Terms and Conditions for North West Physiotherapy/ TUH Preferred Providers
BACKGROUND
TUH’s Physiotherapy and Podiatry preferred provider networks are designed to give TUH / Union Health members access to affordable treatments while retaining clinical independence.
CONDITIONS OF APPLICATION TO BECOME A QUEENSLAND TEACHERS’ UNION HEALTH FUND LTD (TUH) PREFERRED PROVIDER
An authorised representative of the company (preferably the Director) may apply for the North West Physiotherapy – Everton Park Pty Ltd (the Company) and its Related Body Corporate including but not limited to the following entities: North West Physiotherapy – Everton Park Pty Ltd to become a TUH Preferred Provider. If the application is accepted all providers at Company owned practices who meet the conditions specified in clause 1.3 and elsewhere in this document will be considered Preferred Providers unless specifically excluded. Providers should be specifically excluded on the TUH Preferred Provider Application Form.
Where providers are specifically excluded from the TUH Preferred Provider Application it is the responsibility of the Company to advise the member that the provider is excluded from this agreement and ensure Informed Financial Consent is provided to the member prior to the commencement of treatment.
The Company must list each location at which it wishes to be a TUH Preferred Provider. This list of locations may be provided as a complete list for example as an excel file or similar and may be updated by the Company from time to time as additional practices join the North West Physiotherapy – Everton Park Pty Ltd. The list will contain all required fields regarding the provider and practice details.
For a provider at the practice to become a TUH Preferred Provider he or she must (on application, and ongoing for so long as they remain a TUH Preferred Provider):
Maintain appropriate qualifications to practice;
have a current provider number allocated by the relevant regulator the location at which they participate in the Network;
be fully registered with the Australian Health Practitioner Regulation Agency (AHPRA);
at all times, maintain the ethical and professional standards reasonably required; and
remain an employee or contractor of a practice owned by the North West Physiotherapy – Everton Park Pty Ltd.
ASSESSMENT OF REQUESTS TO BECOME A TUH PREFERRED PROVIDER
TUH may accept or refuse an application to become a Preferred Provider at its absolute discretion.
In deciding whether to accept or refuse an application TUH will take into account matters relevant to the viability and effectiveness of the TUH Preferred Provider Network, including:
any restriction on the size of the TUH Preferred Provider network;
the geographical distribution of TUH members;
the number of providers participating in the TUH Preferred Provider network in the same geographical area as the applicant; and
the results of any relevant TUH member satisfaction surveys and claims history audits.
The application must provide:
the name of each provider at the practice;
their AHPRA and Medicare provider numbers; and
any restrictions imposed on their practice.
CONDITIONS OF PARTICIPATION AS A TUH PREFERRED PROVIDER
As part of ongoing participation as a TUH Preferred Provider, the company must:
continue to meet the conditions to become a Preferred Provider;
abide by the TUH Fund Rules insofar as these are applicable to medical practitioners or providers;
maintain public liability insurance with a sum insured of at least $10 million which covers it against claims of personal injury or property damage that a third party suffers (or claims to have suffered) as a result of its business activities;
ensure that every provider covered by the agreement maintains professional indemnity insurance with a sum insured of at least $10 million which covers any provision of clinical services at the practice address provided;
practice within the legal and ethical standards expected in contemporary Australian health practice and in accordance with Australian Safety and Quality Goals for healthcare;
provide TUH members with quality services, including advice and information; and
give TUH permission to publish:
the fact that the provider is a Preferred Provider; and
the contact details for the provider on our website or in any other manner TUH decides.
The company will charge TUH members aged 17 years and under (up until the day before their 18th birthday) no more than $90 for initial physiotherapy services and comprehensive podiatry services. In return, TUH will pay a benefit of $90 for these services.
The company will provide TUH members with the following exclusive offers:
Physiotherapy
10% off initial and standard consultations (excluding the offer in 3.2); and
Podiatry
10% off initial consultations (excluding the offer in 3.2).
The company must keep records necessary to show compliance with these Terms and Conditions. Without limiting this obligation, a provider must retain for 2 years from the date of a professional service the invoice / receipt signed by the TUH member verifying that the service has been provided.
The company must provide TUH with any records or other information TUH may reasonably require to verify that a professional service has been rendered.
The company must provide TUH with any information it may reasonably require to confirm that all Preferred Providers are complying with these Terms and Conditions.
The company must notify TUH within 5 business days of any change to its address details as they appear in the application form.
The company is required to notify TUH in a timely manner of:
the details specified in clause 2.4 for new providers who commence at the company;
details of providers who leave the company.
In the event that the company is sold, the company must notify TUH within 10 business days. TUH may, at its absolute discretion, terminate the preferred provider agreement or transfer it to the new owner.
