Australian Unity Health Recognised Ancillary Provider Terms & Conditions
Australian Unity’s Health Fund Rules defines the below terms as follows:
Ancillary: Means any benefits in respect of dental, medical and other ancillary services, including where a General Treatment item number is referable.
Member: The policy holder or their dependant registered with the fund.
Private Practice: A professional practice (whether sole, partnership or group) that operates on an independent and self-supporting basis. This means that its accommodation, facilities and/or services are not provided or subsidised by another party, such as a Public Hospital or publicly funded facility.
Recognised: In respect of a person, organisation, hospital, facility, treatment or procedure, means a person, organisation, hospital, facility, treatment or procedure which has been recognised or approved by the Company for the purpose only of payment of benefits.
For an ancillary provider to be recognised for the payment of benefits for services to Australian Unity members, the provider Terms and Conditions contained in this document must be adhered to.
Australian Unity reserves the right to refuse any registration or to remove any provider’s current registration if any of the below conditions are not seen to be adequately met. This decision is at the absolute discretion of Australian Unity.
1. Recognition Requirements
All ancillary providers must comply with the registration criteria outlined in the Private Health Insurance (Accreditation) Rules 2011.
In the interests of protecting the safety of Australian Unity’s members and attracting high quality service providers, Australian Unity also requires that all ancillary providers meet the requirements set out in Australian Unity’s ‘Recognised Provider Requirements’ for either Natural Therapy or Allied Health providers, as appropriate. These requirements include, but are not limited to, the following:
1.1 Appropriate full membership with an Australian Unity recognised association or registration with the appropriate AHPRA board/association.
1.1.1 This includes individual providers maintenance of a current first aid certificate, relevant insurance and a minimum of 20 hours Continuing Professional Education hours each year.
1.2 Appropriate accredited professional qualifications facilitated through a registered training organisation
1.3 Providers must be in private practice
Our full recognition requirements for Natural Therapy and Allied Health providers can be found on our website.
2 Receipting and record keeping criteria
Providers must follow the receipting requirements of Australian Unity when processing member receipts. These requirements are;
2.1 A clear and accurate description of the treatment performed.
2.2 Item numbers (where possible)
2.3 A minimum of three identifiers present on the account/receipt to identify the provider. Identifiers must include the provider’s name & practice location and any one of; provider number, phone number, practice name, association number or ABN.
2.4 Receipts should be on formal letterhead or formally stamped.
2.5 Patient records are accurate and appropriately detailed
2.6 The provider must be willing to submit these to Australian Unity upon request
2.7 Patient records are retained for a minimum of two years, or any longer period required where set out in current legislation.
3 Information Requests
When necessary, Australian Unity may make enquiries regarding proof of a provider’s registrations, membership or qualifications with third parties.
Upon written request by Australian Unity, recognised providers must:
3.1 provide Australian Unity with documentation confirming registration, accreditation, association membership, qualifications and compliance with Australian Unity’s recognition requirements;
3.2 Comply with all Australian Unity requests for documentation in a timely manner; and
3.3 Ensure requested information supplied is accurate and without any misrepresentation.
4 Provider conduct
Recognised providers will:
4.1 Not use Australian Unity logos or trademarks or nor imply any association from or endorsement with Australian Unity, without express written authorisation.
4.2 Not provide Australian Unity members any goods sourced directly outside of Australia without first receiving those goods in Australia and inspecting them for safety, quality and all applicable Australian Standards.
4.3 Comply with all laws and regulations applicable to the provider’s services, including, but not limited to, the Competition and Consumer Act 2010, the Privacy Act 1988 and State and Territory fair trading law;
4.4 Comply with any audits Australian Unity conducts in an honest manner, providing all relevant documentation upon request; and
4.5 Not provide treatment for themselves as an individual (or Member) or to a practitioner’s spouse, defacto partner or dependents; or business partner, or the spouse, defacto partner or dependents of the practitioners partner.
5 Deregistration Policy
It will remain the discretion of Australian Unity to deregister a provider at any time without prior notice if found to breach any of these provider terms and conditions, or failure to comply with Australian Unity’s Recognition Requirements for Natural Therapists /Allied Health Providers.
Further information on Australian Unity’s Deregistration Policy can be found on our website.
Australian Unity may suspend a providers HICAPS number while conducting any investigations.