Claiming funded vaccine

Programme dates

  • The 2021 Influenza Immunisation Programme will commence on 14 April 2021, for people aged 65 and over. 
  • FLUAD QUAD is only approved for use in adults aged 65 years or older.
  • The programme for people aged under 65 years is due to begin on 17 May.
  • The Ministry asks vaccinators to focus on immunising people eligible for a funded vaccine. 
  • The influenza vaccination programme runs to 31 December 2021. All groups can be immunised through to December.

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 FLUAD® QUAD

The Ministry of Health advised that PMS systems were updated in 2020 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