(Updated to inc. Novavax) Summary of Covid-Related Claims (24 Mar 22)

Summary of Covid-Related Claims & Processes

24/03/2022

To support recent updates around claiming for Covid-related activity in general practice recently, please see the below summary of the various claiming types and processes for these. Halcyon claims should be made as activity occurs, payments are made on a monthly cycle.

Swab-based Activity Claims Claim Type PCR Testing

Amount (inc. GST) $69 $69 $138 $138

Virtual Consultation Simple Assessment (No Swab) Simple Assessments (+ Swab) Surveillance Assessment (Asymptomatic) + Swab Car or Room Assessment (HIS Criteria) + Swab Full Assessment (HIS Criteria) + Swab

$138 $287.50

Eligibility

For MOH Testing Guidance click here For PHO Halcyon Scenarios & Flowchart click here.

Claim Via

Halcyon For “Covid Swab Type” select “PCR”

Rapid Antigen Testing (RAT) Simple Assessment + RAT Swab*

$138

For MOH RAT Guidance click here. *Supervised OR Unsupervised

Amount (inc. GST)

Eligibility

Halcyon For “Covid Swab Type” select “RAT”

Vaccination Support Claims Claim Type ‘Quick Call’ by Nurse (For Vaccine Hesitant Pts & to Encouraging uptake of eligible vaccination doses & boosters)

$23

Pre-Vaccination Consultation (Pfizer) (All consults prior to Pfizer 1st, 2nd primary dose + booster vaccine - to encourage uptake & discuss patient concerns)

Māori, Pasifika, CSC Holder (or ‘Other’ as per clinical discretion)

Claim as: ‘Pre-Vaccination Consult’ - ‘Nurse’ ‘Quick Call/Virtual’

Māori, Pasifika, CSC Holder (or ‘Other’ as per clinical discretion)

Claim as: ‘Pre-Vaccination Consult’ & Select appropriate Vaccine Dose Number & Type

Halcyon

$69

Simple Consult + Prescription: $69

3rd Primary Dose (Immunocompromised)

Complex Consult + Prescription: $138

Age 12+ severely immunocompromised patients.

(inc. Virtual/In-person consult + Prescription, Consult, no prescription/patient declined)

Patient Declines Vaccine or Deemed Not Eligible: $69

For clinical guidance document click here.

AstraZeneca Consultation All consults prior to AstraZeneca 1st, 2nd primary dose + booster.

Prescription sometimes required - see clinical guide.

All Patients

$69

AstraZeneca Clinical Guidance Document here.

Prescription required only for ‘off label’ use as per clinical guidelines.

All Patients

Novavax Consultation All consults prior to Novavax 1st, 2nd primary dose vaccine.

Prescription sometimes required - see clinical guide.

Claim Via Halcyon

Novavax Clinical Guidance Document here.

$69

Prescription required only for ‘off label’ use as per clinical guidelines.

Novavax is not approved as a booster.

Halcyon

Claim as: ‘Pre-Vaccination Consult’ “3rd Dose” – Simple/Complex Consult + Outcome (e.g. Prescription Given)

Halcyon Claim as: ‘Pre-Vaccination Consult’ Select appropriate Vaccine Dose Number & Type

Halcyon Claim as: ‘Pre-Vaccination Consult’ Select appropriate Vaccine Dose Number & Type

Summary of Covid-Related Claims & Processes

Halcyon

Post–Vaccine Consult: Adverse Event (inc. Virtual/in person limited assessment + in-person full assessment)

Virtual/In Person Limited Assessment: $69 In-Person Full Assessment: $138

Temporary Vaccine Exemption Consult (inc. Standard (no exam) and Complex (with exam)

24/03/2022

Standard (no Pt exam): $69 Complex (Full Pt exam): $138

All patients Claim must be within 14 days of Vaccination Event

Specified exemption criteria.

For Clinical Guidance (including application form) click here.

Claim as: ‘Post-Vaccine (Adverse Event)’ – Limited/Full Assessment.

You can add ‘Additional Costs (such as ECG) in the form.

Halcyon Claim as: ‘Vaccine Exemption’ + Patient Examination/ No Examination’

Community Management Claims Claim Type Chart Review & Contact Initial Assessment (Standard) Initial Assessment (High Needs/ Unenrolled patient) Clinical Escalation to GP/NP as determined at regular review.

Regular Review (Standard)

Amount (inc. GST) Standard

Afterhours

Weekend

$39.10

N/A

$64.52

$215.63

$355.79

$355.79

Eligibility

Claim Via

As per MOH Guidelines As per MOH Guidelines

Halcyon

As per MOH Guidelines $280.31

$462.52

$462.52

$143.75

$237.19

$237.19

$39.10

N/A

$64.52

Clinical Assessment (post transfer of care out of hospital to primary care) Clinical Discharge (Standard) Clinical Discharge (High Needs) Follow-Up Check In-Home Care (per hour) In-Home Care - Mileage (rate per km) In-Person Care in GP Clinic

Halcyon Halcyon

When clinically indicated includes transfer of care to hospital level services.

Fee is additional to regular review rate.

Select “Assessment Type” first, then tick box for “Clinical Escalation”

As per MOH Guidelines

Halcyon

As per MOH Guidelines Regular Review (High Needs)

Halcyon

Halcyon Please ensure correct “Assessment Type” selected: “Regular Review – High Needs”

$50.83

N/A

$83.87

$143.75

N/A

$237.19

$95.83

N/A

N/A

$124.58

N/A

N/A

$71.88

N/A

N/A

As per MOH Guidelines

Halcyon

$287.50

$474.38

$474.38

Where clinically required.

Halcyon

$0.71

$0.71

$0.71

As per MOH Guidelines

Halcyon

$287.50

N/A

$474.38

Full assessment where clinically required.

Halcyon

Halcyon

As per MOH Guidelines

As per MOH Guidelines As per MOH Guidelines

Halcyon Halcyon Halcyon

Other Covid-Related Claims Management of Household Close Contacts *DHB Arrangement*

$39.10

N/A

N/A

Rate per household, regardless of number of close household contacts.

Quick Call/ Call - No Response *DHB Arrangement*

$39.10

N/A

N/A

Max 2 per patient.

1 per day.

Claim as: “Household Monitoring”

Halcyon Claim as: “Non-Contact Quick Call”