As of 1/1/2024, a practitioner must have active accreditation for successful claiming.

What does this mean for the association?

You may receive an increase in association member contacts regarding claim issues for eligible GMHBA and Frank Health Insurance members.

What does this mean for the provider?

Your members will need to ensure that their accreditation with ARHG for subscribed services are maintained; lapses can be the result of expired insurance or first aid and will result in a disrupted claiming experience for clients.

What does this mean for the client?

Electronic Ancillary Claims will fail at point of sale if the accreditation for a subscribed service is not active, resulting in an upfront cost.  There may be times where a client is no longer eligible for health fund benefits if the provider is not accredited for a subscribed service.

What happens next?

We will continue to work through the HICAPS and HealthPoint provider numbers to resolve accreditation errors prior to 1/1/2024.  Please communicate these changes with your members at your earliest convenience.

GMHBA Ltd appreciates that this change may impact many Association members, to reduce calls to our contact centre we request that provider’s review our website Provider Ancilliary Information (gmhba.com.au) and only utilise e-mail contact to registration@gmhba.com.au for any escalations.

Dear alternative therapy providers,

Defence Health has experienced a number of issues with electronic claiming, following the transition to a new operating platform in late July.

 While the performance of electronic claiming has continued to improve, there are several issues that will take longer to resolve.

 If you are experiencing ongoing issues, please contact our Provider Relations team at providerrelations@defencehealth.com.au

 Defence Health would like to thank you for your patience and look forward to continuing to work together.  

HCF has an issue processing claims via HICAPS, this has been occurring since 11:00am today 23 August

This issue is currently being investigated by their IT Teams who are working to have this issue resolved as soon as possible

There has been a change to provider number management for Alternative Therapy providers with GMHBA Ltd.

Previously, where a practitioner was not utilising electronic claiming the fund required additional provider records for each location listed as current with ARHG.  As of 1/08/2023 this process will no longer be required.  GMHBA and Frank Health Insurance will process all manual claims under the health fund provider number issued by the Australian Regional Health Group (ARHG), there are no changes to provider numbers utilised for electronic claiming channels.

GMHBA Ltd is subscribed to the below modalities:

• Acupuncture
• Counselling
• Traditional Chinese Medicine
• Myotherapy
• Remedial Therapy

Further to the above, some association members may receive notification from the fund to advise that their provider numbers will be derecognised by the fund.  Our expectation is that these providers are currently accredited for Massage Therapy or their ARHG accreditation has lapsed/been terminated.  

In Summary, as of 1/01/2024

• All fund generated provider numbers will cease to be utilised for claiming; ARHG Health Fund provider numbers will be required.
• All electronic claiming provider numbers will require active accreditation with ARHG to maintain electronic claiming.
  
  • Association members should review the accreditation details currently provided to HICAPS and HealthPoint to ensure that these are valid and align with the Association Member Numbers listed in the below table:

    

All claims submitted to the fund by the client/member or Electronically through HICAPS or HealthPoint will require the below information on the invoice:
 

• ARHG Health Fund provider number for the modality of the service being delivered.
• ABN
• Clinic location where the service was provided.
• Member name
• Date of Service

HCF will be enabling HICAPS claiming for Chinese Herbal Medicine (CHM) consultations from 1 July 2023.

Acupuncture providers who are already recognised by HCF and use HICAPS for Acupuncture (ACU) – but are also approved for CHM – will be able to claim for consultations (HCF does not cover any herbs or herbal medicine).

When seeing a HCF member, providers who are recognised for ACU + CHM will only be able to make a claim for 1 service per day (either ACU or CHM not both). Our HCF Terms and Conditions for Recognised Providers of Extras Services has been attached for reference.

Terms_and_Conditions_for_Recognised_Providers_of_Extras_Services_July2022.pdf

For point of service claiming, HCF only accepts natural therapy claims via HICAPS, we are working on expanding to include HealthPoint in the future.

