Helping Southern Cross members claim

Monday, 9 November 2015 by Kelsey Fletcher


For Affiliated Providers

Standard process

If a Southern Cross member needs a healthcare service that you are contracted for, please request prior approval through the Affiliated Provider system, Provider Web.

Processing mixed Affiliated Provider/non-contracted services

Sometimes a member’s treatment includes several healthcare services on the same day. One service might be contracted and the other might not. When this happens, you need to request approval for the contracted service(s) through Provider Web, then request approval for the non-contracted service by contacting your Relationship Manager with full estimates and a description of the service. Let the member know you are requesting approval for the non-contracted service and that Southern Cross will contact them if we have any questions. The Relationship Manager will help organise approval for the non-contracted service with the Claims Approval team and the member.

In most cases, an approval letter should be sent to the member within five working days. Where approval for the contracted service has been given through Provider Web, the Affiliated Provider can claim via Provider Web as soon as the healthcare service has been performed. For the non-contracted service, the provider must invoice the member who will need to submit a claim in order to get reimbursed.

For non-contracted providers

Standard process

Southern Cross members can confirm cover under their policy via our prior approval service. Members must obtain prior approval if the cost of the healthcare service is likely to be more than $1,000 or where it involves any hospitalisation (including day stay or in patient surgery). Members can call us on 0800 800 181 or apply online through My Southern Cross, our secure online service for members. After treatment, members need to submit a claim in order to get reimbursed. They can do this easily online or by downloading a claim form, attaching their invoices and posting to us.

Requesting prior approval on behalf of a member

We frequently receive letters and emails from non-contracted providers requesting prior approval on behalf of Southern Cross members. These requests can only be processed once the member gets in touch with us as there is additional information that needs to be collected from them. It is not necessary for providers to send us these requests as we can often get the details we need from them over the phone. Alternatively, providers can supply all the relevant information to Southern Cross members so that they can contact us directly for prior approval.

For providers wanting to apply for prior approval on behalf of a Southern Cross member, we offer this benefit through the Affiliated Provider programme. If you would like to offer this service to members, please contact us about joining the Affiliated Provider programme on 0800 770 843 or email