Sector Services

Claims, Provider Payments & Entitlements

Laboratory

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FAQs

What is a Laboratory Payment?
What is a Schedule Test Purchase List?
How Much Can I Claim?
How Do I Claim?
Where should I send my claims?
How do I contact Sector Services?
I have run out of claim forms, where can I get some more?

What is a Laboratory Payment?
A laboratory payment is where a patient is referred by a Medical Practitioner, Oral Surgeon, Cervical Smear Taker, Approved Nurse or Midwife for a laboratory test. The laboratory then carries out the tests required and provides the Referring Practitioner with the results. The results are then passed on to the patient. To receive payment for the test, the laboratory submits a claim file and/or invoice to Sector Services which Sector Services processes on behalf of the funding District Health Board.

What is a Schedule Test Purchase List?
A Schedule Test Purchase List is included in your contract with the funding District Health Board(s) and includes the following information.

Test Code	An identification code for each individual pathology test. Format is either 1 alpha, 2 numeric eg. S01 or 2 alpha, 1 numeric eg. BA1.
Test Description	The full written description for each individual pathology test.
Price Per Test	The price (GST exclusive) that the funding District Health Board will pay the laboratory to carry out one completed testing procedure for a specified test.
Maximum Number	The maximum number of a specified pathology test that the funding District Health Board will pay the laboratory to carry out for any individual patients on any individual sample.
Approved Practitioner Type	This specifies which type of practitioner can refer a patient for each individual test. Referring practitioners can either be Medical Practitioners, Oral Surgeons, Cervical Smear Takes, Midwives or Nurses.

How Much Can I Claim?
Each laboratory will receive a different amount for each of the tests that they are eligible to claim for. This is due to their being no national laboratory contract. Therefore, each District Health Board can contract with their laboratory service provider(s) as they please. The amount that the laboratory will receive per test is contained within the Schedule Test Purchase List.

How Do I Claim?
How you claim depends on the funding arrangement that is in place between the laboratory and District Health Board(s). There are two funding arrangements.

Fee For Service (FFS)
Bulk Funding

Fee For Service
This arrangement means that you are paid for each individual test providing that each test meets the claiming criteria. Any test that does not meet the criteria is rejected.

A claim file and an accompanying Claim Summary Form is required to be sent to Sector Services Wellington. The claim file can be submitted on floppy diskette or on CD-ROM (providing that the funding District Health Board has given you authorisation to do so).

Bulk Funding
This arrangement means that you receive a set Service Fee on a monthly basis instead of being paid on a test by test basis. An invoice must be sent to Sector Services Dunedin each month. In addition, a claim file and accompanying Claim Summary Form is also required to be sent to Sector Services Wellington so that the claim data can be sent to New Zealand Health Information Service (NZHIS) for inclusion in the national data collection.

Where should I send my claims?
All claim files must be accompanied by a Claim Summary Form and sent to:
Laboratory 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 ext 5743 (Terisa Kelemete)
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, where can I get some more?
Please call the Sector Services on 0800 458 448 ext 5743 (Terisa Kelemete) who will post some more forms to you. Note that you will need to provide your payee number.

Alternatively an electronic copy is available from the forms section of the Sector Services website or below:

Forms

Labs claim summary form (PDF, 60 KB)