This resource was collaboratively developed with a GP clinic in St Kilda, Victoria. You are welcome to use this.
TAC Claiming Procedure for our GP Clinic:
- Verify Eligibility: Ensure that you and your clinic are registered medical practitioners under the Health Practitioner Regulation National Law (e.g., AHPRA). Confirm that the patient is a TAC client and their accident occurred within the last 90 days.
- Initial Treatment (Within 90 Days): Provide medical treatment and services without prior approval within the first 90 days after the client’s transport accident. Ensure that the treatment or service is recommended by a health professional, related to the client’s accident injuries, and aligns with the Clinical Framework.
- Continued Treatment (Beyond 90 Days): If you plan to continue treating a TAC client beyond 90 days, prepare a written request or treatment plan. Submit the request or treatment plan to the TAC for review. The TAC will assess the plan for reasonableness, clinical justification, outcome focus, and alignment with the Clinical Framework. Wait for the TAC’s decision regarding coverage and the duration of payment.
- Medication: Prescribe medication that is in accordance with the Pharmaceutical Benefits Scheme (PBS) and registered on the Australian Register of Therapeutic Goods. Refer to the TAC’s Medication Guidelines for additional information.
- Equipment: The TAC can cover Basic equipment provision without prior approval. Refer to the TAC’s Equipment Guidelines and complete the Equipment Prescription Form for specialised equipment. Submit the written request for specialised equipment to the TAC.
- Travel: If clinically justified, the TAC can help pay for travel costs associated with treatment in the community. Reimbursement may include travel time from the practitioner’s practice address to the appointment location. If multiple clients are visited during a single travel period, apportion the total travel costs equally between clients.
- Family and Group Services: Confirm family members’ eligibility for family counselling services by contacting the TAC. Family counselling services may be paid as part of a severely injured or deceased person’s claim in a transport accident. The Family Counselling Allowance amount depends on when a family member first accessed the service and is specified in the Transport Accident Act 1986.
- Referrals: You can refer TAC clients to nursing, allied health, essential medical and rehabilitation equipment, and family counselling services without prior approval immediately after a transport accident. Obtain prior approval from the TAC before the payment for specialist and other services.
- Surgery and Hospital Admissions: Prior approval is not required for surgical procedures within the first 90 days of the transport accident. For surgical procedures after the initial 90 days, submit a Surgery Request Form or provide a written request to the TAC. Include client details, surgeon’s information, description of the surgery, and clinical justification. Provide the hospital operation report for surgeries performed in a public or private hospital operating theatre.
- Reporting: Fulfil requests for reports from the TAC, providing requested information about the patient’s history, diagnosis, prognosis, progress, outcomes, capacity for work, and medical management. Different types of reports may be required, such as short, standard, comprehensive, or other specific reports. The TAC reimburses the fees for these reports based on the Medical Reports (TAC requested) costs for treating medical practitioners.
- Certificates of Capacity: Complete Certificates of Capacity as required to assess and certify your patient’s capacity for work during their treatment.
- Medical Excess: For accidents before 14 February 2018, determine if a medical excess applies to your patient by checking the TAC’s website. If applicable, invoice the client directly for the medical excess.
- Patients with Severe Injury: If your patient has a severe injury, discuss, make referrals, and seek approval for services as part of the independent planning process with the treating team and the TAC coordinator. Medical services may be included if the patient has an individualised funding package.
- Payment Rates: Medical services are paid based on the Medicare Benefits Schedule (MBS), following the TAC’s Medical Services Reimbursement Rates. If your fee exceeds the TAC fee, you may charge the client the difference as a gap payment. Surgical services payment follows the MBS explanations, definitions, rules, and conditions, with specific exceptions mentioned in the TAC guidelines.
- Ineligible Services: Note that the TAC does not pay for treatment and services included in a hospital inpatient bed fee, provision of a hospital operation report, GP participation in a GP return to work case conference not initiated by the TAC or vocational rehabilitation provider, or hire charges for surgical equipment associated with a patient’s surgery procedures.