Vaccines on the NZ Pharmaceutical Schedule
An immunisation claim cannot be submitted to Sector Operations for a vaccine that is not listed on the New Zealand Pharmaceutical Schedule.
Including NHI numbers in claims
An immunisation claim file must contain at least 85% of valid NHI numbers. Therefore, 15% of the claims do not have to contain NHI numbers provided that they contain both Date of Birth and Surname. However we recommend that you make every effort to obtain a patient’s NHI number and include this in your claim.
Claiming for more than 1 vaccine in a visit
You cannot claim a separate fee for each vaccine.
Only 1 fee will be paid per IMOA (standard administration) — that is, for 1 or more vaccines given on the same visit.
Only 1 IMOA will be paid when influenza vaccine is given with another vaccine at the same visit on the same day. The exception for this is when influenza vaccine is coadministered with zoster vaccine.
See the table below to work out which services to claim based on the vaccinations provided in a single visit.
|Vaccination scenario||Claim code combination|
Submitting an Immunisation Claim and a GMS claim for the same patient and date
Both an Immunisation Claim and a General Medical Service Claim (GMS) may be claimed but only if a full consultation was undertaken with the patient. If the only service provided was an immunisation, then a General Medical Service claim should not be submitted to Sector Operations.
A standard immunisation vaccine and a pre/post splenectomy vaccine on the same day
If a patient receives a standard immunisation vaccine and a pre/post splenectomy vaccine on the same day you are entitled to an extra fee.
An IMOA (standard administration) and IMMB with indication 11 (pre/post splenectomy) should be claimed so that you receive an extra fee.
How to submit a claim if a locum doctor has provided the service
The Payee Number, Agreement Number, Registration Number and name of the host doctor must be provided in addition to the Registration Number and name of the locum.
How to submit a claim if a Nurse Vaccinator provides the service
You can still submit claims. The applicable Payee Number and Contract Number should be provided with the Nursing Council Number of the Nurse Vaccinator. The Payee Number and Contract Number will often be those of the doctor but may be for the nurse if the nurse holds their own agreement.
If your claim rejects and you believe that the correct information was supplied, please contact your PMS vendor for assistance.
Claiming for children who are re-immunised after chemotherapy
General practices are able to submit an immunisation claim for services delivered when children are re-immunised following chemotherapy treatment. The completed Immunisation Benefit Claim Details Form and Immunisation Benefit Claim Summary Form may be submitted to Sector Operations who will seek approval for payment from the DHB.
The indication value that best meets the definition for re-immunisation is 6 - booster.
An Immunisation claim cannot be submitted to Sector Operations for a vaccine that is not listed on the New Zealand Pharmaceutical Schedule.