Aviva's Specialist registration terms and conditions

  1. Introduction

    1. Application for Registration with Aviva

      Please fully read the terms outlined below and complete all applicable parts of the registration form. Your registration will be reviewed by the Specialist Registration team and if successful you will be notified via email. It is therefore essential that an email address is supplied by you.

      Please note that an incomplete application, or an application without supporting documentation will not be accepted and the request for recognition as an approved provider will be declined.

  2. Explanatory Notes and Instructions

    1. Confidentiality

      This document and all the information contained in it are considered to be the property of Aviva, confidential and legitimately protectable.

      It is a condition of this registration form that you comply with all existing confidentiality undertakings and take all proper and reasonable precautions and measures against the contents of this registration document (and any other information gained regarding Aviva) being disclosed to any person not directly concerned with the response to this document.

      Where information contained in this registration document is necessarily disclosed to employees for the purposes of formulating the response, you must take all proper and reasonable measures to ensure that your employees keep secret and treat as confidential all information contained in this registration document (and any other information gained regarding Aviva).

      The information contained within this registration document is confidential and must not be copied, reproduced or distributed at any time. Neither Aviva nor you shall make any announcement or publicity concerning this registration document without the prior written consent of the other party. You should rely only on the information contained within this registration document, and any additional information supplied by Aviva in the clarification phase, in formulating your reply.

    2. Acceptance and Rejection of completed Registration Forms

      Neither the accessing of this registration document by you, the submission of any response by you, nor the evaluation of that response by us shall, in any way, commit Aviva to award to you any recognition for the provision of services by you or to enter into discussions with you regarding the possibility of such recognition.

      In particular, but without limitation, it should be noted by all respondents that Aviva may, in its absolute discretion without giving reasons:

      • Reject any incomplete or completed registration that does not conform to instructions and specifications herein.
      • Discuss, modify or clarify the terms of this registration form with the Respondent at a later date.
    3. Disclaimer

      While the information contained within this registration document has been prepared in good faith, the documents do not purport to be comprehensive or to have been independently verified. Aviva does not accept any liability or responsibility whatsoever for the adequacy, accuracy or completeness of, or make any representation or warranty, express or implied, with respect to the information contained in this registration document.

      Aviva reserves the right to change the registration procedure or terminate discussions without prior notice and at any time prior to the formation of any agreement relating to the process.

      This registration document is issued on the understanding that Aviva is not liable for any costs incurred by you in the preparation of this or subsequent documents. Certain elements of your response may ultimately by incorporated into any subsequent agreement between us, and you will be expected to warrant that the content of your response is and will remain true and accurate in all material respects and that you will notify Aviva in writing of any material change to the information provided.

    4. Asking Questions prior to Registration Submission

      Providers are able to ask questions to Aviva prior to submitting the registration document. Providers are advised that all communication with Aviva in respect of this registration must only be directed to the contact(s) below and to no one else, unless agreed in writing by the contact below first:

      Contact: Specialist Registration Team
      Email: hcreg@aviva.co.uk
      Tel: 0800 404 9418

  3. Terms of Recognition as an Approved Provider with Aviva

    1. Cover and Benefits

      The cover available to patients varies according to policy type. In all cases you are strongly advised to ensure that patients have received prior authorisation from us before proceeding with any treatment or investigation. You must make all efforts to ensure the patient you are treating is eligible for treatment prior to treatment taking place.

      Our claims team are happy to discuss eligibility of planned treatment, they can be contacted on 0800 158 3333.

    2. Specialist Fees

      Providers offered approved status subsequent to September 2013 agree to charge in accordance with our published fee schedule. A copy of our fee schedule can be found on our website www.aviva.co.uk/pmifees

      Providers must not ask any of our members to pay any additional amount themselves. In those instances where a member has a policy excess Providers will be advised in the remittance advice that a policy excess has been applied. In these circumstances members will be responsible for payment of the excess but only to the maximum of the applicable charges set out with our published fee schedule.

      Members will not be reimbursed for specialist fees where the provider is not an approved provider.

    3. New/Experimental Procedures

      Developments in medical practice mean that on occasion providers may wish to perform procedures that are not listed in our published fee schedule. In these situations we ask providers to contact our Hospital and Consultant Management Team on either 023 80354609 or hcfee@aviva.co.uk for advice, prior to the surgery being performed and a minimum of 7 days prior to treatment.

      We will require you to submit full anaesthetic and theatre records when requested.

