Australian Government - Department of Health - Office of Hearing Services
Hearing Services Program

Claiming Information

Service providers should submit claims for services provided to clients as soon as possible. The following information provides answers to common claiming enquiries and errors.

This webpage should be read in conjunction with Conditions for claiming

Non-routine clients

A non-routine client is a client with at least one of the following audiometric presentations

  • An air bone gap of 20dB or greater at 500Hz, 1kHz or 2kHz
  • Speech discrimination poorer than expected given Hearing Threshold Levels (HTLs)
  • Evidence of fluctuation in audiometric thresholds.

Audiological case management (item 610 and 810)

Items 610 and 810 are payments for additional work undertaken in order to complete a client’s assessment (item 600) or reassessment (item 800). Therefore, items 610 and 810 can only be claimed with, or immediately following an assessment or reassessment where

  1. a Qualified Practitioner (QP) Audiologist has provided advice to a QP Audiometrist on the management of a non-routine client who was first assessed by the QP Audiometrist, or
  2. a QP Audiologist has completed additional testing, as part of the assessment of their own client, so they can refer that client to a medical practitioner.

Evidence retained on the client’s file should include

  1. notes by the Audiometrist indicating that advice was sought from an Audiologist and a record of the advice provided, or
  2. notes or marked audiograms regarding additional testing undertaken by the Audiologist and a copy of the referral to a medical practitioner. A copy of any response from the medical practitioner should also be retained on file.

Rechargeable batteries

Service providers cannot charge client’s for rechargeable batteries as they are included in the client’s battery and maintenance agreement. The recharging unit is not subsidised through the voucher component of the Hearing Services Program (the program). If a client requires a recharger due to low vision or blindness they should be referred to Australian Hearing for specialist hearing services

Linking clients to a service provider site

Service providers are responsible for ensuring the client is linked to the appropriate site within their business prior to providing and claiming for services. A service provider may be asked to reimburse the Department of Health (the Department) if they claim for services provided to an unlinked client.

For more information on linking clients, please see linking clients to a service provider site

How to correct errors on approved claims

Service providers will need to recover an approved claim item if an error has been made for one or more of the following claim details

  • device details
  • date of service
  • date of fitting
  • dollar value of the claim
  • liable for GST amount
  • total excluding GST amount
  • GST
  • Claim cost to client

Once the item has been recovered re-submit the claim ensuring all the details are entered correctly. Please see the user guide on how to process a recovery via the HSO portal

The client is not required to re-sign a new claim for payment form. Instead, a copy of the incorrect claim can be attached to the correct Claim for Payment form as proof of signature for audit purposes for services provided prior to 1 October 2019.

If the site ID or practitioner number have been entered incorrectly, please clearly document the correct details or note the incorrect entry made on the client file or claim for payment form, resubmission of the claim is not required.  The incorrect details should be crossed out and initialled by an authorised person. The 3 Frequency Average Hearing Loss (FAHL) should be updated in the client’s Service History in the HSO portal. Please see the user guide on how to edit a client’s service history

Fitting devices that are removed from the fully or partially subsidised device schedule

Prior to a client’s fitting appointment, service providers are responsible for ensuring devices are on either the current fully or partially subsidised schedule. If a device is removed from one of the device schedules prior to the fitting appointment, the fitting cannot be claimed through the program. In this instance, service providers should return the devices to the manufacturer and arrange to fit the client with another appropriate device on the schedule. Service providers are encouraged to regularly check the real time list of approved devices, these can be found on the publications tab in the HSO portal or at the bottom of the following webpages

Claiming process when a client returns their devices

If a client brings back their device(s) within the return period, service providers must recover the fitting claim item. Service providers can claim an item 1 or 2 (through the HSO portal) if a device has been returned for credit or added to a clinic’s hearing device stock. This should be undertaken as soon as possible to avoid issues if the client relocates.

