nib First Choice network

Information for providers

nib First Choice information for providers×

What is the nib First Choice network?

The nib First Choice network features nib recognised health service providers that provide our customers with services and treatment within nib’s First Choice price range. This means nib covered patients will have 100% of eligible costs covered (in line with their policy) when they see an nib First Choice provider.


What is the nib First Choice Portal?

The nib First Choice Portal will make receiving payments easier and faster. Specialists, hospitals and some other providers will soon be able to submit pre-approvals and claims on behalf of their nib patients.


Frequently asked questions

How do I know if I'm a First Choice provider?

nib will communicate to all specialist providers and affected facilities confirming their nib First Choice network status for the different services they provide.

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Do I need to agree to contract with nib to be a First Choice provider?

No. There is no requirement to be contracted to nib to participate. Providers will be automatically included within the network if they charge within nib’s First Choice price range and their status will be directly communicated to them.

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Do First Choice providers need to agree to a fixed price?

No. Providers will be automatically included within the First Choice network if they charge within nib’s First Choice price range.

We will be contacting all providers who charge higher than our First Choice price range to encourage them to join the First Choice network by agreeing to charge in line with this price range.

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As a GP or other referring service provider, can I refer my nib patients to providers who are not in the First Choice network?

Yes. GPs and other referring providers can still choose to refer nib covered patients to recognised health service providers that are not part of the First Choice network. When attending these providers, nib will pay up to an Efficient Market Price (a set price) for the treatment they need (in line with their policy), but patients will need to cover any costs charged by the provider over what nib agrees to pay.

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Does the nib First Choice network apply to all types of claims and providers?

The nib First Choice network focuses on the key health services our customers want and use. Visit the nib First Choice Directory to see if the nib First Choice network applies to the type of claim you need to make or the kind of medical provider you’d like to see.

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What is an nib First Choice provider?

An nib First Choice provider provides our customers with services and treatment within our First Choice price range. When customers choose an nib First Choice provider their claims will be covered for 100% of eligible costs, up to their benefit limit and in line with their policy.

Customers can choose other nib recognised health service providers and nib will still pay the Efficient Market Price (EMP) for the health services they provide. However they will be responsible for paying the difference between the amount the provider charges and the EMP (a co-payment).

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How do I become an nib First Choice provider?

nib First Choice providers qualify based on historical claim costs for procedures provided to nib customers. Each quarter nib reviews pricing to determine if a provider is added or removed from the First Choice network. There is no need to complete any contracts or forms.

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What is the nib First Choice price range?

The nib First Choice price range is the amount that nib recognised health service providers can charge up to for health services or treatments, before they are no longer eligible to be a First Choice Provider. If a recognised provider charges, on average, below this amount for a health service or treatment they will automatically be included within the network and we will cover 100% of their costs, in line with the policy terms and conditions.

We will work with those nib recognised health care providers that charge over this amount, with a view to bringing them into the network.

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What is an Efficient Market Price?

An EMP is the amount nib will pay for health services from an nib recognised health service provider that is not in the nib First Choice network.

nib commissioned independent analysis of health service costs across New Zealand to determine what our customers are currently charged by providers for treatment. This was used to establish an EMP that nib will pay for different health services, based on the average cost of procedures.

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What is co-payment? What does it mean?

If a customer chooses an nib recognised health service provider that’s not in the nib First Choice network, nib will pay up to the EMP for the health service they need. We’ll let customers know what this is when they apply for pre-approval, so they know what co-payment they’ll face, plus any other out-of-pocket expenses.

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How do I know if I am listed on the nib First Choice Directory?

The nib First Choice Directory will be published online and is searchable by: name, procedure, specialty, sub-specialty or location.

If you’d like to be listed as a provider in the nib First Choice Directory, please contact us on 0800 123 642.

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Why is nib making this change?

At nib we believe health insurance should be easy to understand, simple to use and most of all good value for our customers. That’s why we are developing the nib First Choice network. We have found that some specialist providers charge significantly more than others for providing comparable health services. nib pays for these charges when we pay customer claims. This means there are increasing claim costs that can result in higher health insurance premiums for our customers.

So from 1 September 2017 we’re introducing the nib First Choice network to improve the value customers get from their nib health cover by helping us to better manage claims costs and help to make premiums more affordable.

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Will the nib First Choice network be reviewed?

Yes, the nib First Choice network will be regularly reviewed and we will advise providers if their status changes.

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How can I make claims for my patients?

Once you have registered for the portal you will be able to log in and request payment for treatment, provided that pre-approval has been requested beforehand. Choose “Request a payment” from the top menu and enter the pre-approval number and patient’s date of birth.

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If I’m not in the First Choice network, can I still have access to use the nib First Choice Portal?

Yes

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Can my office manager or receptionist use the nib First Choice Portal on my behalf?

Yes they can. You can nominate any number of people to lodge both pre-approvals and payments on your behalf. This is accessed under the maintenance section of the nib First Choice Portal.

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How do I register for the Portal, can you help me?

Yes we can help you. If you require assistance to register as a provider in the nib First Choice portal, please contact us on 0800 123 642.

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There is a technical issue with my provider portal, how do I fix it?

If you require assistance with a technical issue in the nib First Choice portal, please contact us on 0800 123 642.

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My customer prefers to fill in forms instead, what should we do?

We encourage the customer to action these online. However if a customer insists on filling out the forms, they will need to contact nib at [email protected]; and we will be able to send a form to them.

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