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Our values

To protect our members, we only work with providers who show a total commitment to our values

Physio working on patients leg

High standards for patients

We expect our providers to have the same quality and scope across the public and private sectors.

And, to ensure a high level of treatment for our members, our providers must:

  • Practice evidence-based and ethical guidelines
  • Meet the National Minimum Standards for private and voluntary healthcare
  • Follow clinical protocols and guidelines
  • Have reasonable whole-practice audit standards
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    Making working together easier

    Our members expect us to be always open and transparent. Any provider who works with us has a responsibility to do the same. It makes working together simple.

    Our providers must:

  • Ask members whether they have enough cover on their plan for the procedure
  • Be able to provide full details on their bills
  • Submit all invoices via Healthcode – we'll be able to pay you quicker
  • Man working on laptop wearing headset

    No compromises on ethical standards

    We commit to preserving the integrity of the private healthcare sector. So, we continue to track claims trends for irregular billing patterns.

    If we spot a provider charging in unusual or unexplained ways, we will contact them.

    Doctors looking at medical records

    We do not accept

  • Upcoding – billing a procedure of higher complexity than the one performed
  • Unbundling – extra billing for parts of a complex procedure
  • Billing for services that weren’t provided
  • Billing for services that weren’t medically necessary
  • Altering dates or descriptions of services to secure payment
  • Misrepresentation of diagnoses or procedures to get a full payment
  • We fully support the development of CCSD coding principles to define unacceptable code combinations
  • We’re a member of the Health Insurer Counter Fraud Group. We share information with other insurers to aid the prevention of fraud