If the client brings back their hearing device(s) outside of the return period or it cannot be used in the clinic’s stock, service providers are responsible for keeping the devices on the client’s file. If the client relocates, the devices must be transferred with their file to the new service provider.

What to claim when a client loses their hearing device before the follow up

Below are three scenarios where a client is fitted and loses a hearing device before a follow-up can be carried out, one of the procedures below should be followed;

The following procedures can also be applied to both initial and refit of devices as well as damaged devices.

Scenario 1 - When one device is fitted and is lost before a follow-up can occur

  • A Statutory Declaration must be completed by the client stating where or how the device was lost and kept on file
  • An item 651, 631 or 821 can be claimed for the lost device (the date of service should match the fitting date)
  • Once the lost device is replaced an item 840 can be claimed

Note: In cases where the client does not want to be fitted after the device is lost, the Statutory Declaration must also state this before an item 651 or 821 for the lost device is claimed and no replacement should occur.

Scenario 2 - When two devices are fitted and both are lost before a follow-up can occur

  • A Statutory Declaration must be completed by the client stating where or how the device was lost and kept on file
  • An item 661/641 or 831 can be claimed for the lost devices (the date of service should match the fitting date)  
  • Once the lost devices are replaced an item 850 can be claimed

Note: In cases where the client does not want to be fitted after the device is lost, the Statutory Declaration must also state this before an item 661 or 831 for the lost device is claimed and no replacement should occur.

Scenario 3 - When two devices are fitted and one device is lost before a follow-up can occur

  • A Statutory Declaration must be completed by the client stating where or how the device was lost and kept on file
  • An item 651, 631 or 821 can be claimed for the lost device (the date of service should match the fitting date)
  • When an initial fitting item 651 or 631 has been claimed for the lost device, an item 770 or 760 to the opposite ear can be claimed once a follow-up has occurred
  • Once the lost device is replaced an item 840 can be claimed.

OR

  • When a refitting item 821 has been claimed for the lost device an item 820 to the opposite ear can be claimed once a follow-up has occurred
  • Once the lost device is replaced an item 840 can be claimed.

Note: In cases where the client does not want to be fitted and returns the remaining device, the Statutory Declaration must also state this before an item 651 or 821 for the lost device and item 1 for the returned device is be claimed and no replacement should occur.

Variation to all the above scenarios

On the occasion where the lost device is found by the client, the replacement device must be returned to the manufacturer and the item 840 or 850 should not be claimed.  If the item 840 or 850 has been claimed it is expected that you return the device to the manufacturer and recover the item 840 or 850 at your earliest convenience.

If the client wishes to change the device style or model after the device has been lost before a follow-up has occurred, a note on the client file should be made before the 840 or 850 is claimed.

If the device is damaged beyond repair a manufacturer’s letter is required in place of a Statutory Declaration from the client.

A copy of this email should be kept on file for audit purposes.

Claiming for services over two financial years

A the end of financial year we receive enquiries from service providers wanting to undertake claiming where a client has been fitted with a device on or prior to 30 June and the follow up is completed on or after the 1 July, please consider the following

  1. Item benefit is based on the new financial year
  2. Device benefit is based on the previous financial year

Please refer to the correct financial years Schedule of Fees

Updating a client’s details and fitting configuration

Where a client was previously binaurally fitted but is now fitted monaurally, please ensure that you refer to the user guide on editing a client’s service history.

Client Transfers

When a client transfers to a new provider, please ensure that

  • the new provider is informed of any pending claims that have not been submitted, and submit any outstanding claims as soon as possible

When a client transfers to you, before providing any services

  • check with the client whether they have recently received services from their previous provider, and if so
  • contact the previous provider to check if there are any outstanding claims

Who can sign the ‘Certification by Service Provider’ section?

The service provider can nominate a staff member to sign the certification by service provider section on the claim for payment form. The service provider needs to ensure they comply with the conflict of interest clause (7.2) (h) in the Service Provider Contract.

 

Claiming Information (PDF 240 KB)

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