Over recent years, ATMS has enhanced the ATMS Member Portal at atms.com.au in relation to the accessibility of provider numbers. Once ATMS receives the list back, the provider numbers will be uploaded to your member portal

All members are now able to access BUPA/ AHM / ARGH / MEDIBANK PROVIDER NUMBERS, via the member portal. Only medibank letters will be emailed for hicaps. 

To access the ATMS Member Portal, your username is your email address that is registered with ATMS. The website contains a feature to allow you to reset your password via an enabling link to that email address.

ATMS, along with all other provider associations, has been advised that Medibank and AHM will no longer accept handwritten accounts from 1 April 2021. From 1 April 2021 full or partial handwritten invoices or receipts will not be accepted by Medibank. If providers do not comply with this notice by 1 April 2021, their status as a recognised provider of Medibank and AHM may be reviewed and they may be suspended or cancelled.

Members have until 1 April 2021 to move to electronically issued invoices, through email or print. Invoices must meet Medibank requirements for Ancillary Billing Standards. These details are on our website here: www.atms.com.au/health-funds/health-fund-terms-conditions

Bupa has updated its Ancillary Provider Terms, and these will come into effect from 1 February 2021. These Terms will apply to all ATMS members who are recognised and lodge treatment claims with Bupa. These details are on our website here: www.atms.com.au/health-funds/health-fund-terms-conditions

All health funds requirements:
 

• Working with children – Please send your working with children check to ATMS, as health funds now require this information.
• Clinic telephone numbers – Please update your clinic telephone number/s with ATMS. Claims will be rejected if no telephone number is available at your active clinic location/s. This is one of the requirements to be a health fund provider.
• Professional Indemnity Insurance – All health funds require a minimum $5 million Professional Indemnity Insurance & $10 million for Public Liabilities Insurance for all Acupuncture & Chinese Herbal Medicine practitioners. Australian Unity, ARHG, BUPA & HCF require all providers to have a minimum of $2 million Professional Indemnity Insurance and $10 million for Public Liabilities.
• Insurance and/or First Aid renewals – send to ATMS at least 2 weeks before expiry. Some health funds now have automatic cut off after the expiry date.
• Always update ATMS (info@atms.com.au)  with changes to your contact details including email address and mobile number, postal and/or clinic locations.
• Patient Clinic Records: You must write and keep a clinical record of each treatment provided. Each record must be accurate, legible, and easily readable by a third party and written in English.

All health funds requirements:
 

• Working with children – Please send your working with children check to ATMS, as health funds now require this information.
• Clinic telephone numbers – Please update your clinic telephone number/s with ATMS. Claims will be rejected if no telephone number is available at your active clinic location/s. This is one of the requirements to be a health fund provider.
• Professional Indemnity Insurance – All health funds require a minimum $5 million Professional Indemnity Insurance & $10 million for Public Liabilities Insurance for all Acupuncture & Chinese Herbal Medicine practitioners. Australian Unity, ARHG, BUPA & HCF require all providers to have a minimum of $2 million Professional Indemnity Insurance and $10 million for Public Liabilities.
• Insurance and/or First Aid renewals – send to ATMS at least 2 weeks before expiry. Some health funds now have automatic cut off after the expiry date.
• Always update ATMS (info@atms.com.au)  with changes to your contact details including email address and mobile number, postal and/or clinic locations.
• Patient Clinic Records: You must write and keep a clinical record of each treatment provided. Each record must be accurate, legible, and easily readable by a third party and written in English.

• Require electronically issued or printed receipts/invoices for eligible Approved Providers in order to offer a rebate to their clients
• All Therapists  – Invoices/receipts must be electronically issued or printed (no handwritten or stamped receipts to be issued to clients)

ATMS published a Health Insurance Update for members on 29 January 2019. That update provided the most recent information for the major health funds on plans to introduce the health insurance rules that become law on 1 April 2019

The current Coalition Government, at the time of writing, continues to confirm that it will change the Rules for natural medicine treatments in private health insurance. ATMS will continue to champion natural medicine and advocate that this bad decision be changed.

