I am seeing a new patient insured with Aviva, do I need to do anything?
Please ensure that the patient has contacted us PRIOR to any treatment taking place. The patient will be sent a 'Confirmation of Cover' letter once benefit for treatment has been confirmed. They should bring a copy of this letter to their appointment with you.
Can my patient use any hospital?
No, different policies provide access to different hospitals, for further information please our claims department on 0800 158 3333. Each policyholder has a membership card which gives their policy number and policy type.
Can I bill Aviva directly or charge the patient at the time of treatment?
Aviva welcomes invoices sent directly to us following treatment, please do not invoice the patient unless they have specifically requested you do so. When you bill Aviva, you must include your Aviva Provider Number, together with your patient's policy number. Where no policy number is available, we would appreciate full details of your patient, including their date of birth and postcode. Accounts should be marked for the attention of the bill payment department. Bills can be posted to:
Bill Payment Dept 57 Chilworth House,
Hampshire Corporate Park,
How do I invoice Aviva?
Please ensure the following is billed on practice headed paper and includes the following information:
- Name and address
- Email address or contact number if we have any queries
- Your Aviva Provider Number
About the patient:
- Name and address including postcode
- Date of birth
- Aviva policy number
About the treatment:
- Date of treatment for each procedure/service provided
- Procedure description
- CCSD Codes where appropriate
- Charge for each service
- Total of all charges
Bills can be posted to:
Bill Payment Dept 57 Chilworth House,
Hampshire Corporate Park,
Can I receive payment via BACS?
Aviva would be happy to issue your monies direct to your bank. If you would prefer to receive payments by this method, please complete a BACS Request Form (PDF 59KB). Please return the form to:
Dept 10 Aviva Health,
Hampshire Corporate Park,
or alternatively email firstname.lastname@example.org.
Can I bill Aviva electronically?
Yes, Aviva jointly owns Healthcode Ltd, who provides an electronic billing system. This system is easier and more efficient way of billing, cutting out the need for paper and postal delays, reducing administrative costs. Electronic billing is a quick and secure way of transmitting invoices to insurers. All you need is internet access. Register at www.healthcode.co.uk or alternatively contact the Helpdesk on 01784 263150 or email@example.com
This method provides you with certainty your invoice has reached us and has provided us with all the information necessary to process it. Invoices received electronically are processed quicker and payment is received sooner.
Healthcode is the UK’s trusted provider of secure online billing to the private health market and processes bills to the value of £2.5 billion each year for virtually every private UK hospital and medical insurer.
ePractice manager, Healthcode’s online billing and practice management system links with private hospitals and medical insurers across the UK directly and securely. For more information and to register for ePractice manager visit Healthcode or call 01784 263 150.
I will be performing a complex procedure with no CCSD code, who can I discuss this with?
The fee level we have calculated for procedures are intended to cover more complicated and time consuming operations as well as more straightforward ones. Should surgery be significantly more complex than expected, please submit a medical report prior to surgery and anaesthetic notes following surgery so we may review and obtain expert advice. This will allow us to advise our customer and you of the appropriate fee levels available. Please contact the Specialist Relationships team on firstname.lastname@example.org or 02380 354609.
I will be performing a procedure that is new / experimental, who can I discuss this with?
Invoices must be coded using the industry standard CCSD code. If any procedure is undertaken which doesn't have a CCSD code, specialists should contact CCSD to request a new code (www.ccsd.org.uk) or contact the specialist relationships team at Aviva for more advice.
Please note we do not provide benefit for experimental or unproven procedures, including those using new technology or drugs, where safety and effectiveness have not been established or generally accepted. Please contact the specialist relationships team for more advice on email@example.com or 02380 354609.
Under NO circumstances should codes intended for existing procedures be used for new and un-coded procedures. The narratives and codes are protected by copyright and may not be altered or used in any other way. The use of alternative codes for un-coded procedures could.
Please contact the Specialist Relationship Team to discuss PRIOR to treatment taking place on 023 8035 4069 or firstname.lastname@example.org.
