Frequently asked questions

Please ensure that the patient has contacted us PRIOR to any treatment taking place. The patient should give you their authorisation number at their very first appointment.

No, different policies provide access to different hospitals. The patient would be advised of the hospitals available to them at their initial call to our Claims Team. For any further information in relation to a specific patient please contact the claims team on 0800 158 3333.

To ensure you have the greatest chance of receiving referrals from Aviva, we recommend you;

•  Work within our fee structure as a ‘Fee Assured’ Practitioner
• Maintain your practitioner profile with details such as Specialty/Subspeciality, Practice Privileges and any Paediatric capability.
• For Mental Health practitioners, you may wish to register with;
  Onebright Mental Health and/or Vita Health Group
• For Physiotherapists, you may wish to register with IPRS Heath, HCML and/or Vita Heath Group. 

Invoices must be sent directly to us following treatment, please do not invoice the customer unless they have specifically requested you do so, as part of a self pay agreement. 

Invoices can be submitted via Healthcode or the Aviva Online Billing Platform.

Aviva are committed to being a net zero company by 2040, with a net zero operations and supply chain by 2030, therefore all invoices must be submitted electronically. Our preferred method of receiving medical bills is via Electronic Data Interchange (EDI) via Healthcode. Alternatively, you are able to invoice Aviva via the Aviva Online Billing Platform.

At Aviva we strive to ensure timely settlement of invoices, our standard practice is to process and pay invoices within 7-10 working days from the date of receipt.

However, we adhere to the industry-standard payment term of 30 days. This means whilst we aim for prompt payment, the official payment term is 30 days. If you have any concerns or enquires regarding the status of your invoice, please do not hesitate to contact Aviva Bill payments team 0800 015 0107, Mon - Fri 8am - 6pm 

Aviva recommend all practitioners are paid via BACS. This enables payment to be faster, more secure and more efficient, supporting Aviva’s commitment to sustainability.

To switch your invoice payments to BACS, you can request the update directly through the Healthcode Register.

As an Aviva registered Practitioner, you agree to charge in accordance with our published fee schedule as per our Practitioner terms and conditions.

It is important to us that we provide our customer with a fee assured journey and that our premiums remain sustainable. As a result, we are no longer allowing Practitioners to move away from a ‘Fee Assured’ status. 

When setting fees, Aviva consider several combined factors such as patient factors, complexity, operation time, skill level and specialism, private sector conditions and market conditions.

It is important that the fees we pay consultants appropriately reflect procedure complexity, consultants’ skills and expertise, yet allow us to keep our premiums affordable for our customer.

We are committed to our ongoing fee review programme and our Clinical and Commercial team meet monthly to discuss the appropriateness of the fee schedule and individual codes.

All published fees are based on a single surgeon approach. If you are undertaking a dual/multi-handed approach, please see ‘How do I request agreement for a multi-surgeon approach?’

In the case of therapies, our fee is per session/treatment, rather than duration. The duration of the session should be determined by the clinical need of the patient. We would settle one session, per patient, per day, irrespective of duration.

Invoices must be coded using the most clinically appropriate industry standard CCSD code. If any procedure is undertaken which does not have a CCSD code, specialists should contact CCSD to request a new code 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 by the National Institute for Health and Care Excellence. Please contact the Practitioner Team for more advice by email: avivapractitioners@aviva.com or by phone: 0800 015 7756.

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. 

Please contact the Practitioner Team to discuss PRIOR to treatment taking place by email: avivapractitioners@aviva.com or by phone: 0800 015 7756.

Subject to the customers terms and conditions, Aviva provide benefit for robotic assisted surgeries, where the procedure is represented by an approved CCSD code and is approved by NICE guidelines.

All fees within the published fee schedule are based on a single surgeon and a non-robotic approach. We do not remunerate at a higher fee where there is robotic involvement, nor would we automatically expect there to be uplifted fee’s for an assistant or a multi-surgeon approach, solely attributed to the use of the robot.

Please see ‘How do I request agreement for a multi-surgeon approach?’

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.

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

Or

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

Or

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.

In cases where a patient stays longer than the norm, or where treatment is of a complex nature. For more information, please contact our claims helpline on: 0800 158 3333.

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.

In those instances where our customer has a policy excess, these are settled directly by the customer. Invoices should be submitted directly to Aviva and our claims system automatically deducts the excess from relevant invoices. We will advise you in the remittance advice that a policy excess has been applied and make the customer aware which provider to make payments to. You must not charge more than the applicable excess charges.

Aviva are unable to intervene in disputes regarding non-payment of excesses however, we do ensure the customer is fully aware of any costs for which they are liable.

If you have a query regarding an excess payment please call our Helpline on 0800 158 3333.

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.

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 0800 015 7756 or email us at: avivapractitioners@aviva.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 - 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.

As set out in the Terms and Conditions for Providers, it is important that you submit invoices promptly. Invoices submitted after a period of 6 months from the date of treatment will be declined. If this happens you agree not to contact the patient for payment.

No, as per the Terms and Conditions, you must not provide 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.

On occasion, where Aviva’s published fee Is not satisfactory due to extreme circumstances outside of expected parameters, we have a process in place to consider more appropriate fees retrospectively. 

Please contact avivapractitioners@aviva.com to obtain an uplifted fee form, which will advise of the requirement to consider such requests.

Uplift requests need to be submitted within 6 months of the surgical date otherwise they are at risk of being declined.