The company must notify TUH within 5 business days of any issues that may affect a provider’s registration including the imposition of disciplinary sanctions, restrictions, suspensions, or other conditions which may affect their ability to meet these Terms and Conditions.
In consultation with the Company, TUH may provide public notice and information of a company’s participation in the preferred provider network through point of service material to be placed in a noticeable position at the company’s premises.
PROCESSING CLAIMS
TUH has the capacity to receive claims electronically through HICAPS or iSoft systems unless there is a technical issue at any point in time.
Whether claims are submitted electronically or manually, an invoice from the provider must include:
the patient’s name for manual claims and patient ID code for electronic claims;
the date of service;
a description of each service rendered;
item numbers;
the provider’s name, address and provider number;
the fee for the service; and
the net amount required to be paid by the patient.
Claims will be processed in accordance with the TUH Health Fund Benefit Rules. TUH pay benefits to our members in accordance with their level of cover and our policy terms and conditions. Conditions that may affect a member’s eligibility to receive benefits include, but are not restricted to: waiting periods; annual limits; compensation payable by another party and premium payments in arrears.
TUH will monitor claiming patterns and charges applied at its discretion. The TUH member will be responsible for the payment of any amount between the fee charged and the level of benefit paid (‘out of pocket expenses’).
GENERAL MATTERS
Where a company enters into an agreement with TUH to become a Preferred Provider, that agreement consists solely of:
these Terms and Conditions;
any General Treatment Terms and Conditions which may be made available by TUH from time to time;
the application to join the Preferred Provider network submitted by the company to TUH, in the form determined by TUH; and
the letter from TUH to the company notifying it that TUH has accepted its application to become a Preferred Provider with the names of the recognised providers.
Where there is any inconsistency between any of the documents listed at 5.1 then these Terms and Conditions prevail.
An agreement referred to in clause 5.1 is governed by the law of the State of Queensland and is subject to the exclusive jurisdiction of the State of Queensland.
TUH makes no guarantee, representation or warranty that by becoming a Preferred Provider a practice will receive increased business from TUH members.
A practice does not become an agent of TUH by becoming a Preferred Provider.
TUH is not liable to any person for any loss, damage or injury incurred as a result of a preferred provider providing treatment or failing to provide treatment to a TUH member.
By becoming a TUH Preferred Provider a practice agrees to indemnify TUH against all expenses, losses, damages and costs that TUH may incur as a result of:
any breach of these Terms and Conditions by the provider; or
any loss or damage to any property or injury to or death of any person caused by any negligent act or omission or wilful misconduct of the practitioner or his or her partners, employees or contractors,
except to the extent that any such expenses, losses, damages and costs are caused or contributed to by TUH.
TUH may not give directions to a provider or otherwise attempt to influence a provider’s decision about the appropriate treatment for a TUH member, although it may require information about treatment given to a TUH member as described in clause 3.
TUH may contact a member to discuss any claimed treatment provided and/or ask the member to have a clinical examination if there are questions raised to which the company is unable to provide an explanation that satisfies TUH.
Preferred Provider Agreements will be issued for a maximum period of two years with the option of a two year extension at TUHs sole discretion. An agreement will only be valid when it is returned to TUH no later than 2 months after issue and is signed.
Preferred Provider Agreements will have a common expiry date of 31st December.
CHANGES TO THE TERMS AND CONDITIONS
TUH may amend these Terms and Conditions at any time by giving the company notice in writing at least 28 days before the amendment is due to come into effect.
If the company wishes to amend these Terms and Conditions, its Director/Principal must make a written proposal to TUH, which TUH may accept or refuse at its absolute discretion.
If TUH accepts an amendment proposal from the company, then the amendment comes into effect from a date nominated by TUH.
LEAVING THE NETWORK
The participation of a company in the TUH Preferred Provider network may be terminated by the company or TUH at any time by giving three months’ written notice to the other party.
TUH may terminate the agreement in writing immediately if:
TUH reasonably finds that any or all providers at the company have failed to observe relevant regulatory body policy statements or guidelines; or
any or all providers at the company no longer meets the conditions in clause 1.4;
the company’s access to electronic claiming systems such as HICAPS is terminated;
In TUH’s reasonable opinion, the company’s conduct may adversely impact our goodwill, reputation or business; or
the company is sold.
and the termination of the company’s participation takes effect from the day on which TUH gives written notice to the company.
After termination has taken effect, the company:
must remove any promotional materials about the Preferred Provider network from display; and
must take any other steps necessary to ensure that it does not represent to any person that it continues to participate as a TUH Preferred Provider.
RESOLVING DISPUTES
If any dispute arises between TUH and a provider or the company in relation to the Preferred Provider network, then both parties should, in good faith, try to resolve any disputes informally in the first instance.
NOTICES
Any notice to TUH in accordance with these terms and conditions should be in writing and signed on behalf of the company by an authorised party and sent by email to providers@tuh.com.au
