Claiming funded vaccine

Programme dates

The 2020 funded Influenza Immunisation Programme runs from 18 March through 31 December in 2020

  • Funded influenza vaccine administered to eligible individuals aged 6 months or older can be claimed from 18 March 2020.
  • Pharmacist vaccinators with a contract to administer funded influenza vaccines can claim for influenza vaccination of eligible individuals aged 13 years and over from 18 March 2020.
  • Purchased influenza vaccination became available for the general public who are aged 3 years or older from Monday 27 April.
  • Important: Influenza vaccination for children aged 6–35 months (AFLURIA® QUAD JUNIOR) is currently available for children with a condition eligible to receive funded influenza vaccination.

NHI numbers

The patient’s correct NHI number is essential to process the claim - an incorrect NHI number (often adding the letter ‘o’ rather than a zero ‘0’) is the most common reason for rejected claims.

If you do not know your patient’s NHI number, phone Sector Services on 0800 855 151. You will need:

  1. Your payee number
  2. Patient’s surname, first name and middle name
  3. Patient’s gender and date of birth
  4. Patient’s previous address
  5. Any other name/s the patient has been known as

Electronic forms

Available via most Practice Management Systems.

Manual forms

Download the form at: 

www.health.govt.nz/system/files/documents/pages/immunisation-benefitclaim-details-form.pdf

Please note manual claims require District Health Board written approval. The written approval must accompany manual claims when sent to Sector Services.

Please select correct coding box.

Funded vaccines eligible for payment need to be submitted within eight months from the date the patient received the influenza vaccine. Funded vaccines eligible for payment must be administered within the subsidised period. 
Note: The second influenza vaccine dose for eligible children aged under 9 years must have been given within one month after the end of the subsidised period to be able to be claimed and only when prior approval has been given by your DHB.

General practices: Claiming for ZOSTAVAX® and INFLUVAC® TETRA or AFLURIA QUAD®

The Ministry of Health advised that PMS systems have been updated as of 18 March to enable dual claiming of zoster vaccine at the same time as influenza vaccines – claims for zoster and influenza vaccines administered before then can be manually claimed for.

Pharmacies: Claiming for funded influenza vaccination for 13–64 years

Pharmacists should claim for administration of all funded influenza vaccinations to individuals aged 13–64 years through their pharmacy system as they currently do for other funded influenza vaccinations. The Ministry is currently investigating the feasibility of amending ImmuniseNow to support the new funded criteria, and will communicate the findings to the sector once the investigation is complete.

For claim enquiries, please contact Pharmacy Claim enquiries on 0800 353 2425 and select option 1.

Patient eligibility and clinical queries contact
The Immunisation Advisory Centre (IMAC)
The University of Auckland
Phone: 0800 IMMUNE (0800 466 863)
Email: [email protected]

For manual claiming and Payment Queries
Call sector services contact centre on 0800 458 448