What is a Type C certificate?
Types of hospital procedures
The Private Health Insurance (Benefits Requirements) Rules 2011 set out the minimum default accommodation benefits that private health insurers need to pay for hospital treatment. These depend on the MBS items for the procedure performed or services provided.
The rules define these procedures by grouping MBS items into:
- Type A procedures – usually done in hospital, with part of an overnight stay (higher accommodation benefits)
- Type B procedures – usually done in hospital, without part of an overnight stay (lower accommodation benefits)
- Type C procedures – don’t normally need hospital treatment or accommodation (no accommodation benefits).
If the medical practitioner certifies that the patient requires hospital treatment, health insurers can pay higher hospital accommodation benefits for Type B and C procedures.
Under Rule 7, the regulations state that 'the medical practitioner providing the professional service must certify in writing that due to the medical condition of the patient or because of the special circumstances specified, it would be contrary to accepted medical practice to provide the procedure to the patient except in a hospital'. This is known as a Type C certificate.
Clinicians must complete certification documents as set out in the rules, and private health insurers must check that certification documents meet the requirements.
Collecting Type C Certificate documentation through the admission and claiming process
For the majority of certificates, these are managed via Medical Certificates - allowing a clinician to document and certify.
For Type C certificate, CareRight streamlines this data collection.
Admission Category Configuration
Main article: Configuring Admission Categories
Visit Admin > Admission > Admission Categories > Setup. The admission category will allow you to define if for this treatment, a Type C certificate is always required,or if it is optional;or if it is never required and should be hidden.
Capturing data in the admission
For the admission, the primary fields are displayed when creating a new pre-admission.
The following configuration must be set:
- Admission category is marked as requiring type C certificates
- If there is a preadmission, the funding choice must be health fund
- The patient must have a primary health fund
- That guarantor (health fund) must be configured for online claiming
- Check that nature of illness and certifying provider are not hidden.
(Screenshot)
Capturing data during the claim
When Requires Type C Certificate field has been selected during the Admission process, this information is displayed when commencing the claim.
In the Type C Certificate panel:
- In the Certifying Doctor field, select a medical provider's name if different than the attending doctor.
- In the Nature Of Illness field, enter a brief description of the illness.
- Proceed with the claim.
