Nurse and patient by MRI
Nurse and patient by MRI

Answering your questions

Changes to imaging for our Affiliated Provider programme

PACR process update

Following your feedback, we have made changes to the new Affiliated Provider agreement.

Please view these changes here:

Process

  • What is the deadline for submitting applications?
    28 March 2025
  • What process have you followed to develop this new contracting mode?

    Our objective is a sustainable radiology sector that delivers value to our members. We have listened to feedback from providers and taken that feedback on board when formulating our new approach. As part of this, we have arranged for comprehensive pricing analysis to be conducted, including independent benchmarking against national and international markets. We are satisfied that our new pricing is efficient, competitive, and sustainable for Southern Cross, our members, and our radiology providers.

  • Are you looking to reduce the number of providers in the market?

    No, we are happy to contract with any provider who agrees to the new terms.

  • If I choose not to accept the terms now but later decide I want to, can I reconsider?

    Yes, we are happy to consider acceptance at a later stage, if you choose to decline the terms initially.

Contracting

  • Is IANZ accreditation required for all imaging services?
    No, IANZ accreditation is only required for high-tech imaging services. We will make the necessary amendments to the new Affiliated Provider agreement to clarify this point.
  • What happens to the other services under my existing Affiliated Provider agreement that are not included in the new schedule?

    Any services that are out of scope in the new schedule can be transferred to the new Affiliated Provider agreement. These services will be included as a separate Appendix and will be subject to the existing pricing and price review terms as your current Affiliated Provider agreement. Examples of these services include consultations and surgical procedures. The new service levels and “one referral, one appointment” principle will not apply to these services.

  • If codes and pricing are standard, does that mean we can open anywhere without a new Affiliated Provider (AP) agreement?

    Radiology services are AP only, which means for members to receive funding under their policy, it must be performed by an Affiliated Provider (excluding UltraCare plans). We are happy to add any additional locations or enter into new AP agreements with any new facilities who can meet the standardised terms and conditions.

  • Will the price review in the new AP agreement be linked to CPI?

    The price review mechanism will be included in the draft AP agreement being supplied with the Proposed Agreement Change Request (PACR).

  • How do you plan to ensure providers are providing a quality service?

    We are introducing service levels into the new AP agreement. These will outline the value we are seeking on behalf of our members.

  • Imaging is a service industry driven by referrals from specialists. Are you working with specialists to ensure referrals are appropriate and not repeated?

    As the funder, we are not involved in the referral pathway. We trust that referring practitioners request appropriate imaging. We acknowledge that radiologists play an important role in ensuring any imaging undertaken balances the risks and benefits to the member, including repeat procedures. This may mean adjusting the radiology services delivered from those requested.

  • As new codes are developed for new technology/services, will we be updated with new codes as they become available?

    Yes, any updates to the codes will be notified to you. If you choose to add the new codes to your AP agreement, this will be recorded in a variation and signed by both of us.

  • Why have you included contrast in the scan price under this new model?

    Following feedback, we have accommodated contrast to be used only when required and not built it into the base scan price. We have also recognised the more expensive contrast mediums.

  • What do you mean by “standardised approach to secondary scans”?

    The system will apply a discount to second or subsequent scans when performed together in the same modality. The system will pay the most expensive scan at full price, then discount the second and any subsequent scans. For scans across different modalities, (e.g. MRI and ultrasound) - the discount will not apply. The percentage discount will be the same for all providers.