Claims, Claims Queries & Medical Certificate Testing Scenarios

Requirements for ACC claim submissions

Six claim submission scenarios

  1. Submission of a claim (Apple)
  2. Submission of a claim (Banana)
    • a - that fails and returns an error message
    • b - resubmission of scenario 2a but with correction
  3. Submission of a claim for a self-employed client with a referral to a physiotherapist(Chocolate)
  4. 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)
  5. 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)
  6. Submission of a claim that fails and returns an error message (and remains on PMS records for queries) (Lemon)

Four claim printing scenarios

  1. Print a copy of claim submission scenario 5 (Orange) for a client
  2. Print a copy of claim submission scenario 5 (Orange) for a clinician for their records (and as a potential manual submission)
  3. 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
  4. 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

  1. Submission of a medical certificate adding a diagnosis code to an existing claim (Adam)
  2. Submission of a medical certificate adding a diagnosis code to an existing claim and making this the primary diagnosis (Bob)
  3. Submission of a medical certificate modifying a diagnosis code on an existing claim (Charlie)
  4. Submission of a medical certificate advising that the client is fully unfit to work for 1 week (David) 
  5. Submission of a medical certificate advising that the client is partially unfit to work for 1 week with certain conditions (Eddie)
  6. 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

  1. Print a copy of medical certificate submission from scenario 5 (Eddie) for a client
  2. Print a copy of medical certificate submission from scenario 5 (Eddie) for a clinician for their records (and as a potential manual submission)
  3. 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

  1. Submission of a change diagnosis request modifying a diagnosis code on an existing claim (George)
  2. Submission of a change diagnosis request adding a diagnosis code on an existing claim (Harry)