Medical and related services

Allied health practitioners

Allied health practitioners are health professionals engaged to help workers recover from a work-related injury/illness.

The allied health practitioners most commonly involved in workers compensation claims include (but are not limited to):

• physiotherapists
• chiropractors
• osteopaths
• exercise physiologists
• psychologists
• counsellors.

In order to deliver treatment services in the NSW workers compensation scheme, the allied health practitioners listed above must be approved by SIRA. Approved practitioners are issued a provider number.

Other allied health practitioners such as podiatrists, occupational therapists and massage therapists do not require SIRA approval.

The role of allied health practitioners

Allied health practitioners use evidence-based clinical intervention (treatment) and management to help the worker in their recovery through work/return to work. The allied health practitioner’s role may include:

• conducting a detailed assessment of the worker and (where applicable) providing information to inform and/or confirm diagnosis, and develop and implement treatment strategies
• obtaining information from the worker, insurer and/or employer to help with goal-setting and treatment interventions
• treating the worker in accordance with the Clinical framework for the delivery of health services
• setting expectations regarding recovery through work/return to work, active participation in recovery, planning and treatment
• using the Allied Health Treatment Request (AHTR) (see ‘Communication with allied health practitioners’ below) to inform the insurer of the worker’s progress and capacity for work
• educating all parties about the health benefits of good work.

Clinical framework for the delivery of health services

Allied health practitioners should provide health services in accordance with the Clinical framework for the delivery of health services. The framework outlines a set of guiding principles intended to support healthcare professionals in their treatment of an injury through:

• measurement and demonstration of the effectiveness of treatment
• the adoption of a biopsychosocial approach
• empowering the worker to manage their injury
• implementing goals focused on optimising function, participation and return to work
• basing treatment on the best available research evidence.

Communication with allied health practitioners

It is the role of the insurer to establish and communicate the worker’s goals with all stakeholders, including allied health practitioners. This ensures everyone is focused on the same goals and timeframes.

The AHTR is the primary communication tool for allied health practitioners to inform the support team of the worker’s recovery and the provision of services.

The AHTR allows allied health practitioners to:

• describe the impact of the injury on the worker in terms of reported and observed signs and symptoms, as well as their capacity to engage in their roles at work, home and in the community
• set goals and empower the worker to be actively involved in their recovery
• outline an action plan
• demonstrate the effectiveness of treatment using measurable outcomes
• request approval of treatment services, including equipment needs and case conferencing
• indicate the anticipated timeframe for recovery
• receive an insurer decision to their treatment request.

Practitioners can request approval for up to eight treatment services on a single AHTR form. However, they should only request the number of sessions they believe the worker will need.

Questions about treatment

If an insurer has concerns regarding the duration, frequency, or nature of the treatment, or whether it is reasonably necessary, they should contact the allied health practitioner directly to discuss the issue. If this does not resolve the issue, a referral can be made to an independent consultant.

An independent consultant is an allied health practitioner approved by SIRA to provide an independent peer review of allied health practitioner treatment (either physical or psychological). They can be called on to provide expert opinion or advice regarding treatment and any barriers to the worker’s recovery. See 'Independent consultants'.

Insurers must use the independent consultant referral form to engage an independent consultant.

Fees and invoicing

In most cases, the allied health provider will forward an invoice directly to the insurer.

The provider is not permitted to directly bill the worker for services related to the claim.

Fees for allied health providers are set out in the relevant Fees and practice requirements.

The Fees and practice requirements specify how much can be charged and what codes providers are to use. Fees and practice requirements specify the maximum amount payable per service and any service restrictions and reiterate that workers are not liable for these costs.

No fees are payable for cancellation or non-attendances. Pre-payment of fees for reports or services is not permitted.

Invoices should include:

• the worker's first and last name, and claim number
• payee name, address, telephone number and email address
• payee Australian Business Number (ABN)
• name of the relevant service provider who delivered the relevant service
• in the case of allied health services, the following provider numbers: 
  • the provider’s SIRA approval number (where applicable*), and
  • the provider’s AHPRA number/professional association accreditation/membership number
• relevant SIRA payment classification code. Refer to the relevant Fees Order and the Workers Compensation Insurer Data Reporting Requirements.
• service cost for each SIRA payment classification code and service duration (if applicable).
• the date of service
• the date of invoice (must be on the day of or after last date of service listed on the invoice)

*INT0000 is to be used by interstate providers without an approval number and EXT0000 for service providers without an approval number providing services to exempt workers.

To prevent delays in payment, these details need to be provided on all invoices.

Treatment provided by an allied health professional other than a physiotherapist, chiropractor, osteopath, exercise physiologist, psychologist, counsellor or massage therapist is not covered by Fees and practice requirements.

The insurer should negotiate an appropriate fee prior to the commencement of treatment, taking into account existing Fees and practice requirements, and what would be customarily paid in the community.

Interstate allied health practitioners

Sometimes NSW workers may be treated by interstate providers. Even though they are in a different state, these providers must adhere to the NSW workers compensation scheme requirements.

NSW legislation states that interstate treatment providers delivering services to NSW workers do not need to be approved by SIRA (unless issuing certificates of capacity), however, they do need to meet the approval criteria (other than the completion of the NSW allied health practitioner training).

Interstate treatment providers cannot access exemptions from prior approval unless the treatment is provided within 48 hours of the injury occurring.

When invoicing, interstate practitioners should use the service provider code ‘INT0000’ if they do not have a SIRA approval number. In addition, they need to state on their invoice their AHPRA registration number or professional association accreditation/membership number if their discipline is not eligible for registration with AHPRA. Fees charged cannot exceed the maximum fee payable in NSW.