Claims, Claims Queries & Medical Certificate Testing Scenarios
Requirements for ACC claim submissions
Six claim submission scenarios
- Submission of a claim (Apple)
- Submission of a claim (Banana)
- a - that fails and returns an error message
- b - resubmission of scenario 2a but with correction
- Submission of a claim for a self-employed client with a referral to a physiotherapist(Chocolate)
- Submission of a claim for an employed client who is injured and will go to work on restricted duties for 4 days. The client will need to provide a medical certificate to their employer showing these details. ACC to contact the provider to discuss more details about the claim. (Strawberry)
- Submission of a claim for an employed client who is unable to work for 7 days and then will be able to return to work for 3 days on restricted duties. The client will need to provide a medical certificate to their employer showing these details. ACC to contact the provider to discuss more details about the claim (Orange)
- Submission of a claim that fails and returns an error message (and remains on PMS records for queries) (Lemon)
Four claim printing scenarios
- Print a copy of claim submission scenario 5 (Orange) for a client
- Print a copy of claim submission scenario 5 (Orange) for a clinician for their records (and as a potential manual submission)
- Print a copy of claim submission scenario 5 (Orange) for a client's employer which shows all the relevant fit for work information and none of the medical/clinical information
- Print a copy of claim submission scenario 3 (Chocolate) for a referral for to be given to a physiotherapist
Requirements for ACC medical certificate submissions
Six ACC medical certificate submissions scenarios
- Submission of a medical certificate adding a diagnosis code to an existing claim (Adam)
- Submission of a medical certificate adding a diagnosis code to an existing claim and making this the primary diagnosis (Bob)
- Submission of a medical certificate modifying a diagnosis code on an existing claim (Charlie)
- Submission of a medical certificate advising that the client is fully unfit to work for 1 week (David)
- Submission of a medical certificate advising that the client is partially unfit to work for 1 week with certain conditions (Eddie)
- Submission of a medical certificate advising that the client is fully unfit for 1 week and then partially unfit to work for a further week with certain conditions (Frank)
Three ACC medcert printing scenarios
- Print a copy of medical certificate submission from scenario 5 (Eddie) for a client
- Print a copy of medical certificate submission from scenario 5 (Eddie) for a clinician for their records (and as a potential manual submission)
- Print a copy of medical certificate submission from scenario 5 (Eddie) for a client's employer which shows all the relevant fit for work information and none of the medical/clinical information
Requirements for ACC change diagnosis submissions
Two change diagnosis submission scenarios
- Submission of a change diagnosis request modifying a diagnosis code on an existing claim (George)
- Submission of a change diagnosis request adding a diagnosis code on an existing claim (Harry)