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General PHIAC Circulars

NEW PROSTHESES REPORTING REQUIREMENTS – REVISED PHIAC 3

In Circular 05/19 of 20 December 2005 funds were advised they would be required to submit quarterly prostheses reports (PHIAC 3) from the March quarter 2006. It is also required that a separate catch-up return be submitted for the December 2005 quarter no later than 28 April 2006, and earlier if possible. An electronic template was provided on PHIAC’s website.

This circular is to advise that the PHIAC3 template has been revised to include charges for Gap Permitted prostheses. Previously PHIAC had been advised that funds would not be able to provide charge data but later communication with funds and software suppliers indicate that collection of charge data is feasible. Collection of charge data will allow analysis of out of pocket expenses for Gap Permitted prostheses so the template has been revised to collect charge data. The revised electronic template for the PHIAC 3 return is attached to this circular on PHIAC’s web site www.phiac.gov.au.

Circular PHI 46/05 of 31 August 2005 from the Department of Health and Ageing advised that the Minister for Health and Ageing has made a determination giving effect to the first Prostheses List under the new arrangements for listing of products and setting benefits. This List became effective on 31 October 2005 when the new arrangements commenced.

The Minister determined, under subsections 73AAG(6) and 73AAG(7) of the Act, that there will be “No gap prostheses’ and “Gap permitted prostheses’. The intention of this new PHIAC 3 template is to collect data that will assist in monitoring the affect of the introduction of the new prostheses arrangements.

The data will be required to be provided quarterly to PHIAC. The due date for submission of the data is the same as for the PHIAC 1 returns, 28 days after the end of the quarter to which the data relates.

The template provided (PHIAC 3) shows prostheses by major categories. At the bottom of the template the prosthetic groups are shown next to the prostheses category, or CAG groups, to which they should be mapped. Six of these categories, Spine, Trauma, Urogenital, Hip and Knee Accessories, Cardio Thoracic, and Vascular Stents and Grafts have yet to be assigned to groups. All groups not assigned should be reported under the ‘Other’ category. As soon as these categories are grouped, funds will be informed so that data can be provided in the correct category.

The data reported in the PHIAC 3 template is required separately by state, where the states required are the same as those for which the fund reports PHIAC 1 data. The totals reported on this new quarterly PHIAC 3 Prostheses Report should be consistent with data reported in the quarterly PHIAC 1 return.

Aggregate state reports generated from this prostheses data will be made available quarterly.

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Private Health Insurance Administration Council

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Last modified: 22 July, 2005