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Informations for suppliers | UniHealth
the UniHealth rules, we only provide payment for treatments provided by a recognised supplier. The present General Business Rules ("the present Rules") are the rules under which we accept general care providers for the purposes of providing care. You are deemed to agree to these Rules when a Member makes a legitimate request for your Service from us unless you notify us otherwise. b) This Privacy Statement outlines, but is not limited to, the circumstance in which we are able to identify or not identify a Supplier. c) If there is a conflict between these Rules and the rules of any other arrangement between us and you, these Rules will take precedence to the full extent of such conflict.
b ) "General treatment" has the same significance as in 121-10 of the Private Health Insurance Act 2007 or any modification or substitution thereof. c) "Member" means a natural or legal entity who is a UniHealth member who is insured for general treatment and who, in the case of members of a UniHealth household, comprises all members included in that member.
2. a healthcare professional as specified or used in the private health insurance (accreditation) 2011 regulations, or any modification or substitution thereof. j) means'Normal and adequate fee': k ) "Date of Recognition" means the date on which you first provided a General Treatment to a Member for whom a right has been claimed and for whom we have recognized you as a General Treatment Providers for the purposes of providing services.
l ) "We", "Our", "We", "THF" and "UniHealth" means Teachers Federation Health Ltd ABN 86 097 030 414, which is a privately held insurance company incorporated as a Teachers Health Fund or UniHealth. m) "You", "Your" and "Recognised Provider" means a UniHealth accredited supplier, with the exception of: 1. providers of outpatient care facilities; 2. providers of authorised health care programmes; 5. providers of replacement care in hospitals.
The recognition by UNICHalth is a precondition for the receipt of payments. You are a recognized supplier to United Health if: d) you fulfill all of the criteria and fulfill all of our expectation sets forth in these General Business Practices, as they may be modified from case to case. If you are a recognized treatment providers, you can ask us to reimburse you for any general treatment fees you may charge our members:
1. Your full name, practice address and phone number (must be provided as part of the provider's heading or seal and not handwritten). The words "duplicate" or "copy" on all exhibited replica bills, or if the provided documents are an offer, should be identified as "offer" or "quote". b) You or your staff may not act as an attorney and make a claim on a Member's behalf except when using e-rights ( "HICAPS" or "CSC HealthPoint"). a) For each Member you are treating, you must keep precise medical records:
Guidance (ii) Date of each operation. iii ) type of therapy. iv) type of disease (symptom/reason for initiation of treatment). If there is no such legal provision - for a duration of at least 7 years and if the member is under 21 years for a duration of 7 years after becoming 21 years old. c) You must keep an accounting system that keeps a record of the full name and duration of each member case.
d ) Members' medical files must be kept in English or must be English translation at your cost. e) If you are supplying goods made or adapted specifically for the exclusive use of an individual UniHealth member client, you must keep a copy of all order slips and supplier's bills relating to such goods and make them available on request.
f ) The Member medical files for complaints must be made available to us on demand for auditing within 10 workingdays of a written inquiry or at the moment of an on-site review. g) The electronic Member medical files must be backed up periodically with a copy of a copy that is kept secure off-site. h) You acknowledge and consent that we may review our Members' medical files at any times and with appropriate delay during regular office working hour to verify benefit entitlements and to make appropriate claim payments.
f ) The goods or provision of provision of services have not been made to the Member at the time of the entitlement; g) The provision of provision of services shall not be due if an Insured is not able to present a voucher in the manner reasonably required by the TFH; h) Account/Invoice/Receipt is not genuine or the particulars have been changed; i) The fee relates to non coverage e.
g. the provision of reporting; j) payments are also required from another resource for all or part of the Activities, Medicare Australia included; k) the Member has obtained more than one Activity (other than dentistry and optics ) on the same date from the same supplier, in which case the highest benefit medical care is provided; l) the Activity is unlawful (e.g. drugs imported); m) the Activity has not been performed by you.
