How to submit an elective surgery request for prior approval
In most cases, you will need to get prior approval from us before we can fund an elective surgery procedure for your patient. Find out when you’ll need prior approval and how to get it.
On this page
When you need prior approval
Written approval is required from us before any elective surgery is performed unless is it a procedure listed in the Non-Prior Approval (NPA) Procedures List found in Appendix 4 of the Elective Surgery Services Operational Guidelines.
Surgeries requiring prior approval cannot be retrospectively funded.
Below is more detailed information regarding the different types of elective surgery procedures we cover.
Elective Surgery Services - operational guidelines
Elective Surgery Services - service schedule
Submitting a request for prior approval
To request approval of surgical treatment, you will need to complete the Surgical Assessment Report and Treatment Plan (ARTP) form.
The Surgical ARTP online form is the only version of the ARTP that will be accepted. We have recently updated this form to make it clearer and easier to use. The new form includes minor layout changes, mandatory fields, drop-down fields, clarification of the medical insurance statement and revisions to the clinical and proposed management/prognosis sections.
Below is the most recent version for you to download.
ARTP template
Send the completed ARTP to the Treatment and Support Team or via HealthLink mailbox: ACCEARTP
Email ARTPS4ESU@acc.co.nz
Include the clinical priority and procedure code in the subject line when you send your ARTP request. This helps our system correctly sort your submission.
Subject line example: [H1/H2/H3/H4/Routine] – [Procedure Code] - [Patients Name] – [Claim number / ACC45]
Important requirements
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Named providers (treating specialists) are required to submit an ARTP via the supplier (for example, hospital) for all surgery requests.
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The ARTP should be submitted within seven working days of assessing the patient.
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The supplier is responsible for ensuring the ARTP meets our requirements for submission before submitting the ARTP to us.
What information needs to be included in an ARTP?
The ARTP should provide us with the information needed to make a decision on the surgery request. All mandatory fields (*) must be completed. If any information is missing or is unclear, we may have to request further information which can lead to delays for your patient.
View information on ARTP requirements.
What is the process once an ARTP has been submitted?
Our Treatment and Support Team will assess the surgery request and determine whether additional information and/or medical advice is required. Once a decision has been made, we will advise the supplier and the client.
Please note that some procedures may have additional requirements during the assessment process.
If the proposed surgical procedures are approved by us, the supplier is responsible for arranging the earliest possible mutually appropriate date for treatment with the client.
Invoicing for Elective Surgery Services
Invoices should be submitted to our Treatment and Support Team. All invoices must be submitted to us within 12 months of the treatment provided or they will not be paid.
You can submit invoices online and keep track of them using ProviderHub, eBusiness Gateway, or your practice management system (PMS). Our online systems are easy to use and you’ll get paid faster than doing it manually.
Working with us using our digital services
What to include
One schedule per client is submitted for all surgeries. Make sure you include on the invoice the:
- purchase order number in the comments field of the e-schedule.
- admission and discharge dates in the comments field of e-schedule.
You’ll also need to send us supporting documentation, such as operation notes, discharge summaries, supply cost and implant invoices, when invoicing for elective surgery services.
You can send supporting documentation to:
Email disop@acc.co.nz
More information on how to invoice us
Manual invoices
If you cannot submit your invoices through one of the online services, you can send a PDF copy and a rationale for requiring manual billing to:
Email electivesurgeryinvoices@acc.co.nz
FAQ
Please do not submit an ARTP to us if:
- the surgery request is a prerequisite to access medical insurance, and
- you believe there is no causal link between the accident event and the specific clinical diagnosis requiring treatment.
These cases should be discussed directly with the patient’s insurer.
If the surgery is one listed in Appendix 4 of the Elective Surgery Operational Guidelines as not requiring prior approval, and it meets the criteria, then it does not require an ARTP.
Further support
Our provider education webinars are for health providers looking for an informal way to keep up to date and learn more about working with us. These cover a range of topics across three formats: Beginner’s guides, how-to guides, and special interest topics.
Consideration factors have been jointly developed between our Clinical Services team and respective medical groups/associations (for example, NZOA) to outline factors we consider when making decisions on cover and entitlement requests.
View them in our Resources hub:
Contact us
For general queries, contact our Provider Helpline team:
Phone 0800 222 070 (Monday to Friday 8am to 6pm)
Email providerhelp@acc.co.nz
For non-prior approval cover queries and/or unusual queries that require attention/urgent escalation:
For post-operative queries relating to invoicing:
For queries and/or requests pertaining to elective surgery retrospective reimbursement: