Health provider payments
Important news
We have improved our electronic funds transfer (EFT) system and it is now available to all providers.
From 28 November 2008, all provider payments will be made by EFT. Many providers are already receiving payment through EFT, which means faster and easier payments (than cheques).
Payments
WorkCover Queensland covers the reasonable cost of medical treatment and rehabilitation, having regard to the worker’s injury and the relevant table of costs.
Legislatively, we are unable to pay invoices submitted more than 60 days after the date of service.
Before WorkCover can accept liability for any medical or rehabilitation costs relating to a claim, they must approve the application for compensation. If WorkCover does not accept the claim, WorkCover is not responsible for any costs.
How much will health providers be paid?
The fees paid for treatment and medical reports are outlined in Q-COMP's, the Workers’ Compensation Regulatory Authority, table of costs. To obtain a copy of the table of costs, please contact Q-COMP on 1300 361 235 or visit Q-COMP's web site at www.qcomp.com.au.
How will health providers receive payment?
There are two ways health providers can receive payment:
- send their account directly to WorkCover Queensland and we will reimburse the health provider directly electronic funds transfer (EFT) or
- bill the injured worker directly, and WorkCover will reimburse the injured worker for the appropriate amount.
What if the health provider's fees are higher than the amount in the table of costs?
It is important for health providers to explain WorkCover Queensland will only pay the amount stated in the table of costs. Any amount over this is a matter for the health providers to discuss with their patient.
What does WorkCover need to process payment?
If a health provider is invoicing WorkCover Queensland for the first time, they will need to complete a Service provider application form. This will enable WorkCover Queensland to provide the health provider with a Client Registration number. Without this number WorkCover Queensland cannot process any accounts.
Health providers must provide WorkCover Queensland with the following information when submitting an account:
- name (as the treating health providers)
- trading business name
- patient's name and claim number
- Australian Business Number (ABN)
- business address
- date the service was delivered
- item number (if applicable)
To make invoicing WorkCover Queensland easier, health providers can now include charges for more than one patient on an invoice. There is no need for a separate invoice per patient. Please include all the necessary information above for each patient. Invoices for multiple patients can also be submitted and claimed for using the fax fee process. For further information, please contact us on 1300 362 128.
If you have faxed information to us, please note that you do not need to send in the original paperwork as well. Duplicate paperwork can slow our processes down. If you have any queries about the information you’ve sent, please call us first on 1300 362 128.
Please note: health providers need to be aware that certain services will attract GST. The table of costs has a list of special item numbers that allow for services where GST may need to be charged.
What does WorkCover do after receiving the invoice from the health provider?
The claim and invoice are checked to see if:
- the claim has been accepted
- the account relates to the compensable injury
- there is a medical certificate for the period.
If the service (e.g. doctor’s consultation) does not require prior approval by WorkCover the account will be immediately approved for payment.
What can a health provider do if they have not received payment?
If a health provider has not received payment on an accepted claim, please phone WorkCover Queensland on 1300 362 128 to check on the progress of your payment before sending a duplicate account.
Why do health providers need prior approval for some services?
For accepted claims, WorkCover Queensland has a liability to pay reasonable costs to rehabilitate the worker. In some instances prior approval for service provision is required in order to determine:
- whether the requested allied health service is reasonable
- whether the worker's treating doctor medically approves the allied health service
The table of costs provides information on which services will need WorkCover's prior approval.
Example: A physiotherapist is able to provide seven initial physiotherapy sessions without WorkCover's prior approval if referred by a medical practitioner. However, if the physiotherapist wants to provide 6 more sessions they will need to get WorkCover's approval for payment.
If a health provider does not obtain prior approval where necessary we may not be responsible for paying the account. To get our prior approval for allied health services, providers will need to complete a provider management plan.
