POAC Frequently Asked Questions
ELIGIBILITY
Who is eligible to receive POAC services across the Auckland region?
The following criteria apply:
The patient would otherwise require an acute referral or admission to a hospital within the Auckland Metro Region.
The required health care can be provided safely in a community setting.
The patient is eligible for funding in New Zealand (NZ Residents; UK or Australian citizens visiting New Zealand; visitors residing in New Zealand who hold a working visa with continuous stay of two years or more). Refer to the Health New Zealand website for more details on public healthcare funding here.
The required treatment is NOT available using an alternative funding stream (ACC, Maternity, NASC, Taikura Trust) or private insurance.
The condition or management is not excluded in any of the POAC clinical policies
REFERRAL AND CLAIMING PROCESS
How do I submit a referral and claim for services?
Submit the initial referral at the time the patient is placed under POAC. This can be submitted using the electronic POAC form (myPractice or Medtech) or by faxing a POAC referral form.
Once all acute care has been completed, discharge the patient from POAC and submit a final claim either by sending in the completed referral form or electronically by submitting the Outcome + Invoice. Ensure all clinical notes are provided to support the claim.
Do I need to phone for approval to initiate a referral?
You may start a referral at any time. If you are uncertain whether the patient is eligible, phone POAC to discuss.
Some referrals may require clinical endorsement by relevant hospital specialist service. Refer POAC clinical policies and pathways for more information.
All paediatric (0‐14 years) radiology services need to be endorsed by the on‐call Paediatric Consultant.
How can services be accessed for patients?
Practice based services can be provided as clinically indicated. No prior approval is necessary.
POAC funded X‐Rays where required acutely (same day) can be accessed by referring the patient to a community based radiology department. Ensure the POAC case reference number is documented on the radiology request. NB: POAC fund for acute/same day X‐rays only, repeat CXRs are not funded by POAC. Refer to the radiology section in the POAC Information Manual or website for further information and access criteria.
All other services can be accessed by phoning the POAC co‐ordinator (09) 535 7218 to arrange on behalf of your patient.
How do I get a case reference number?
The POAC case reference is automatically generated when referring electronically via the Practice Management System or via the online referral form. Ensure this number is quoted on all service requests and invoices.
Does the patient have to pay for any services?
The patient pays the initial consultation to General Practice or Urgent Care Clinic as per normal. The patient may also be charged by St John if POAC has been initiated following an ambulance callout and assessment.
All other costs are covered by POAC for the acute episode of care (usually up to 3 days).
How much can I claim?
Refer to the claiming guide (www.poac.co.nz) which has been developed to assist in the claiming process.
A set fee has been applied for some commonly used services. GP consultations can be claimed based on the individual practice normal fee for a casual patient. No GMS should be claimed for POAC visits.
What can I claim if I have used POAC to access to radiology services?
POAC will fund a GP review (within 24 hours) following the investigation to discuss results and management plans. This would usually conclude the POAC episode and any ongoing care would revert to standard primary care funding and the patient would be responsible for ongoing charges.
The radiology services will be invoiced to POAC directly.
Is there a fixed budget per case?
No, there is no fixed budget per case. Each episode of care is reviewed on the individual requirements against the POAC funding criteria.
Refer to the POAC claiming guide for information on what services can be claimed and the specific clinical criteria that apply.
External services are pre-approved by POAC (ultrasound, CT, residential care, home support, transport) based on individual clinical (or social) requirements.
How are claims submitted by external providers?
External service providers can submit an invoice to POAC using the POAC case number as a reference and email accounts@poac.co.nz.
Who can assist with claims or account queries?
Phone (09) 535 7218 to discuss specific and time-sensitive cases.
Email any account queries to accounts@poac.co.nz
Can services be accessed for the same patient for more than one episode?
Yes, funding is allocated per patient, per episode of care. The patient must meet the normal POAC clinical criteria each time for the case to be eligible for funding. There is no limit to how many times a patient may be referred.
Does the patient need to be enrolled with a practice?
No. Patients do not need to be enrolled with you or any other practice to receive treatment under this service.
What if the patient is registered with another GP?
When a doctor who is not the patient's registered GP refers a patient to the service, the initiating doctor agrees to advise and hand over care to the patient's GP at the earliest opportunity.
What if the patient is visiting from another part of New Zealand or Overseas?
