A practical SHA dialysis claim-readiness checklist

How to use this checklist

Use the checklist as an internal working review. It does not replace current SHA instructions and it cannot guarantee approval. Requirements and system behaviour can change, so keep the facility’s live guidance and response history beside the checklist.

Patient and coverage

• □Patient identity is consistent across the record
• □Coverage or eligibility status is recorded at the point of care
• □Required consent evidence is available
• □Facility and practitioner details are current

Preauthorisation

• □The course or session requirement is identified
• □The available preauthorisation reference and status are attached
• □Dates and treatment scope match the clinical record

Clinical record

• □The dialysis flowsheet is complete and legible
• □Prescription, observations, medicines and interventions are recorded
• □The clinical summary matches the underlying session
• □Required nurse and doctor review or signatures are present

Billing and evidence

• □The bill is itemised from the delivered session
• □Access type, medicines and consumables match the clinical record
• □Supporting documents use consistent patient and treatment dates
• □The package has been checked for missing or conflicting items

Follow-up

• □Hand-off date and available reference are recorded
• □Status changes and return reasons are preserved
• □Each correction has an owner and date
• □Resubmission and payment follow-up remain visible

Why the status trail matters

The Social Health Insurance Regulations describe a central platform that supports preauthorisation, claim processing, follow-up and payment for contracted facilities. A facility still needs its own accountable record of what it prepared, handed off, received back and corrected. Read the Social Health Insurance Regulations.

Digital health obligations sit beside claim rules

The Digital Health Act establishes a framework for digital health services, privacy, security and health information exchange. The 2025 health information management regulations also set certification and evidence requirements for digital health solutions. Facilities and vendors should verify the current position rather than treating technical readiness as certification. Digital Health Act, 2023 and Health Information Management Procedures Regulations, 2025.