    4. Supply of Equipment, Consumables & Drugs etc.

      Aviva Clinical Governance does not permit specialists to supply equipment, consumables and, or drugs directly or indirectly to our customers. Aviva specifies the purchase of these goods and services are permitted only for hospitals and registered facilities subject to full and current registration compliance with the appropriate governing body, currently the Care Quality Commission (CQC) and all such goods are for direct use within these facilities only. On request, governance assurances from these registered facilities will be provided to Aviva audit full compliances with health and safety risk management processes including (but not exclusive to):

      • Purchasing, handling and storing of drugs
      • Purchasing, maintenance, calibration and decontamination of equipment
      • Purchasing, handling and storage of consumables
    5. Clinic/Facility Recognition

      As above, Independent clinics and, or treatment facilities, rented rooms or otherwise allocated consultancy rooms will only be recognised if they have attained full and current registration compliance with CQC and on completion and assessment of Aviva’s Clinic Recognition procedures, demonstrating we are satisfied all relevant policies, procedures and processes evidence Aviva’s clinical governance requirements in full. These may include (but not exclusive to): lone worker and chaperone policies, emergency procedures, equipment purchase and calibration as per manufacture guidelines, decontamination and infection prevention and control, consumables and drugs purchase invoicing and cold store chain, and evidence of appropriate skills and training of staff, e.g. CPR, anaphylaxis and professional revalidation

    6. Request for Information

      In cases that require updates or where we have requested further information we ask that responses are prompt (within 72 hours) and in writing. This is to ensure cover is in place for on-going treatment.

    7. Case Management

      Aviva offers a number of health products and works in partnership with a number of Rehabilitation Case Management providers to support its customers. To facilitate the case management process we require providers to accept referrals directly from these Rehabilitation partners and to provide information and updates to these providers at their request to ensure continuity of patients’ care.

    8. Billing

      All providers are requested to bill Aviva electronically via Healthcode.

      For more information about electronic billing please contact Healthcode on 01784 263150 or visit ebilling.healthcode.co.uk

      Invoice Details

      To ensure the successful processing and payment of any bill submitted by a Provider, all bills must include the following information:

      • Name of Provider
      • Aviva Provider number
      • Name of payee and payee address
      • Invoice number
      • Invoice date
      • Member policy number (where the member policy number is unknown, the member name, member address and member date of birth will be required)
      • Member name
      • Member date of birth
      • Date(s) of treatment
      • CCSD code of the procedure(s) carried out
      • Description of the procedure carried out
      • Amount requested - per procedure
      • Amount requested – total

      Please ensure that you select the code and narrative that accurately describes the main procedure being carried out.

      Failure to include the above information on a submitted invoice will result in a delay of payment

      Where the procedure(s) performed is exceptionally complex, out of the ordinary, or not listed in our published Fee Schedule, please contact the Hospital and Consultant Management Team on 023 8035 4609 or hcfee@aviva.co.uk prior to surgery being carried out (if possible), or immediately following.

      We will require you to submit full anaesthetic and theatre records when requested.


      Some of the procedures listed our fee schedule incorporate other procedures which appear in their own right, but are also an integral part of the main procedure. Aviva will not pay additional fees where a procedure is unbundled, that is, broken down into its separate components and then charged for as an itemised list of procedures, where such an approach leads to a higher overall charge.

      A list of unacceptable code combinations with reasons can be found on our fee schedule.

      Examples of unbundling are:

      1. Main Procedure:
        • W8600 - Therapeutic arthroscopic operation on cavity of joint (not otherwise specified) (as sole procedure)

          This includes the lesser procedure:

        • W8700 - Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure).

          The lesser procedure should not be billed for separately.

      2. Main Procedure:
        • Q0710 - Radical Hysterectomy and lymphadenectomy (Wertheim's)

          This includes the lesser procedure:

        • Q2230 - Oophorectomy and salpingectomy. (as sole procedure) (including bilateral)

          The lesser procedure should not be billed for separately.

      Multiple Procedures

      If more than one procedure is performed we will normally pay for only the highest value procedure. Where we are satisfied that any other procedures performed do not form an integral part of the highest value procedure we will pay an additional 50% of the second and 25% of the third procedure. (We will not remunerate for more than three procedures).

      We do not reimburse additional charges for component parts of surgical procedures. As such we will not consider requests for payment for post-operative analgesia including nerve blocks. For these codes (including but not restricted to A5210, S5210, W9012, W9013, W9014, W9015, W9016, W9040 or A7350), the fee for pain relief is included in the main CCSD code.

      Bilateral procedures are shown as a separate code in most instances. If you are performing a procedure which is not listed in our published Fee Schedule, you should contact our Hospital and Consultant Management Team on either 023 8035 4609 or hcfee@aviva.co.uk

      Assistants /Treatment requiring more than one Specialist

      No additional fees are payable for assistants, as assistants are considered to be employed by the specialist.