As an example, the provision of our enrolment fees has been made by patients working under your immediate control and/or guidance (with the exclusion of those enrolled by oral health care professionals for whom we have not provided vendor numbers and where the Act allows such practice); n) The enrolment fee does not comply with the 2011 Private Health Insurance (Accreditation) Regulations, or any change or substitution thereof; o) The enrolment fee is not a general fee for a particular health status; p) We consider the enrolment fee to be unreasonable upon receipt of unbiased health or clinic consultation;
q ) Services are not to be paid if a Services has not been provided personally and personally with the Member (except for Skype meetings for psychology); r) Services are not to be paid for Services which an Insured is eligible to obtain free of cost, e.g. return or welfare insurance services; s) Services are not to be paid if the Services have been provided free of cost or on production of a free present;
t ) The goods or service have not been provided to the Member in Australia; u) Service and handling for yourself as an individual (or Member) or for the husband, wife, de facto associate or relatives of a practicing professional; or associate; or associate; or spouse, de facto associate or relatives of the partitioner associate.
In addition, you consent to cooperate with our appropriate requests or instructions for the collection, safety, use and disclosures of our members' personally identifiable information. b) If you do not want us to collect your information, we cannot evaluate our members' entitlements and you cannot be a recognized vendor.
a) You consent to us disclosing your name, office address, postal address, contact information, postal address and billing information to Members, while you are a Recognized Supplier, which may include, but are not restricted to, publication on our website. c) We may choose to deactivate a Recognized Supplier if we determine that, in our sole judgment, the Recognized Supplier has done so:
a) the recognised supplier has been found guilty of a crime; 2) your medical care does not comply with the standard set out in regulations 7, 8, 9 and 10 of the Private Health Insurance (Accreditation) 2011 Regulations; 3) you have behaved in an improper or unprofessional manner, which means that your conduct in relation to the recognised supplier has resulted in a dislike of the recognised supplier;
Recognised Provider has contravened any contract that it has with us; (5) Act in a way that would be contrary to the general group of Providers in that disciplinary area; (6) Violate any codes of ethics, accredition or other regulation of their group; (6) Violate any other legal or ethical requirement of their group; or (6) Violate any other legal or ethical obligation of their group; Failure by UniHealth to comply with its obligations under this Directive may result in the Recognised Service Provider having to pay more than a customary and reasonable fee for its service; (7) Participation in dissatisfactory accounting practice, which means that the Recognised Service Provider has routinely charged more than a customary and reasonable fee for its service; (8) Record keeping of service claims is reasonably considered by UniHealth to be abnormal, unreasonable or imprecise;
9 ) use UniHealth's trademark or IP without UniHealth's permission; 10) harm UniHealth's interest, goodwill or reputations; 11) UniHealth has decided to discontinue acceptance of the provider's services; 13) We believe in our reasoned belief that the security of a member or its members may be compromised.
Neither you nor we may have any claims against the others resulting from these Conditions at the time of cancellation, such notification by notification shall not apply to you or we. c) We may cancel these Conditions by giving you 21 days' written notice if you or the service you have provided does not or no longer comply with the standard of care set out in Regulations 7, 8, 9 or 10 of the 2011 Private Health Insurance (Accreditation) Regulations.
Said cancellation by notification shall have no effect on any claims you or we may have against the others at the time of cancellation under these Conditions. 11 ) How long will a provider not be recognized? a) A non-recognized provider can be informed of a date after which he can apply for a new provider license.
The restoration of acceptance is due to the fact that the vendor is able to reasonably meet our concern about their eligibility as an accepted vendor. b) A vendor who is deregistered due to unlawful activity or serious wrongdoing is not eligible to re-register with UniHealth. a) If a vendor wants to file an objection to deregistration, it should do so immediately and in written form.
If we receive more than 7 workingdays after the announcement of our intent to cancel, we will not consider any appointments from providers. b) We will attempt to respond to the appointment within 7 workingdays of receiving it. When we need more free space, we will inform the vendor of the anticipated timescale.
Acceptance of the supplier will be deferred during the appeals procedure. c) We will inform the supplier of our definitive ruling in written form. In the event that you are not happy with the answer, you may refer the matter in a written form to an outside arbitration body such as the Private Health Insurance Ombudsman. a) From Time to Time, we may revise these conditions. b) We will post on our website a statement of changes that may affect our reputable providers.
Said conditions shall be subject to the law of the State of New South Wales and the Contracting Party shall submit each other to the exclusive jurisdiction and venue of the New South Wales Court.