Applicable Clause Business Rules, 12, p.83.
“Claims must be submitted within six calendar months of the date of service. Any claim not submitted within six calendar months of the date of service shall be rejected unpaid.”
Claims received by Sector Services - Wellington more than 6 months after the service to which they relate are considered ‘late’ and must be approved by the DHB before they can be paid.
Claims come either from Sector Services - either Wellington or Wanganui or direct from the provider.
- NRA Liaises with provider.
- Contract validity is checked
- Memo prepared recommending to DHB whether to decline/approve payment with an explanation of the circumstance(s) that led to the claim being late.
- Letter confirming approval/decline of claim sent to provider (with reason if declined).
- A copy of the letter, signed approval memo, and claim are sent to Sector Services - Wellington or Wanganui to make payment