Patients visiting Auckland who would be referred to one of the Auckland Metro hospitals are eligible for funding under the service. Under these circumstances, the referral will be under the District where the practice is located.
DEFINING A POAC EPISODE OF CARE
When do I initiate POAC?
POAC is a funding stream and co‐ordination service available to support community based healthcare for patients who would otherwise require acute admission to one of the Auckland Metro hospitals. An episode of care covers the acute phase of care (normally the period of time they would have been an inpatient, had they been referred to hospital).
A POAC referral should be initiated at the time the patient would otherwise be referred acutely to the hospital.
When should an episode of care end?
The patient would be discharged from POAC once they are medically stable and no longer need the intensive care funded by POAC. The episode of care would usually be between 1‐3 days, depending on the clinical management required and the individual patient's needs. During this acute episode, it would be expected that the patient is seen on consecutive days.
There are occasions where extended care is required and this may be approved by discussing with POAC by emailing referral@poac.co.nz.
Can a referral be made to POAC as a safety net to review the patient?
Initiation of POAC solely to review the patient the same day or the following day (where the patient is not acutely unwell and acute hospital referral is not indicated) is not an appropriate use of funding and claims of this nature are unfortunately unable to be accepted.
When do I refer to POAC for a patient who may need radiology services?
The initial work-up of a patient, including blood tests and observations, is part of primary care management and is not funded by POAC.
A referral to POAC should only be initiated once it is decided that the patient requires an acute (same-day) radiology investigation to avoid an acute hospital referral.
Further information can be found online www.poac.co.nz/radiology
Will POAC provide funding for stabilising a patient pending hospital admission?
POAC funding is available only where there is a delay in ambulance transfer to hospital of greater than 30 minutes. See further information here.
POAC funding should not be used where a hospital admission is imminent and immediate transportation occurs.
SERVICE HOURS
What hours is POAC available?
A patient may be referred to POAC 7 days a week, 24 hours IF the service required is available within the clinically appropriate timeframe.
Radiology services can be requested online or the radiology form can be emailed to referral@poac.co.nz. These will be coordinated the next business day.
Home Support Services can be referred 7 days per week and will be arranged upon receipt of referral by the Homecare provider.
Residential Care placement requests may be referred any time but admission is usually limited to business days, before 3pm.
X‐Ray services are available after hours. Please check with your community provider before referring a patient to ensure they are open and available for urgent reporting.
POAC coordination service is available by phone between 8.30am and 4.30pm, Monday to Friday.
CLINICAL
What clinical conditions are accepted?
We encourage consideration of using POAC for any situation where you would otherwise refer the patient acutely to the hospital. This decision is based on the clinical assessment of the patient where care can be safely delivered in the community. This may include referral for psychosocial reasons.
Clinical pathways and policies are available online www.poac.co.nz/clinical to support the management of some of the more common conditions.
Who takes clinical responsibility for the patient?
The clinician who initially refers the patient carries the ongoing clinical responsibility for the patient unless specifically handed over to the care of another clinician.
What happens if my patient eventually needs to be admitted?
It is understood that some POAC cases may require hospital referral for further management. If hospital admission becomes necessary, refer the patient to hospital services following standard protocols. POAC will cover services provided up until the point of referral to the hospital.
It is crucial that patients are admitted when clinically indicated—risks should never be taken to avoid hospital admission.
What if my patient refuses hospital admission against clinical advice?
For medico-legal protection, it is recommended to complete a disclaimer form signed by the patient. Further information and the disclaimer form are available on the POAC website.
Who can assist with medical management advice?
The hospital-relevant specialist may be contacted for medical advice. Contact your local hospital for discussion.
What type of cellulitis cases should be claimed under ACC?
Aside from normal trauma such as infected cuts/wounds, ACC provide funding for Cellulitis resulting from any direct trauma. This includes insect bites/stings, spider bites, animal bites, human bites, tattoos, blisters. Post‐operative wound infections are also covered under ACC funding.
ELECTRONIC CLAIMING
How does POAC electronic claiming work?
The POAC electronic claiming system integrates seamlessly with Medtech 32, Evolution, My Practice, and Indici, allowing referrals and claims to be submitted electronically directly from your PMS to POAC.
Is there any cost?
No, this service is free of charge. However, the practice must have access to the secure health network to use it.
How do I set up electronic claiming?
You can find the link to install the POAC form, along with detailed installation and user instruction manuals, on the POAC website here.