Administrator account - the practice account within the Provider Web system which is used for maintaining staff and practice details within the system.

Claims assessment advice - a document generated by Southern Cross and provided to members for any claim submitted or reversed under their policy.

Eligibility criteria - for any Service to be reimbursed under an Affiliated Provider agreement, it must be medically necessary for the member concerned. Eligibility criteria explain the specific criteria which Southern Cross uses to define medical necessity and are included in Appendix 3 of the Affiliated Provider Agreement.

Member - a policyholder and the policyholder's spouse or partner and their dependants who are members of Southern Cross.

Member card - the Southern Cross Member card provided to all members over the age of 16 years.

Member data - the personal and health information (including name, Member card number, membership number, contact details and medical information) of each member collected by the approved practitioner in relation to the eligible healthcare services.

Payment entity - the name of the person or business to which payment is being made.

Plan description - the specific Southern Cross plan that the member has.

Policy - the contract of insurance between Southern Cross and the policyholder.

Procedure - the service or treatment provided to the member.

Provider Web - the Southern Cross online portal through which the Affiliated Provider service is run.

Remittance advice - a document generated by Southern Cross and provided to practices for any payments completed within the Provider Web system by their practice.

Service - the treatment or procedure provided to the member.

Service date - the date the service or treatment was provided.

Shortfall - the amount not covered by a member's policy. This is to be billed to the member.

Treatment - the service or procedure provided to the member.

Web user account - the practice's account within the Provider Web system which is used to submit applications, request payments and view event history.

Common member questions Below are some common member queries and responses that may help you assist Southern Cross members throughout the Affiliated Provider approval and claiming process.

How will I know I have approval for this procedure? We can confirm your approval for you and advise if you need to pay a contribution to the cost. If Southern Cross needs more information to make a decision they will contact you directly. If your approval is declined you will need to contact Southern Cross on 0800 757 838 for further details. Southern Cross will confirm your cover in a letter.

How do I claim for this procedure? In most cases we will claim on your behalf for your contracted service. The payment for the contracted service will be paid directly to us. You will only need to pay if your procedure (or a portion of it) is not covered by your Southern Cross policy. Southern Cross will always send the policyholder a remittance advice for any claim paid for you.

What if my procedure changes? We will request a new approval if the expected procedure, date, facility or provider changes. We will let you know if there is a change to your cover or the amount you have to pay.

Do I need to call Southern Cross? You do not need to call Southern Cross to organise the approval or claim for your procedure. If you have any other questions please contact Southern Cross on 0800 757 838.

What type of policy am I on? We can't tell you what kind of policy you have. You will need to contact Southern Cross on 0800 757 838 for details about your policy.

How was my approval / claim worked out? The Southern Cross system only advises us how much Southern Cross will contribute based on your policy type and benefit available, and how much you have to pay (if anything). For details about the claiming process and benefits under your policy, you'll need to talk to Southern Cross on 0800 757 838.

Why was my approval declined? We do not have information about why an approval is declined. To find out more please contact Southern Cross on 0800 757 838.

Can you please call Southern Cross for me? Due to privacy issues, you'll need to contact them directly. You can call them on 0800 757 838.

Can I create a shortcut to access Provider Web? Yes. While on the login page, press Ctrl+B on your keyboard to add Provider Web to your Favourites/Bookmarks. You can also place a Provider Web icon on your desktop by right clicking the desktop, then clicking 'Create shortcut'. Type the Provider Web address into the location field and follow the prompts.

Why haven't I received the username and password emails? Check your 'SPAM' folder, just in case the messages have been sent there by your email software. If the emails haven't arrived, we may have your email address recorded incorrectly. Please call the Systems and Training Specialist on 09 925 6010 or 021 226 3389 to confirm your email address and have the username and password resent.

Can I use the passwords assigned by Southern Cross without having to change them? No. The initial administrator and staff passwords that are emailed to you by Southern Cross should be used for the first-time login only.

What if the member doesn't have a Member card? You can also search for the member using their membership number or full name and date of birth. Searching the details of another member on the same policy (eg a parent) will show all members on that policy.

What if the member presents a blue 'Plus' card? Some members may present an old blue 'Plus' card and not the orange branded card. You can try to use the old card number, but their card number may have changed. We recommend the member contacts Southern Cross to get a new orange branded card issued.

What if I can't find my service, provider or facility name in the service list? The service drop-down list contains the list of services that you are contracted to provide to eligible Southern Cross members. Only contracted procedures, facilities and providers contracted will appear in this list. For other procedures, the member will need to apply to Southern Cross for approval by calling 0800 757 838.

