Extras Provider Recognition

CBHS has a policy that outlines the Provider Recognition Criteria for each treatment type covered under its Extras Covers.

CBHS recognises many Associations and Boards as meeting or exceeding CBHS' recognition criteria and therefore providers are registered with CBHS via these Associations and Boards.

Providers registered with Medicare Australia are recognised by CBHS.

Providers seeking recognition for benefit purposes from CBHS and are not registered with an Association, Board or Medicare Australia, are asked to complete a Provider Recognition Application Form.

Providers seeking recognition must satisfy CBHS recognition criteria before they are recognised as a CBHS provider. Evidence of the following is requested and must accompany the Provider Recognition Application Form.

• Copy/ies of qualifications for the modality practiced.
• Copy of current professional indemnity insurance certificate.
• Copy of current senior first aid certificate.

A provider's application is assessed and the outcome of the assessment is confirmed in writing.

CBHS is a provider of health insurance benefits. This means that CBHS does not recommend practitioners and the choice of a practitioner in any modality is a matter for the member.

Likewise, the clinical relationship between member and provider is not one into which CBHS ventures. The treatment afforded by a recognised provider is a matter between the provider and the member.

CBHS does not hold itself out as responsible for the clinical outcomes of any treatment or lack of treatment by a recognised provider. It limits itself to the decision to pay or not to pay fund benefits in accordance with the CBHS Health Benefit Fund Rules.

1. Accounts/Receipts
   All accounts/receipts must clearly detail the following information:
   1. Provider's full name printed clearly.
   2. Full practice address and telephone number.
   3. Full name of patient incurring the treatment or service.
   4. Date and cost of service/s.
   5. Details of payments made and any outstanding balance.
   6. Description of the type of service provided by:
      1. indicating if the consultation was initial or a subsequent consultation
      2. description of the treatment provided e.g. Naturopath consultation
   7. Separate costs (e.g. Herbs, remedies).
   8. Provider number e.g. Association/Board/Medicare Australia/CBHS number.
   9. There should only be one fully itemised original receipt or account. All copies of accounts and/or receipts should be identified as a duplicate copy.
   10. Where a quote has been provided to a patient, such a quote should be endorsed as an estimate or quote.
   11. All accounts and/or receipts should be on printed stationary or stamped by provider. 
2. Benefits are not payable by CBHS for:
   1. Services provided by a student, clinic assistant of the professional or any such other person. If services are provided, this must be clearly indicated on the account/receipt.
   2. Telephone, mail or online consultations.
   3. Written reports.
   4. Herbs, remedies and medicines.
   5. Benefits are not payable in respect of services provided to a patient as a result of an accident for which there has been established the right of recourse to receive compensation (eg. Workers Compensation, Third Party Insurance, etc) which includes an amount equivalent to the fund benefit, unless the patient has contacted CBHS and received relevant documentation and approval.
   6. For alternate therapies, benefits are only payable for treatments approved by CBHS according to CBHS' provider recognition criteria.
   Other items as determined by CBHS from time to time.
3. Patient Records for CBHS Members:
   CBHS Health Fund Limited members authorise the fund by signing a declaration to obtain any information from the provider relating to a claim. In order for this information to be correctly obtained, please record the following information on patient's history.
   1. Patients name, address and date of birth
   2. Contact numbers
   3. Date and Details of service/s provided
   4. Fees charged
   5. Illness or condition being treated