is submitted to Sector Services, the General Practitioner cannot charge the patient for the service that was provided.

Can I submit an Immunisation claim and a General Medical Service (GMS) claim for the same patient and same date of service?
Both services may be claimed but only if a full consultation was undertaken with the patient. If the only service provided was an immunisation, then a General Medical Service claim should not be submitted to Sector Services.

How can I submit my claims to Sector Services?
Claims must be submitted electronically using version 2.8 of the GMS & IMMS HL7 Specification if the Date of Service is on or after 1 June 2008. For claims where the Date of Service is prior to 1 June 2008, claims must be submitted using version 2.7.

To start claiming electronically you will need to contact a Practice Management System (PMS) vendor.

Claims may be submitted manually if approval has been given by the funding DHB. The most common claims that are received manually are ‘stale claims’ that are submitted more than 6 months after the Date of Service.

What is the GMS & IMMS HL7 Specification?
The GMS & IMMS HL7 Specification defines the messaging and communication standards for the electronic transfer of claims information between providers and Sector Services. It defines the format of the electronic file.

Claiming Specifications
GMS & IMMS HL7 Electronic Claim Specification v2.9 Effective 1 Sept 2008
GMS & IMMS HL7 Electronic Claim Specification v2.8 June 2008

What is a PMS vendor?
A PMS vendor is a company that supplies practice management software. Errors relating to the format of the claim file may need to be referred back to the PMS vendor.

How long will it take for my Immunisation claim to be paid?

Claims submitted electronically will be paid no later than 10 business days from the date of receipt at Sector Services.

Claims submitted manually will be paid no later than 20 business days from the date of receipt at Sector Services.

If a claim is fully rejected and subsequently resubmitted, the payment date will be calculated from the date of receipt of the resubmitted claim.

What should I do if Sector Services has received my claim but the whole file has been rejected?
There could be two possible reasons for the whole file being rejected. In both cases, no payment will be made.

Header level error
A header level error means that there is something wrong with the structure of the file.
All items within the file rejected
All items in a file may reject for a number of different reasons.

In both cases, refer to the ‘Rejected Electronic Claim’ letter and ‘Error Report’ and/or call the Contact Centre on 0800 458 448 for further information.

Some items within the claim file have rejected with errors. What do these errors mean?
If the Error Report that is attached to either a ‘Rejected Electronic Claim’ letter or ‘Buyer Created Tax Invoice (BCTI) is not sufficient, please refer to the attached spreadsheet that contains a list of possible error messages, a full description of what the error means and what needs to be done to correct the error. If further information is required, phone the Contact Centre on 0800 458 448.

I don’t understand the ‘indications’ that Sector Services staff refer to on the phone. What do these mean?
The indication is the reason that the vaccine was administered. The scheduled reason eg. 6 weeks, is used to report where the vaccination falls on the NZ vaccination schedule. Refer to the table below for the Indication value that Sector Services staff refer to and the description which is most likely what the provider will see on their screen.

Indication Value	Description
1	Over 65 years (Influenza)
2	Under 16 years, eligible condition (Influenza)
3	Eligible condition (Influenza)
4	Sexual or household contact
5	Primary course
6	Booster
7	Post Partum
8	Low birth weight
9	HepB carrier mother
10	At risk for TB
11	Pre-post splenectomy schedule
12	At risk, no previous history
13	At risk, previous PCV7
14	At risk, previous 23PPV
15	Pre-emergency
21	PCV7 catch up
6W	6 weeks
3M	3 months
5M	5 months
15M	15 months
4Y	4 years
11Y	11 years
45Y	45 years
65Y	65 years

I don’t understand the vaccine code combinations that Sector Services staff refer to on the phone. What do these mean?
The vaccine code combination consists of three parts.

Vaccine Code (identifies the vaccine given)
Indication (reason the vaccine was administered)
Sequence (the dose number of the vaccine being given)

The table below represents the only valid code combinations that are possible for claiming through Sector Services. The sequence should be between 1 and 99 unless specified otherwise. Note that age rules may also apply for specific vaccines.

If you do not see these valid code combinations on your screen, please contact your PMS vendor for assistance in determining the correct option to choose.