If you wish to suggest a change to the list of available services, please contact your Contract Manager.

What if my approval application is Urgent? You can change the priority of the application from a standard 24 hour service to an Urgent 2 hour service time, by selecting Urgent in the Priority field of the Application Request screen as you enter the service details. You can change the service time after submitting the application by clicking on the yellow folder in Approval Tracking.

What do I do if an application status says 'Delayed.. See Comments'? If your application is 'Delayed.. See Comments' - there will be a note in the approval application from your Relationship Manager. Open the yellow folder in Approval Tracking to view the message.

I didn't receive the result I expected. Can I try again? No. Please accept the result and advise the member. Resubmitting the application again will create duplicate records and confusion for the member.

What if the system is unavailable? Provider Web is available from 7am to 7pm Monday to Friday, and most Saturdays. On Sunday the system is often unavailable and is always unavailable after 5pm. If the system is unavailable during working hours Monday to Friday, please contact your Relationship Manager (RM). Your RM will let you know by email if there will be any disruption to your usual access times.

The member's treatment is related to ACC. Can I put the application through? Always check your contract for any specific criteria related to your contracted services. If the member's treatment is a Personal Injury Caused by Accident (PICBA or PIBA) - you will need to claim this through ACC. This should not be submitted through Provider Web.

If the member's treatment has been declined by ACC, please submit the application and select 'ACC Decline' under the ACC check box options. Send a copy of the ACC decline letter, assessment report and treatment plan and any supporting reports to your Relationship Manager.

If the member's treatment is related to a Treatment Injury, please submit the application and select Treatment Injury under the ACC check box options. You will need to put a note in the Comments box for your Relationship Manager to confirm that the provider will complete the ACC45 form, and the ACC45 number (if available).

System requirements
To use the Provider Web system, your computer requires a compatible web browser and a broadband internet connection.

Provider Web is compatible with the following web browsers:

» Firefox 14 and above

» Safari 5 and above

» Chrome 20 and above.

Logins, passwords and profiles
Practices will be provided with a login and password for each user. There are three profile options :

» Administrator - manages Provider Web user login/password and profile.

» Web user - submits approval applications and requests payment.

» Provider - Administrator and web user for one specific provider.

Administrator access
Ideally this profile will be held by only one person at the practice. The administrator account allows the user to:

» add, remove and change logins, passwords and profiles for staff who will be submitting applications and claims payments

» edit practice staff details

» view applications and claims that have been submitted by the practice.

Web user access
This account will be used by all practice staff, primarily for submitting applications and requesting payment. The Web user account allows the user to:

» submit applications

» request payments

» view previously requested applications and payments.

Affiliated Provider practice obligations when using the Provider Web system
Access to the Southern Cross Provider Web system is provided to authorised users to perform the duties associated with Affiliated Provider services. Staff should take all reasonable steps to ensure their use of the Provider Web system is secure by following the practices set out below.

» Keep all systems and media containing Southern Cross member data in a secure manner to prevent access by or disclosure to anyone other than personnel who are authorised users of Provider Web or Southern Cross.

» Selecting a password and keeping it secure is important. Passwords should be kept confidential to the people they've been assigned to. Writing down (or storing the password electronically), or sharing it either verbally or in writing is not recommended.

» Passwords should be changed regularly, including when practice staff leave.

Getting around the Provider Web system
Once you are logged into Provider Web, using your mouse is the most efficient way to get around.

Help link
For extra help, click on the 'Help' link to access the video training library. The library offers help for each section of the Provider Web system.
You will need Adobe Flash to view the video training library. If your browser doesn't have Flash, you'll be prompted to download it. If you're unable to view the video training library, the operating guide contains the same information.

Unexpected system errors and outages
If you receive an 'unexpected error' message, the system may have timed-out. Please:

» restart your web browser

» begin the application process again.

If you continue to experience issues, contact your Relationship Manager. Please make a note of the steps you took that led to the error.

Advise the member that you can't submit the application at the moment. You can try again later. The member will need to pay for the service, collect their receipt and send it to Southern Cross with a completed claim form.

Planned Provider Web system outages

» If there is an outage initiated by Southern Cross, the administrator will be advised by email before the outage.

» Access to the system will be disabled by Southern Cross during the outage.

Changes to practice details
From time to time it may be necessary to change the details of the practice, due to changes of:

» physical or mailing addresses

» bank account details

» key contact people.

Some changes may require forms to be completed. Please contact your Contract Manager

Other queries or issues related to Provider Web
Please contact your Relationship Manager for approval application or eligibility-related queries.