How to request services on behalf of a CTP Care client

Information about the services CTP Care pays for, how to request services and the reasonable and necessary criteria.

CTP Care pays for treatment and care for people who have a long-term injury caused by a motor accident in NSW and who have an accepted claim with a CTP insurer.

Each client has a dedicated CTP Care contact who can guide you and the client through the request process as needed.

Services we pay for

CTP Care pays for reasonable and necessary treatment and care related to the client's motor accident injuries. Services can include:

  • medical treatment, including pharmaceuticals
  • dental treatment
  • rehabilitation
  • ambulance transportation
  • respite care
  • attendant care services
  • aids and appliances
  • prostheses
  • education and vocational training
  • home and transport modification
  • workplace and educational facility modifications.

Steps for how to request services for a client

  1. Ensure the client is aware of and in agreement with the requested service(s)
    The client must be aware of and in agreement with the treatment and care request before you submit the request to us.
  2. Obtain prior approval

    You should not deliver treatment and care services until you have obtained approval for your request.

    If you assess the client's needs as urgent, please contact us immediately as we may be able to arrange for urgent, short-term approval while the service request is being processed.

  3. Use State Insurance Regulatory Authority (SIRA) request forms
    Use SIRA request forms to request treatment and care.

    Note: In some instances, we may guide you to use CTP Care request forms, for example, if a client has complex needs such as a need for prosthetics.

  4. Include CTP Care payment codes on the request
    Include CTP Care's payment codes (PDF, 0.14MB) on the request you submit to us. If you are unsure what payment codes to use contact the client's CTP Care contact.
  5. Provide evidence of how the requested service meets SIRA's reasonable and necessary criteria and clinical framework for treatment
    All requested services must be linked to the client's specific goals when submitting a request. Include relevant information such as reports, standardised outcome measures and evidence to address SIRA's reasonable and necessary criteria with the request.
  6. Email CTP Care

    Email treatment and care requests and relevant reports to
    In the email subject heading, include the client’s full name and CTP claim number. 

What happens next?

We'll formally communicate the decision to you in writing within 10 days of receiving the request. We'll explain to you in writing if we don't approve a service.

We communicate approved services to you via a Service Approval/Purchase Order.

How to address the reasonable and necessary criteria

When requesting services for a client, address SIRA's reasonable and necessary criteria by providing evidence that the service:

Directly relates to injuries sustained in the motor accident

The request should only propose services for a client's accepted injury/s. We can only fund services for the injuries sustained in the motor accident for which the person became a client in the NSW CTP Scheme from 1 December 2017 onwards. If the client needs services for pre-existing or subsequent conditions, the client will need to seek funding through other avenues.

Will help the client return to their pre-accident functioning

Write the request in an objective, measurable and functional way. We cannot approve services if they are a duplication of services already provided by somebody else for the same purpose. For example, concurrent physiotherapy and chiropractic services that address the same injury-related need.

Is appropriate for the type of injury the client has

The requested services should be professionally recognised or supported by research evidence to deliver results for the purpose intended in the request.

Is provided by an appropriate service provider that can meet the client's injury-related needs

Also consider the provider's location; providers should be local to the client.

Is cost-effective

Demonstrate the cost-benefit of the service or item. For example, there should be no less-expensive alternatives readily available to the client.

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