Where a GMS claim is paid and the Enrolled Person’s NHI, Enrolling Organisation HPI-O, PHO HPI-O, and date of service match the PHOs records for payments for Enrolled Persons; the fee for service subsidy amount paid will be deducted from the next available Capitation Based Funding payment for the corresponding PHO. Description The number of GMS deductions against an Enrolled Person’s CBF Payment will be at three consultations within a given month ‘capped’ (based on date of service). GMS deductions will not be made for a newborn with a status (B code) during the pre-enrolment period of 3 months. Source NES and GMS Claims References PHO Services Agreement GMS deductions will be reported to the PHO monthly. GMS claims that have not been deducted as a result of the deduction will also be reported to the PHO monthly. ‘cap’ Notes The timeframe for submitting a GMS claim is 60 days after the date of service. A newborn pre-enrolment status is consistent with the commonly used term code’ for newborn pre-enrolment. ‘B- BR# 4.4 PHO notification of change to Capitation Based Funding – Item Details Unique Identifier BR# 4.4 Title / Name PHO Notifications
Description Where a GMS claim is paid and the Enrolled Person’s NHI, Enrolling Organisation HPI-O, PHO HPI-O, and date of service match the PHOs records for payments for Enrolled Persons; the fee for service subsidy amount paid will be deducted from the next available Capitation Based Funding payment for the corresponding PHO. The number of GMS deductions against an Enrolled Person’s CBF Payment will be ‘capped’ at three consultations within a given month (based on date of service). GMS deductions will not be made for a newborn with a status (B code) during the pre-enrolment period of 3 months. Source NES and GMS Claims References PHO Services Agreement Notes GMS deductions will be reported to the PHO monthly. GMS claims that have not been deducted as a result of the deduction ‘cap’ will also be reported to the PHO monthly. The timeframe for submitting a GMS claim is 60 days after the date of service. A newborn pre-enrolment status is consistent with the commonly used term ‘B- code’ for newborn pre-enrolment. BR# 4.4 – PHO notification of change to Capitation Based Funding Item Details Unique Identifier BR# 4.4 Title / Name PHO Notifications
Business-Requirements-National-Enrolment-Service-and-Capitation-Based-Funding-v1.0.docx