Provider Status Eligibility Requirements

Health Funds

ATMS Accredited Modalities & Health Fund Requirements

ATMS is a ‘professional organisation’ within the meaning of section 10 of the Private Health Insurance Accreditation Rules 2011. This potentially allows ATMS accredited members to be recognised as approved providers by the various private health funds. Approved health fund provider status is, however, subject to each individual health fund’s requirements. Consequently membership of ATMS does not automatically guarantee provider status with all health funds.

Health Funds currently recognise practitioners of the following modalities, provided that they meet the individual eligibility requirements set by the health funds. It is also of note, that not every health fund covers every one of these modalities.

To be eligible for health fund provider status, an Accredited Member of ATMS must:

  • Fill out the Health Fund Application&Declaration Form.
  • Be in private practice.
    ATMS and the Health Funds define Private Practice as ‘Independent private practice means a professional practice (whether sole, partnership or group) that is self-supporting. This means that its accommodation, facilities and services are not provided or subsidised by another party such as a public hospital or publicly funded facility.
  • Have current Provide First Aid on file with ATMS at all times.
  • Have current Professional Indemnity Insurance on file with ATMS at all times.
  • Comply with the ATMS Continuing Professional Education (CPE) Policy.
  • Have a clinic address (mobile services must have an invoice address and Full street address, no PO Box addresses are accepted).
  • Hold accreditation with ATMS in the relevant modality.
  • Meet the health fund provider status requirements for that modality, which may differ between funds.

The eligibility requirements are explained in the following pages. It is the responsibility of the member to provide the required information in order for ATMS to assess the members’ eligibility. ATMS reserves the right to request additional documentation as required in order to assess your eligibility for health fund provider status.

If you have existing provider numbers, please provide each provider number against each clinic and modality. ATMS will then verify with the health funds that these provider numbers are still valid.

Lapsed membership, insurance or first aid or non-compliance with continuing education requirements, will result in a member being removed from the health funds list. As health funds change their provider eligibility requirements from time to time, upgrading qualifications may be necessary to be re-instated with some health funds.

Please be aware that whilst a health fund may indicate that they provide a rebate for specific modalities, this rebate may only be claimable if the client has the appropriate level of health cover with that fund and has not exceeded any limits on how much they are eligible to claim back over a certain period of time. Rebates are only claimable for the consultation (not the medicines or remedies); however this does not extend to mobile work including markets, corporate or hotels or online or phone consultations. Home visits however are eligible for rebates.

All practitioners looking to gain health fund provider status must be familiar with the terms and conditions of provider status with all of the health funds. Being a Provider implies acceptance of the Terms and Conditions for the health funds.