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About laboratory payments

When a patient is referred to a laboratory, it carries out the tests required and provides the referring practitioner with the results. The results are then passed on to the patient.

To receive payment for the test, the laboratory submits a claim file and / or invoice to Sector Operations to be processed on behalf of Te Whatu Ora.

Schedule Test Purchase List

A Schedule Test Purchase List is included in your contract with Te Whatu Ora and includes the following information.

Test Code

An identification code for each individual pathology test. Format is either 1 alpha, 2 numeric eg, S01 or 2 alpha, 1 numeric, for example BA1.

Test Description

The full written description for each individual pathology test.

Price Per Test

The price (GST exclusive) that the funding district health board will pay the laboratory to carry out one completed testing procedure for a specified test.

Maximum Number

The maximum number of a specified pathology test that the funding district health board will pay the laboratory to carry out for any individual patients on any individual sample.

Approved Practitioner Type

This specifies which type of practitioner can refer a patient for each individual test. Referring practitioners can either be medical practitioners, oral surgeons, cervical smear takers, midwives or nurses.

How much you can claim

Each laboratory will receive a different amount for each of the tests that they are eligible to claim for. This is because there is no national laboratory contract.

The amount that the laboratory will receive per test is contained within the Schedule Test Purchase List.

How to make a claim

How you claim depends on the funding arrangement that is in place between the laboratory and Te Whatu Ora.

There are two funding arrangements:

  • Fee For Service (FFS)
  • Bulk Funding.

Fee For Service

This arrangement means that you are paid for each individual test as long as each test meets the claiming criteria.

Any test that does not meet the criteria will be rejected.

Send your claim file and an accompanying Claim Summary Form to Sector Operations.

Bulk Funding

This arrangement means that you receive a set Service Fee on a monthly basis instead of being paid on a test by test basis.

Send an invoice to Sector Operations Dunedin each month. In addition, send a claim file and accompanying Claim Summary Form to Sector Operations Wellington so that the claim data can be included in the national data collection.

Where to send your claims

All claim files must be accompanied by a Claim Summary Form and sent to:

Laboratory claims
Sector Operations
PO Box 1026
Wellington 6140

Get a claim form

An electronic copy is available to download.

Alternatively, you can call us on 0800 855 066 or email customerservice@moh.govt.nz. You will need to provide your payee number.

Contact Sector Operations

Call the Sector Operations Contact Centre to find out more:
0800 855 066 – Option 2: Claims

Mon, Tue, Thu, Fri: 8am – 5pm
Wed: 9.30am – 5pm