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Eligibility

The following FAQs deal with responsibility for assessing a patient's eligibility to enrol in a PHO, when to re-enrol, how to check a patient's enrolment status with the MoH, and what to do with your enrolment form.

1. What is a practice's responsibility for assessing eligibility to enrol in a PHO?

You are responsible for making an assessment of a patient's eligibility for health services including whether they are eligible to enrol in a PHO. To do this, you must ask all the necessary questions to determine eligibility. Some of these questions will be on your enrolment form. As the patient must sign this form, it is your proof of what the patient has informed you. 

If you need to ask additional questions, we strongly recommend that you keep notes of the questions asked and ideally get the patient to sign that as well.

Whenever a patient supplies evidence to back up their claim for eligibility, you should take a scan/copy of that evidence. Best practice would be to attach it to the enrolment form for future reference.

When a patient does not have evidence with them, you have no choice but to take their word. However, it would be prudent to keep a good record of what they said.

For more details about what questions to ask, refer to the MoH web site - Eligibiliy for publicly funded health services or download their PHO Enrolment Checklist (PDF, 180 Kb) 

You may want to work through the common situations you encounter and put these questions into your receptionist training package.

2. Do we have to re-enrol all our patients after three years?

No!  Once you have enrolled a patient the 'three year clock starts ticking' from that date.  But every time the patient visits, 'the three year clock gets reset' to zero so you can keep the patient for three years after they last visited.

However, if a patient hasn't visited in three years and they still want to be with your practice, the easiest way to keep them is to re-enrol them. That re-enrolment will 'reset the clock' just like a visit does.

3. When should we re-enrol a patient?

There are two situations when you would re-enrol a patient:

  • If the patient has mistakenly been enrolled in another practice, the only way to have them 'return' to your practice is to re-enrol them. Having the latest visit date makes NO difference. It is only the latest enrolment date that counts.
  • If the patient has not visited the practice for three years, re-enrolment is a valid method of retaining the patient in your practice.

Please note that the only way that you can re-enrol a patient is by getting them to sign a re-enrolment form. A phone call is not sufficient for re-enrolment.

4. How do I check a patient's enrolment status with MoH?

You can't directly check with the MoH whether a patient is enrolled elsewhere or with which practice they are enrolled. This information is not available because of privacy law.

You can look up whether a patient was rejected for funding in your 'update spreadsheet'.

However, patients themselves can ring HPAC to find out with which practice they are enrolled.  The claimant enquiries (non-pharmacy) number is 0800 HLTH4U (0800 458 448).