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Services requiring prior approval

Prior financial approval is required before providing certain medical and/or allied health services to eligible veterans. The criteria for whether prior approval is required differs for some types of health services. You must submit a request before administering these services to be able to claim payment for the service.

When is prior financial approval required?

  • When the service you are providing has NOT been assigned an item number under the Medicare Schedule of benefits.
  • When the fee you charge for the service you are providing is ABOVE the fee stated in the relevant DVA Schedule of Fees. These schedules are on the DVA website.
  • When the service you are claiming is highlighted with shading in the relevant Schedule of Fees.
  • In the case of dentistry, all items on Schedule B, and items where the treatment provided is above the quantity and/or time limits that apply to the schedule. More about dental prior approvals.

If unsure if prior approval is required please contact the Provider Hotline number: 1300 550 457 (metro). For country callers, 1800 550 457- choose Option 3 then Option 1.

Please note: Previous approval for a service for an entitled person does not equate to approval for that service for the same person in the future. You most request prior approval for each instance of service, where prior approval is required.

How to request prior financial approval?

To request prior financial approval you need to

  • complete the relevant form/s,
  • ensure you have provided clinical justification for the service, and any other necessary supporting documentation,
  • email the form and any required supporting documents to Health.Approval@dva.gov.au

If you do not have access to email you can post the form and any required supporting documentation to:

Health Approvals & Home Care team
Department of Veterans’ Affairs
GPO Box 9998
ADELAIDE SA 5001

What forms and/or documentation do I need to submit?

There are specific forms for certain types of health services. See the list of forms below. If the service you provide does not have a specific form please complete form D1328 Treatment Prior Financial Approval Request form.

What to expect once you have submitted your request for prior financial approval

DVA will not automatically approve the request for prior financial approval. The approval process can take anywhere from one week to two months depending on:

  • whether all necessary documentation and information has been supplied;
  • the complexity of the eligibility for the service or for the veteran; and
  • the type of service being requested.

You can assist by ensuring that you follow all guidelines on what information and documentation to submit to request a prior financial approval.

DVA will always advise you in writing of the outcome of the request.

Prior Approval Requests specifically for Alcohol and Other Substance Abuse (AOSA) treatment programs

There are various treatment options available for eligible veterans requiring treatment for alcohol and/or other substance abuse. Information on these options can be found in Factsheet HSV140 – Alcohol and Other Substance Treatment Services.

The majority of these treatment options do not require prior approval where the treatment meets the criteria of having an MBS item number, and is within the DVA fee. Prior approval is also not required where the service is being provided by a hospital or facility that has a contractual arrangement with DVA. Treatments which do not have an MBS item number or are highlighted on the relevant fee schedule require prior approval.

DVA has a panel of community-based providers to assist in treating veterans experiencing alcohol and other substance use disorders. The list of providers on this panel is available from the DVA online mental health portal. DVA strongly encourages the use of contracted hospitals or providers on this panel in the first instance, as they have undergone rigorous screening.

A list of private hospitals and mental health private hospitals who are contracted with DVA is available on the DVA website.

Where there are no vacancies with approved providers, or there is a compelling clinical need for an individual to access services not provided by the facilities on the panel (or with a contracted hospital or provider) a non-contracted provider may be used. In this instance you will need to seek prior approval using the formD9314 – Prior Approval Request for Treatment of Alcohol and Other Substance Abuse’.

Please ensure that you check whether the veteran is eligible for treatment prior to requesting prior approval. You can check this by calling the Provider Hotline on 1300 550 457. Where the veteran does not have an accepted condition relating to alcohol or substance abuse they may still be eligible for treatment under DVA’s Non Liability Health Care arrangements. The veteran will need to contact DVA to register for non liability health care.

Where an individual is in crisis or there is an acute emergency, they should be admitted to a public hospital in the first instance.

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