About the practice nurse subsidy
The practice nurse subsidy is to support the costs of hiring a practice nurse. Claims can be made for up to 40 hours per week. The nurse must be performing medical duties to be eligible for the subsidy.
Paying for practice nurse statutory holidays
The practice nurse subsidy is only available to cover the hours where actual practice nurse duties are performed. You can not claim the subsidy for holiday pay (statutory holidays or annual leave) sick leave, study leave etc. Only worked hours can be claimed.
Eligibility to claim for the practice nurse subsidy
Only general practices that claim for payments under the Section 88 Notice may claim for the practice nurse subsidy. General practices that receive funding via their primary health organisation (PHO) receive funding for the practice nurse subsidy as part of the base capitation funding.
The PHO Services Agreement doesn’t allow claims to be made under a Section 88 Notice for general practices receiving capitation funding. Part B, clause B.17(1), states: “a Contracted Provider who is entitled to receive a payment for services under this Agreement and a Section 88 Notice must Claim under this Agreement and may not make a claim under the Section 88 Notice.”
Resolving claim payment issues
If you have not been paid for an entire practice nurse subsidy claim, call the Sector Operations Contact Centre. Find out if the claim has been received or whether payment has stopped due to an error with the claim or a processing problem.
0800 855 066 – Option 2
If the claim has not been received it will need to be resubmitted to Sector Operations via the usual routes. If the claim is over 6 months old it will need special approval from Te Whatu Ora before Sector Operations can process it.
Paying PN claims into the right accounts
It's possible to separate PN claims being paid into your doctor's personal account along with their GMS and IMMS. You will need to set up a payee number with Sector Operations for your practice. This number can be used for practice nurse claims and rural ranking payments – it cannot be used for GMS or IMMS.
Error messages on the variance report
Error 0513 – Invalid Medical Council number
The Medical Council number (NZMC) given has expired or is not in the Sector Operations database. Check your records and call the Sector Operations Contact Centre with the correct details so that adjustments can be made.
If the NZMC is correct then Sector Operations will need to check that the doctor’s APC is still valid and covers the dates of service of the claim.
Error 0517 – Claim is stale
The dates of service on the claim are more than 6 months old and will require special approval from Te Whatu Ora before we can release payment.
Error 0520 – Invalid service for contract
The contract number given has expired or is not in Sector Operations' database.
Check your records and call the Sector Operations Contact Centre with the correct details so that adjustments can be made. If the Contract number is correct then Sector Operations will need to check that the Doctor’s APC is still valid and covers the dates of service of the claim.
Error 0542 – Practitioner hours exceeded
This means the hours claimed for the doctor have exceeded 27 hours per week – this is the maximum number of hours that a doctor can claim per week. Check the dates of service have not been covered in a previous claim, if you cannot locate any overlap the Sector Operations Contact Centre will be able to assist you.
Error 0543 – Practice-nurse hours exceeded
This means the hours claimed for the nurse have exceeded 40 hours per week – this is the maximum number of nurse hours that can be claimed per week. Check the dates of service have not been covered in a previous claim, if you cannot locate any overlap the Sector Operations Contact Centre will be able to assist you.
Information on submitting claims
Back dating practice nurse approval
Sector Operations will approve a nurse or doctor’s hours from the date we receive the application. We are unable to back date this with out special approval from your DHB.
If your doctor claims some of your doctor’s practice nurse subsidy at another clinic
Sector Operations works on a first in, first served basis. If the other clinic has made a legitimate claim (that is, they are not claiming more hours than they should) before to the usual clinic’s claim, then Sector Operations are obliged pay that claim. Claimants are advised to seek reimbursement from the other clinic.
Grouping nurse claims together as a practice claim
Sector Operations is in the process of moving as many clinics as possible away from claiming the practice nurse subsidy as a clinic. Certain large A&E clinics have been given permission to continue claiming like this due to the transitory nature of their medical staff, if you believe your clinic should be able to claim in this way you can apply in writing to Te Whatu Ora.
Signing the claim if the nurse is away
If the nurse off work, for example sick or on leave, cannot sign the Practice Nurse Claim themselves then the practice manager or Doctor can pp sign it for them.
This should only be done in exceptional circumstances.
How to claim for a locum
As for all locum claims, use the NZMC and payee number of the host doctor. The locum will be working under the Section 51 of the host and will use their eligibility.
Include a job description with the application for a new nurse
The practice nurse subsidy is provided to help pay for actual nurse work. Sector Operations requires a job description to ensure the nurse is not being hired for reception duties or anything else that is not performing the duties of a practice nurse.
How to submit your claims
Download, complete and send your claim forms to:
Practice Nurse Subsidy
PO Box 1043, Wellington
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