Get Claim Form For Non-lmc Services - Healthgovtnz

Filling out the Claim Form For Non-LMC Services is an essential step for users seeking reimbursement for various health services provided. This guide will walk you through the necessary sections of the form to ensure accurate and complete submission, making the process as smooth and straightforward as possible.

Follow the steps to accurately complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the practitioner details section. Here, indicate the type of practitioner, registration number, and practitioner name. Make sure this information accurately reflects the registered health professional providing the service.
3. Next, move to the service and claim details section. Indicate who the service was provided to by selecting either 'birth mother' or 'baby'. Ensure to enter the patient's NHI number, as this is mandatory.
4. Fill in the date of birth for the baby and the expected delivery date (EDD) for the birth mother, both of which are required fields.
5. Select the service type from the options provided. Choose from: urgent normal hours pregnancy care, urgent out of hours pregnancy care, labor and birth (rural support), or urgent postnatal care.
6. Enter the date of service, which is crucial for processing your claim. This should reflect the actual date the service was rendered.
7. In the amount claimed section, carefully input the amount being claimed for each service provided. Note that these amounts should be listed exclusive of GST.
8. Once all individual amounts are listed, calculate the total amount claimed, also exclusive of GST. Make sure this total has been double-checked for accuracy.
9. Before finalizing, review all entries for completeness and correctness. Ensure that no mandatory fields are left blank.
10. Upon completion, you can save your changes, download, print, or share the form as required for submission. Remember to attach completed forms to the Claim Summary before sending it to the Ministry of Health.

Complete your claim form online today for a seamless submission experience.