Elective Services (ES)
Below is a list of all the Elective Services forms available for submission using the Inbound Documents API.
|
Form / Document |
Description |
| ACC ED1 | Extended Discretion Surgical Reimbursement: Client questionnaire |
| ACC1171 | Request pharmaceutical funding from us for your patient. |
| ACC1172 | Questionnaire + Medical Notes / Reports |
| ACC2531 | Anti-Convulsants for Neuropathic Pain Management |
| ACC2539 | ED Prior Approval Request |
| ACC4246 | Pain Management Request |
| ACC5966 | Request For Extended Discretion For Surgery Funding |
| ACC7421 | Elective Surgery Option Choice Form - part / fully funded / defer for now |
|
ACC855 / ACC1855 |
Burns Outpatient Treatment & Consumables - Prior Approval Request |
| ACC856 | Scar Management Treatment & Consumables Prior Approval Request |
| ACC1856 | Scar Management Treatment & Consumables |
| ARTP | Elective Surgery Request |
| ARTP - Noncore | Elective Surgery Request |
| BOTOX Non-Surgical ARTP / BTA01 Injection Code | Request for Botulinum Toxin Intramuscular Injection |
| Cervical Disc Replacement Approval Protocol | |
| Change of Lead Provider / Change of Surgeon Request | |
| Client Reimbursement | |
| CSARTP (Clinical Services ARTP) | CSARTP from Provider |
| CSARTP from R Pitto | |
| CST9 Request | CST9 ARTP - CLS |
| E-Billing Surgery Invoice (EB) | E-Billing Schedule |
| E-Billing Surgery Invoice with notes (EBMED) | E-Billing Schedule - Med/Operation notes attached |
| Epidural Steroid Record (ESR) | |
| High Tech Imaging | Radiology Reports |
| Letter from GP or Provider | |
| Letters from client | |
| Lumbar Disc Replacement Approval Protocol | |
| Medical Notes / Reports | IB - Medical Reports/ Notes |
| Non-core pricing sheet | |
| Non-core pricing sheet (NC) | |
| Non-Surgical / Follow-up ARTP | Non-Surgical / Follow-up ARTP from Provider |
| Notice of Discharge / Discharge Summary (NOD) | |
| Operation Notes (O) | |
| Operation Notes + Notice of Discharge (ONOD) | |
| PICBA Surgery Invoices (+ Operation notes) | |
| Request for Hyperbaric Oxygen Therapy Treatment (HBOT) | |
| Retrospective Change of Funding Code (Surgery Already Approved) | Retrospective Change of Funding Code |
| Suppliers Invoice (SI) | |
| Suppliers Invoice + Operation Notes (SIO) | |
| Treating Practitioner - Confirmation of Diagnosis | Confirmation of Diagnosis |
| Treatment Injury Surgery Invoices (+ Operation notes) | |
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