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Allied health professionals

For: Service providers Information seekers

If you are an allied health professional, we provide information on guiding principles set out in the Clinical Framework as well as steps for billing.


Clinical Framework

Comcare has endorsed the Clinical Framework for the Delivery of Health Services (PDF, 1.2 MB) which outlines a set of guiding principles for the delivery of allied health services to injured or ill employees. The principles include:

  1. Measure and demonstrate the effectiveness of treatment
  2. Adopt a biopsychosocial approach
  3. Empower the injured person to manage their injury
  4. Implement goals focused on optimising function, participation and return to work
  5. Base treatment on the best available research evidence.

The Clinical Framework is supported by the following peak bodies and associations:

  • Australian Physiotherapy Association
  • Australian Psychological Society
  • Australian Osteopathic Association
  • Occupational Therapy Australia
  • Chiropractors Association of Australia.

We expect providers of allied health services who are dealing with injured or ill employees to adopt these principles within the standards of their professions.

Medical certificates

Under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act), a medical certificate must be provided by a legally qualified medical practitioner if an employee wants to claim for income support. A legally qualified medical practitioner can be a general practitioner or a specialist, such as a surgeon, psychiatrist or a dentist.

However, if the employee is only claiming for treatment provided by an allied health professional, such as a physiotherapist or psychologist, a medical certificate may be provided by the allied health provider. The certificate must state a precise diagnosis and cause for the injury or illness.

The certificate is a form of medical evidence. Comcare's preferred medical certificate is the certificate of capacity as it fulfils the legal requirements of the SRC Act.

A completed state medical certificate or other medical certificate is also accepted if it meets the requirements of the SRC Act.

Treatment Notification Plans

When a plan must be completed

A Treatment Notification Plan needs to be completed when:

  • treatment is expected to exceed five sessions
  • there has been a gap in treatment of more than 12 months
  • the injured employee is attending a new clinic.

Forms

Physiotherapy forms:

Psychology or counselling forms:

Invoicing

See Billing for Treatment Notification Plans.

Billing and payments

Invoices should be sent to the employee’s claim manager. Ask the employee who their claims manager is or contact Comcare on 1300 366 979. See Table 1 for different claims management arrangements.

Table 1: Claims management arrangements in the Comcare scheme
For the employees of The claim is managed by
Australian Government agencies and statutory authorities Comcare
Australian Government agencies with a delegated claims management arrangement The employer, a claims management provider contracted by Comcare, or Comcare
Self-insured licensees The employer or their approved claims management provider

Employees of an Australian Government agency or statutory authority

The reasonable cost of allied health services for treatment of a work-related injury or illness can be paid as part of a claim when:

  • there is clinical justification for treatment
  • the treatment is likely to be effective and achieve or maintain measurable functional improvement
  • the treatment helps the employee move towards functional independence, participation and self-management
  • in the case of psychology and counselling services, an up-to-date referral (within 12 months) from a legally qualified medical practitioner has been provided.

Invoicing requirements

If Comcare is managing the employee’s claim, send invoices for approved services directly to us.

It is your responsibility as a service provider to make sure invoices submitted to us are correct, regardless of who has prepared the account.

Invoices must include:

Submit your invoice to Comcare:

We usually make payment within 28 days of receiving the invoice.

Billing for Treatment Notification Plans

We pay for the completion and submission of the Treatment Notification Plan that includes a consultation. See Rates for allied health treatment.

The item numbers are:

  • physiotherapy - PHYST1 (Consult with TNP)
  • psychology - PSYT1 (Psychology and Counselling Consult with TNP)

Typical billing may involve:

  • one initial consultation session
  • one consultation session with Treatment Notification Plan
  • three standard consultation sessions.

This is a total of five consultations including a Treatment Notification Plan.

Employees of a self-insured licensee

Payment rates should be discussed directly with the licensee. Invoices should also be sent directly to the licensee.

Page last reviewed: 03 December 2019
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Comcare
GPO Box 9905, Canberra, ACT 2601
1300 366 979 | www.comcare.gov.au

Date printed 08 Jul 2020

https://www.comcare.gov.au/service-providers/medical-allied-health/allied-health