Claims for Services provided to non-Eligible Persons. If the PHO Provides Services to a person who is not an Eligible Person, the DHB will be liable to pay Claims for those Services only if:
Claims for Services provided to non-Eligible Persons. If the PHO Provides Services to a person who is not an Eligible Person, the DHB will be liable to pay Claims for those Services only if: the PHO assessed the person's eligibility in accordance with the requirements set out in the Referenced Document entitled "Enrolment Requirements for Providers and Primary Health Organisations", and can demonstrate that it took reasonable steps to establish that the person was an Eligible Person and entitled to enrol in a PHO; and the PHO or the relevant practice is not required to remove the person from the Register or, from the NES Start Date, the National Enrolment Service, in accordance with the requirements set out in the Referenced Document entitled "Enrolment Requirements for Providers and Primary Health Organisations". No cost or volume shifting: We agree: the PHO must not knowingly be a party to any arrangement that results in the DHB effectively having to pay more than once for the provision of the same services; and unless otherwise agreed, neither of us will operate in a way that shifts costs or volumes between services and results in additional costs to either of us. This does not preclude movements of individuals between providers for reasons of good clinical practice. No double payment: Subject to subclause (5), the PHO may not Claim or receive a payment under this Agreement for services if the PHO is entitled to receive payment for those, either directly or indirectly, under any other agreement or arrangement with the DHB or any other organisation, Government body, or agency, including the Accident Compensation Corporation.