Vaccine Code	Short Description	Long Description	Indication	Sequence
20	DTaP	Diphtheria, tetanus toxoids and acellular Pertussis	6W, 3M, 5M, 15M, 4Y, 6	1 to 99
50	DTaP/Hib	DTaP-Haemophilus influenzae type b conjugate vaccine	6W, 3M, 5M, 15M, 6	1 to 99
28	DT, Paed	Diphtheria, adsorbed paediatric dosage	6W, 3M, 5M, 15M, 4Y, 6	1 to 99
99001	DTaP-IPV	Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio	6W, 3M, 5M, 4Y, 6	1 to 99
99011	dTaP-IPV	Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio	11Y	1 to 99
99012	dTap	Diphtheria adult dosage, Tetanus, acellular Pertussis adult dosage	6W, 3M, 5M, 11Y	1 to 99
110	DTaP-Hep B-IPV	DTaP-hepatitis B and poliovirus vaccine	6W, 3M, 5M	1 to 99
210307	DTaP-IPV-HeP B/Hib	Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio vaccine, Hepatitis B, Haemophilus influenzae type b	6W, 3M, 5M	1 to 99
09	Td, adult	Tetanus and diphtheria toxoids, adsorbed for adult use	6W, 3M, 5M, 4Y, 11Y, 5, 6	1 to 99
EVP	EVP	EVP	15, 5, 6	1 to 99
30	HBIG	Hepatitis B immune globulin	6, 9	1 to 99
43	HepB, Adult	Hepatitis B vaccine, adult dosage	4	1 to 99
08	HepB, paed	Hepatitis B vaccine, paediatric dosage	6W, 3M, 5M, 4, 6, 9	1 to 99
51	Hib-HepB	Haemophilus influenzae type b conjugate and hepatitis B vaccine	6W, 3M, 5M, 6, 9	1 to 99
48	Hib (PRP-T)	Haemophilus influenzae type b vaccine, PRP-T conjugate	6W, 3M, 5M, 15M, 6, 8	1 to 99
48	Hib (PRP-T)	Haemophilus influenzae type b vaccine, PRP-T conjugate	11	1
118	HPV, bivalent	Human papilloma virus vaccine, bivalent	5	1 to 99
62	HPV, quadrivalent	Human papilloma virus vaccine, quadrivalent	5	1 to 99
99006	Influenza	Influenza	1, 2, 3	1 to 99
10	IPV	Poliovirus vaccine, inactivated	6W, 3M, 5M, 4Y, 11Y	1 to 99
99002	MeNZB	Meningococcal B	5	1 to 4
99002	MeNZB	Meningococcal B	6	1 to 99
99002	MeNZB	Meningococcal B	11	1 to 3
99008	MenACY W135	Meningococcal A, C, Y, W-135	5	1 to 4
99008	MenACY W135	Meningococcal A, C, Y, W-135	6	1 to 9
99008	MenACY W135	Meningococcal A, C, Y, W-135	11	1 to 3
03	MMR	Measles, mumps and rubella virus vaccine	15M, 4Y, 5, 6, 7	1 to 99
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	6W, 3M, 5M, 15M, 21	1 to 99
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	5	1 to 4
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	6	1 to 9
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	12	1 to 4
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	13	1
100	PCV7	Pneumococcal conjugate, vaccine, polyvalent	14	1 to 2
33	23PPV	Pneumococcal polysaccharide	5	1 to 4
33	23PPV	Pneumococcal polysaccharide	6	1 to 9
33	23PPV	Pneumococcal polysaccharide	11	1 to 9
33	23PPV	Pneumococcal polysaccharide	12	1 to 2
33	23PPV	Pneumococcal polysaccharide	13	1 to 2
33	23PPV	Pneumococcal polysaccharide	14	1 to 2
35	Tetanus toxoid	Tetanus toxoid, adsorbed	5, 6, 6W, 3M, 5M	1 to 99

How should booster doses of the HepB Paed vaccine (where the original Indication is 9 – HepB Carrier Mother) be claimed?
Booster doses should be claimed using Indication 6 (Booster).

What is an alternative vaccine?
An alternative vaccine is a valid vaccine that may be used instead of the normal Schedule vaccine if, for some clinical reason the Schedule vaccine may not be used.

Are NHI numbers required for every patient within a claim file?
An Immunisation claim file must contain at least 85% of valid NHI numbers. Therefore, 15% of the claims do not have to contain NHI numbers provided that they contain both Date of Birth and Surname. However it is advisable that you make every effort to obtain a patient’s NHI number and include this in your claim.

How do I submit a claim where a locum doctor has provided the service?
The Payee Number, Agreement Number, Registration Number and Name of the host doctor must be provided in addition to the Registration Number and Name of the locum.