Health funds are compelled by these Government reforms to now redesign all policies and benefit schedules, to be ready on 1 April 2019. The health funds acknowledge this is an enormous challenge.

For ATMS members we celebrate those treatments that will continue to be covered and attract potential rebates: Acupuncture; Ayurveda; Chinese herbal medicine; Chiropractic; Remedial Massage; Nutrition and Osteopathy.
 
Each Health Fund will make its own decisions about provider eligibility and treatment rebates. ATMS will continue to work with the funds to manage eligibility, provider registration and maintain accurate lists into 2019 and beyond.
 
For other ATMS members we acknowledge with deep regret that these treatments have been listed by the current Government as no longer to be covered by health insurance from 1 April 2019: Alexander technique; Aromatherapy; Bowen therapy; Buteyko; Feldenkrais; Western Herbalism; Homeopathy; Iridology; Kinesiology; Naturopathy; Pilates; Reflexology; Rolfing; Shiatsu; Tai chi; Yoga

It is with deep regret that despite an active and passionate lobby from natural medicine practitioners, the current government continues to confirm that the Business Rules for health funds will restrict a list of natural therapies from 1 April 2019. From this date onwards, health funds will not be allowed to offer treatment and rebate coverage for the listed therapies.

At the time of writing the listed therapies are:
Alexander technique; aromatherapy; Bowen therapy; Buteyko; Feldenkrais; Western herbalism; homeopathy; iridology; kinesiology; naturopathy; Pilates; reflexology; Rolfing; shiatsu; tai chi; yoga.

It is now inevitable that individual health funds will begin to implement these changes. ATMS will keep members advised as we are told what these changes will be.

The first health fund to make changes is HBF who have advised ATMS they will implement these changes from 1 January 2019, before the government commencement date of 1 April 2019.

Important Health Fund reminders

• BUPA requires $2 million in professional indemnity insurance cover, effective 1 July 2017
• BUPA has a maximum 4 clinics for all modalities
• Medibank has a maximum 3 clinics for Remedial Massage members only
• No online/Skype/email/phone consultations for rebates for all health funds
• Patient clinic Records: you must write and keep a clinical record of each treatment provided. Each record must be accurate, legible and easily readable by a third party and written in English.

It is a requirement of AHPRA and the Chinese Medicine Board that all (TCM) Traditional Chinese Medicine practitioners hold a minimum of $5 million professional indemnity cover for any single claim.

Please revise your insurance policy to $5million for individual professional indemnity claims as soon as possible and forward a copy of your revised insurance policy to info@atms.com.au as soon as possible.

Read More 

The following are valuable reminders of key elements for health insurance provider numbers.

Full details of health fund conditions are available for members here.

• Gift vouchers or Gift cards are not entitled to health fund rebates;
• BUPA requires $2 million in professional indemnity insurance cover, effective 1 July 2017;
• BUPA has a maximum 4 clinics for all modalities;
• Medibank has a maximum 3 clinics for Remedial Massage members only;
• ARHG, AHM and Medibank do not recognise mobile treatments, only treatments within a clinic environment is acceptable (professional, clinically appropriate facilities);
• No online/Skype/email/phone consultations for rebates for all health funds;
• Always update ATMS with changes to your contact details including email address and mobile number, postal and/or clinic locations;
• Do not allow your Provider Number(s) to be used by any other person;
• Patient clinic Records: You must write and keep a clinical record of each treatment provided. Each record must be accurate, legible and easily readable by a third party and written in English. 

Medibank has asked ATMS to clarify for all members the view of Medibank as to whether a gift card or voucher can be used to claim a benefit from Medibank or ahm. Medibank/ahm does not pay benefits for services when the services are fully covered by a third party. Medibank advises that this applies to gift cards and vouchers. Members requiring further information in relation to Medibank rules and policies should refer to the Medibank Member Guide available here. Medibank’s Fund Rules and policies are summarised in the Member Guide. The Member Guide details when benefits are not payable (in this instance refer to p27 of the Guide).