My employment details have changed / I have moved house, do I need to contact you?
In the event that your employment or personal details change, please complete and return the enclosed Provider Change of Details Form (PDF 15KB). This will enable us to maintain accurate provider records. Failure to do so may affect or delay payment for services. Please note that all notifications must be made in writing, information cannot be accepted over the telephone due to the Data Protection Act.
How do I bill for Local Anaesthetic/Sedation?
No additional benefit is payable for the application of local anaesthesia and/or sedation where we consider this to be an integral part of the procedure based on accepted, standard medical practice. These procedures are indicated by an * in the schedule and the published fee is the maximum payable by us, inclusive of any anaesthesia and/or sedation used.
Aviva does however recognise that ongoing changes in medical practice mean that there are a growing number of occasions when a surgeon / anaesthetist will use a local anaesthetic and/or IV sedation for a procedure where in the past, general anaesthetic will have been used. In such circumstances an additional fee of 25% of the surgical units up to a maximum of £84 will be payable.
No additional fees for anaesthesia and/or sedation will be payable by us, for those procedures where no anaesthetic value is shown and which are not indicated by an * in the fee schedule.
Does Aviva recognise all Specialists?
No. Aviva’s criteria for recognition of a Specialist are that he/she has at any time held and is not precluded from holding a substantive consultant appointment in the relevant speciality in a NHS Hospital
Holds a Certificate of Higher Specialist Training in the relevant speciality issued by the Higher Specialist Training College of the relevant Royal College of Faculty
Is included as required by the European Specialist Medical Qualifications Order 1995 in the Specialist Register kept by the General Medical Council in respect of the relevant speciality.
What information will Aviva request on long-stay or "complex" patients? Why do you require this information and what will be done with it?
In cases where a patient stays longer than the norm, or where treatment is of a complex nature, please contact our Helpline 0800 158 333.
We require a current medical report giving full patient details, which should be completed by the Specialist in charge of treatment, giving reasons for long stay and the medical necessity for ongoing treatment.
This information remains confidential and will be used in the assessment of the claim. Aviva encourages pre-authorisation of all admissions wherever possible.
How should we handle excesses on policies?
Excesses are available on most Aviva policies. Excesses should be settled directly by the individual patients either with the hospital or Specialist. Aviva's claims system automatically deducts the excess from relevant invoices. This will be noted on your Statement of Account when payment is made and the policyholder will be made aware of which Provider to pay the excess to.
If you have a query regarding the existence of an excess payment please call our Helpline 0800 158 333
What happens if a patient cancels or does not attend his/her appointment?
Aviva does not make payment for missed or cancelled appointments. The patient will be liable for any costs incurred due to non-attendance or cancelled appointments.
What are code combinations?
Introduction to Inappropriate Code Combinations
Some of the procedures listed in our fee schedule include other procedures that are also listed in their own right, but are an integral part of the main procedure. We will not pay additional fees where a procedure is broken down into its separate components, where such an approach results in a higher overall charge.
We continue to work with healthcare providers and CCSD (Clinical and Coding Schedule Development) group to define inappropriate code combinations and welcome feedback to inform our approach. Please contact our Specialist Relationships Team on 02380 354609 or email us at: email@example.com.
To clarify why we deem some code combinations inappropriate, we have described six scenarios below:
- Impossible - procedures which are deemed unable to be performed together or, rarely, as a sole procedure.
- Minor additional - a procedure, additional to the main procedure, where the extra time taken to perform it is deemed insignificant (in relation to the main procedure) and hence no additional fee is justified.
- Part & parcel - a procedure which is so frequently performed as part of the main procedure that it forms an integral part of it.
- Mutually exclusive - procedures which are usually precluded from being performed together or are describing different methods of performing essentially the same operation.
- Another code - another code either more accurately describes the procedure or amalgamates different components of the procedure.
- Either/Or – both codes describe the same procedure, although may be different techniques or approaches.