How do I receive payment for claims that are over 6 months old?
Approval must be received from the Funding/Portfolio Manager at the funding DHB. The provider should contact their DHB first to determine the process but in most cases the DHB will require the claims to be submitted manually to them with an accompanying letter explaining why the claims were not submitted within the contractual timeframe.

If approval is granted, the approval letter should be sent to Sector Services with the claims.

If I have ongoing computer problems, can I obtain approval from my DHB to claim manually for a specified period of time or do I need to obtain approval each time I submit claims?
This will depend on the funding DHB. Some may require you to obtain approval each time but others may give you an exemption for a specific period of time. Sector Services will keep a record of the exemption.

If I immunise a patient with more than one vaccine in a single visit, can I claim a separate fee for each vaccine?
One fee will be paid per IMOA/IMFA service, one fee will be paid per IMMB service and one fee will be paid per IMFV service.

Refer to the table below to determine which services to claim based on the vaccinations that were provided in a single visit.

Combination	IMOA	IMMB	IMFA	IMFV
One standard vaccine excluding MeNZB and Influenza	IMOA
One standard vaccine plus MeNZB	IMOA	IMMB
One standard vaccine plus Influenza*	IMOA			IMFV
One standard vaccine plus MenZB and Influenza	IMOA	IMMB		IMFV
Multiple vaccines excluding MeNZB and Influenza	IMOA
Multiple vaccines including MeNZB	IMOA	IMMB
Multiple vaccines including Influenza*	IMOA			IMFV
Multiple vaccines including MeNZB and Influenza	IMOA	IMMB		IMFV
MeNZB only		IMMB
Influenza only			IMFA	IMFV
MeNZB and Influenza		IMMB	IMFA	IMFV

* Note that there is currently an issue where IMOA/IMFA combinations are submitted electronically. These will need to be submitted manually and DHB approval will be required.

Can I submit claims where a Nurse Vaccinator has provided the service?
Yes but currently only via manual claiming. The applicable Payee Number and Contract Number should be provided with the Nursing Council Number of the Nurse Vaccinator. The Payee Number and Contract Number will often be those of the doctor but may be for the nurse if the nurse holds their own agreement.

If your claim rejects and you believe that the correct information was supplied, please contact your PMS vendor for assistance.

If a patient receives a standard immunisation vaccine in addition to a pre/post splenectomy vaccine on the same day, am I entitled to an extra fee?
Yes. An IMOA (standard administration) and IMMB with indication 11 (pre/post splenectomy) should be claimed so that you receive an extra fee.

How often is the National Immunisation Schedule updated?
The National Immunisation Schedule is updated every two years as a result of recommendations made by the Immunisation Technical Working Group (ITWG) and subsequent approval by the Minister of Health. The details are published on the website below.

Where can I find more general information about Immunisation?
Visit the Ministry of Health Immunisation page at:
www.moh.govt.nz/immunisation

When does the National Immunisation Schedule 2008 apply from?
It applies to all Immunisation claims with dates of service on and after 1 June 2008.

Is the pneumococcal conjugate vaccine only available to children at special risk?
From 1 June 2008 this vaccine will be offered to all babies born on and after 1 January 2008. Four doses of the vaccine will be available at:

6 weeks
3 months
5 months
15 months

What are the rules for the Human Papilloma Virus (HPV) vaccine?

At this stage, there are no age validations for this vaccine. This vaccine can only be claimed for female patients.

Where do I send my manual claim forms?
Send all completed claim forms to:

Immunisation claims
Sector Services
PO Box 1026
Wellington 6140

How do I contact Sector Services?
For further information, please call the Sector Services Contact Centre on:
0800 458 448
Monday – Friday 8:00am – 5:00pm,
Except Wednesday when the Contact Centre’s hours are 9:30am – 5:00pm

I have run out of claim forms - how do I order more?
Claim forms are available free from Wickliffe Ltd on 0800 259 138, you will need to provide your payee number.

Forms

Sector Services Benefits IMMS Claims June 2008(PDF, 165 KB)
Sector Services Benefits IMMS Summary June 2008 (PDF, 135 KB)

Publications

Claiming Specifications
GMS & IMMS HL7 Electronic Claim Specification v2.9 Effective 1 Sept 2008
GMS &IMMS HL& Electronic Claim Specification v2.8 June 2008

IMMs errors (Excel, 36 KB) effective 1 september 2008)

Links

Immunisation

Immunisation Advisory Centre (www.immune.org.nz)

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