      In those instances where a procedure requires specialists in two different disciplines to be present at the time of surgery, the lead surgeon must contact us to agree fee arrangements in advance of surgery.

      Local Anaesthesia/IV Sedation/Anaesthetic Blocks

      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 our published Fee Schedule and the published fee is the maximum payable by us, inclusive of any anaesthesia and/or sedation used.

      Aviva does however recognise that on-going 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 will be payable on accordance with our fee schedule.

      No additional fees for local anaesthesia will be payable by us, for those procedures where no anaesthetic value is shown on the fee schedule and which are not indicated by an * in the fee schedule.

      Anaesthesia fees including fees for blocks will be paid once only to the operator of the procedure.

      Notes for Anaesthetists

      Routine pre-operative assessment of patients is included in the anaesthetic fee shown for each procedure. Where extensive pre-operative management is required or a consultation prior to admission is necessary, you are advised to contact us to discuss further.

      Attendance by an anaesthetist during expected or planned intensive care (e.g. post cardiac surgery) is covered by the anaesthetic fee for the operation. Part of the routine post-operative management includes initiation of intravenous infusion for pain relief e.g. PCA and no separate fee will be paid for this.

    9. Payment

      Payment will be made monthly by BACS only. Each payment will be accompanied with a remittance advice detailing the following:

      • Patient name
      • Provider invoice number
      • Member policy number
      • Invoice amount submitted
      • Member liability (as a result of member policy excess)
      • Total amount paid

      In the event a policy excess applies our member will be made aware of the amount to pay you.

    10. Professional Registration and Professional Indemnity

      Evidence of current and unrestricted professional registration (i.e. GMC, GDC, HCPC) and UK medical malpractice indemnity (MDU/MDDUS equivalent) commensurate with their field of practice is required for all specialists and healthcare professionals who provide hands on care to Aviva customers. It is a professional’s responsibility to provide evidence of such annual renewals to Aviva on request.

    11. Audit

      Providers shall grant to Aviva (to include its employees), any governmental or regulatory body, auditors (whether internal or external), contractors and agents, the right, on reasonable notice to:

      1. Access any of the provider’s premises from where any of the services are managed or administered;
      2. Interview the Provider’s personnel; and/or
      3. Copy the relevant records, subject to the necessary consents.

      In order to:

      1. Investigate or identify suspected fraud or material accounting mistakes, in which case Aviva and any auditors of the Aviva Group or any governmental regulatory body or its authorised agents may discuss any matter with any Provider personnel as Aviva may reasonably require, and Aviva shall be under no obligation to inform the Provider of the objective of its investigation;
      2. Fulfil any request by any governmental or regulatory body in the course of carrying out its regulatory functions;
      3. Verify the accuracy of the fees and any other amounts payable or receivable by Aviva.
      4. Investigate any concerns raised with Aviva regarding the Provider’s service;
      5. Audit the Provider’s compliance with its obligations under the registration form.

      All submitted invoices will be subject to periodic audit. Where necessary a refund shall be paid to Aviva immediately, to include written assurance that future billing will be in accordance with our published fee schedule.

      Aviva also reserves the right to access, without notice, Healthcode in order to obtain quality measures regarding you the provider

    12. Fraud and Misrepresentation

      We act in good faith on the basis of information that members and providers give to us. We take a very serious view of fraud or misrepresentation in any claim. As a matter of policy we will investigate fully any incidence of suspected fraud or misrepresentation whether by members or providers of healthcare. Inaccurate billing is a matter of serious concern across the insurance industry and Aviva work closely with other insurers to address such issues and it would be prudent of you to ensure appropriate billing is reflected across your practice.

      In addition we reserve the right to withdraw our recognition of providers who have submitted fraudulent claims or misrepresented the circumstances of a claim so as to obtain or facilitate benefit that would not otherwise be eligible under the terms of our members’ policy.

    13. De-recognition

      Aviva reserves the right, at any time, without reason, to withdraw your recognition as a provider.

  4. Amendments to Employment or Personal Details

    In the event that your employment or personal details change, please contact Specialist Registration Team by email to hcreg@aviva.co.uk. All changes must be submitted in writing and include your provider number.

    You must inform us if any restrictions or warnings are made against your practice. Failure to do so may result in the removal of your registration with Aviva.

  5. Amendments to Terms and Conditions

    Aviva reserves the right to amend, add to or remove from these terms and conditions at anytime. Should such a change be made you will be notified by email.

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