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Is there ANY source that provides a list of what item numbers are covered by which health funds in Australia? And does anyone have a list they can provide me? I do have the list that HICAPS provide but that doesn't mean health funds will cover them.

I know I can give a patient a code & ask them to call their health fund but that is such an inconvenience.

 

Hi Zac,

We're in the process of updating the item codes for Australian podiatrists at the moment. Our draft is complete and we're fine tuning it in consultation with the health funds. Once that's complete, the HICAPS codes will be updated through a negotiation between the APodC, the Private Health Insurance Association (PHA) and HICAPS.

Unfortunately, every health fund has hundreds (sometimes thousands) of products as they can't cancel a product while there are customers buying it. Many of the products have different rebates so it's very difficult to document. Added to this, funds are competitors so they won't give out lists that are simple to follow. There are standard information statements on current product but it's still difficult to navigate.

Funds will allow you to enter codes into HICAPS and then cancel them to determine the rebate for a particular client but be careful not to code shop looking to match billing to rebates (rather than the service provided) as this comes up on audit reports and will get you flagged for audit.

Cheers,
Damian.

 

I think with every consult you do you should do it with the expectation to be audited on it.