Getting prior approval for further treatment

You may need to get prior approval from us before we can fund more treatment for your patient. Find out when you’ll need prior approval and how to get it.

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    When you need prior approval

    If your patient has an injury we cover, you need to get prior approval from us.

    For regulation providers

    You need to get prior approval from us when:

    • the treatment trigger number of 16 has, or is about to be reached
    • it’s been more than a year since an allied health provider treated your patient for the first time
    • you're adding or changing a diagnosis.

    For contracted providers

    You need to get prior approval from us when:

    • the treatment trigger number of 50 has, or is about to be reached
    • you're adding or changing a diagnosis.

    Before requesting prior approval

    There needs to be a clear link between your patient’s ongoing condition and the injury we cover.

    When you ask for prior approval, you need to tell us:

    • the claim number
    • the date of the injury
    • details of the injury
    • what treatment you’ve provided so far.

    If your patient is a new referral you can contact us to get this information.

    Contact us

    Submitting a request for prior approval

    We group requests for prior approval as ‘standard’ or ‘non-standard’. Most are ‘standard’ and follow an easy process.

    Criteria for a standard request

    Your request will be a standard request if:

    • for regulated providers, your request is made within 12 months of the date of the injury or most recent surgery
    • it's for an injury we've already covered
    • it's the first request for further treatment from your clinic for the claim
    • it's for hand splinting and costs don’t exceed $300 (excluding GST)
    • it's for the original diagnosis
    • it's for a changed or added diagnosis that’s on the standard Read code list

    You don’t need to include medical evidence for standard requests.

    Standard Read code list

    Submit a standard request

    There are two ways to make a standard request:

    Contact us for an immediate decision
    You’ll need to let your patient know that we’ve approved further treatment.

    Contact us

    Fill in the ACC32 request prior approval form
    Complete the patient treatment and provider details sections of the ACC32 request prior approval form:
    Complete the ACC32 application form online

    Criteria for a non-standard request

    If any of the standard criteria aren’t met you’ll need to complete the full prior approval form.

    A request is non-standard when:

    • for regulation providers, your request has been more than 12 months since the date of your patient’s first treatment
    • for contracted providers, you've exceeded the profile of 50 treatments
    • it’s not the first request for further treatment from your clinic for the claim after the injury or most recent surgery
    • it’s a request for hand splinting that exceeds $300 (excluding GST)
    • it's for changing or adding a diagnosis that isn’t on the standard Read code list.

    Standard Read code list

    Support your request with medical evidence. Attach:

    • patient notes and reports
    • outcome measures
    • patient treatment plan
    • any other relevant medical information.

    We’ll consider each request on a case-by-case basis and tell you if we’ve approved or declined your request.

    Submitting the ACC32 request prior approval form

    You can submit the ACC32 request prior approval form through:

    • the ACC32 online form
    • your HealthLink account
    • email
    • your practice management system.

    Complete the ACC32 application form online

    Email acc32@acc.co.nz

    After you submit a prior approval form

    If you’ve submitted a form, we’ll let you know our decision within three working days.

    There may be a delay if we need a clinical advisor to assess your request, or we need more information. We’ll let you know if this happens.

    When we’ve made our decision we’ll write to you and your patient.

    Contact us

    If you have any questions, contact us:

    Phone 0800 222 070 (Monday to Friday, 7am - 7pm)
    Email providerhelp@acc.co.nz

    Last reviewed: 17 June 2017