Mobile Therapy does not meet ARHG criteria or Private Health Insurance Legislation regarding Practice Quality.  This also includes any Massage or Remedial treatment provided within a corporate environment. GMHBA, including Frank Health & Budget Direct will no longer be paying benefits on Massage Therapy (Cert IV Qualification).  They will only be accepting a minimum qualification for Remedial Therapists (Diploma of Remedial Therapy).

• Need to be rubber stamped, a pre-printed receipt book, letterhead or computer generated.
• Do not allow your Provider Number(s) to be used by any other person
• Date of the service and name of the patient who received the treatment
• Address where the service was provided and the contact telephone number

The Australian Health Practitioner Regulation Agency (AHPRA) registration for Acupuncturists, Chinese Herbal Medicine Practitioners, Chiropractors and Osteopaths expires 30 November 2017. If you have not already renewed your AHPRA registration, please renew as soon as possible to avoid removal of health fund provider status and possible late fees.

ATMS requests members to provide a copy of your renewed AHPRA registration to ensure that you remain ATMS accredited for these modalities.

Please email a copy of your registration to info@atms.com.au 

For registration renewal applications received during December, AHPRA may require the annual registration fee plus a late fee. If you have not renewed your registration by 1 January 2018, please note that you will be removed from the AHPRA register and these modalities will be removed from your list of ATMS accredited modalities. If these modalities are your only ATMS accredited modalities, your membership will be downgraded from Accredited to Associate Membership, until you can demonstrate current Practising registration with AHPRA. Your ATMS membership will also be downgraded to Associate if you renew AHPRA registration in the Non-Practising category.

For further information, please contact AHPRA on 1300 419 495 or visit their website www.ahpra.gov.au

ATMS is audited by a number of health funds annually to ensure provider compliance, but to also ensure the Associations’ compliance to the individual health fund contracts.

A small number of members randomly selected by these health funds have unfortunately, either not completed any CPE or have undertaken insufficient activities to meet the required 20 ATMS CPE points for 2016/2017. 

These members have also renewed their ATMS membership declaring completion of the required ATMS CPE points for 2016/2017. Members, who fail a health fund audit, not only risk their own provider status being removed, but also that of every other provider with ATMS.

We therefore ask all members to:

1. Read and understand the ATMS CPE Policy and the CPE FAQ documents (both available on the ATMS website).
    
2. Start planning your CPE activities for 2017/2018 now, if you have not already done so.
    
3. Ensure that the activities you have chosen to do relate to natural medicine, and more specifically for any, and all, modalities in which you have health fund recognition.
    
4. Aim for more than 20 ATMS CPE points. It’s better to have more, than not enough.
    
5. Ensure that you fill out the ATMS CPE Record and that you keep sufficient substantiating documentation. Points will not be awarded where the supporting evidence is not sufficient.
    
6. All CPE Evidence must be in your name. Points will not be awarded where the supporting evidence is in someone else’s name.
    
7. Ensure that you keep this evidence secure and easily accessible. Some health funds require members to submit their CPE within 24 hours of being audited and will not provide extensions or exemptions for members on holidays, overseas or facing personal hardship.
    

Contact the ATMS Office on 1800 456 855 or by email at info@atms.com.auif you have any questions regarding the ATMS CPE Policy.

TCM Members who completed their studies in a non-English language, please note the IELTS Overall Band 7 requirement to qualify for BUPA recognition.

The ATMS Health Fund Report will advise Accredited Members of specific changes relating to individual health funds Read More

The essential general requirement to be recognised by a health fund is to maintain professional standing as an ATMS Accredited Member Read More

It is worth recapping that ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance (Accreditation) Rules 2011 Read More