Transport Accident Commission patients

Invoicing TAC for activity

Funding arrangements for TAC patients are detailed annually in Part 2: Funding and activity levels of the Department of Health (DH) Policy and Funding Guidelines.

DH receives funding directly from the TAC for NWAU-funded separations. DH in turn cash flow hospitals accordingly. Separate uncapped TAC NWAU targets have been incorporated into hospital budgets, based on prior year throughput reported in the VAED, VEMD, and VINAH.

For more information, please visit the Transport Accident Commission (TAC) website.

How the payment process works

For DH to receive payment from TAC, TAC must accept the claim and issue a claim number. The patient information reported by the hospitals to DH via VEMD, VAED, and VINAH must match exactly those held by the TAC for each admitted patient separation (discharge date). Details of the new data elements required to assist in this process are published to the VEMD, VAED and VINAH as updated at Health Data Standards and Systems (HDSS).

DH will pay hospitals a rate applicable for all accepted TAC patients matched with TAC records (as reported in the VEMD, VAED and VINAH) including numbers in excess of the published target. If hospitals do not achieve their TAC target, any above target funding which has been cash flowed will be recalled at the full TAC rate in the prior year adjustment (PYA) process. It is imperative that hospitals ensure that their own records are complete, comprehensive and timely.

Hospitals should only accrue revenue for accepted TAC records. It is preferable that denied TAC records are resubmitted as public. Any remaining denied records will be automatically funded as public in the prior year adjustment (PYA) process, up to the agreed public or private NWAU target.

DH will provide health services with information where claims could not be paid. Hospitals should use this information to either amend and update TAC records via the VEMD, VAED and VINAH or reclassify as a public patient, depending on the denial reason. This will ensure that updated records will be accepted by TAC and therefore minimise delays in reconciling activity and payment for records with TAC.

Lodgement and payment process

The TAC has simplified the hospital claim lodgement process for public hospitals to enhance the TAC client experience. This will allow streamlined lodgement and billing certainty for hospitals.

For hospital claims lodged online, the TAC can provide hospitals access to the Provider Online Services (POS). This is a digital platform for the hospital to confirm the status of the claim and access the claim number for eligible patients within three to five business days of the lodgement. This then allows the hospital to update its records in a timely manner.

To assist the TAC’s ability to efficiently determine a patient’s claim entitlement, hospitals are requested to ensure details of the injuries sustained in the transport accident are included when lodging a claim or providing hospital documentation (e.g. discharge summary, certificate of capacity). Hospitals also need to ensure they have the consent of the patient or their relatives to lodge the TAC claim on their behalf.

TAC clients have 12 months from the date of accident to lodge a claim with the TAC. Where health services can facilitate the lodgement process on behalf of and with the consent of the client, it will assist in both the timely payment of TAC activity and enable earlier access to treatment and supports for the client.

For more information about the TAC hospital lodgements process or POS access please contact the lodgements team via email lodgements@tac.vic.gov.au, or phone (03 5225 7600).

For hospitals that are not yet engaged with the TAC online lodgements portal, hospitals and/or patients can continue to lodge a claim under the existing arrangements and are encouraged to contact the TAC for claim lodgement by calling 1300 654 329.

TAC hospital learning module

The TAC has an online learning module (TAC Hospital eLearn) to provide Patient Liaison Officers (PLOs) or relevant hospital employees with up-to-date information regarding the TAC, and how to lodge electronic claims for clients. This can be accessed in the Hospital Lodgement Portal or on the Transport Accident Commission website.

It is recommended hospital staff complete the online training at least once per year, so they are equipped with up-to-date information to discuss the TAC with clients and lodge claims for them whilst they are still in hospital.

The TAC can also provide hospitals with client brochures so that TAC information is visible to the clients in the hospital and they can access the right information up front, these can be requested by emailing info@tac.vic.gov.au

Reporting provided to hospitals

Status reports will continue to be provided by DH to hospitals following processing of each remit file supplied by the TAC.

• The Remit report includes all new claims processed by the TAC since the previous remit file. The claims will be either Paid or Denied and will include a payment description or denial reason
• A year-to-date update report on all outstanding claims, including those that were paid, denied or not processed due to missing, incorrect or unmatched data.

The reporting format includes the NWAU value for the agreed claim and the amount paid by DH on this basis. DH remuneration rates per NWAU are shown in Table 1. All hospital payments by DH will be reconciled with the actual NWAU as agreed by TAC.

An additional report will be supplied on a monthly basis following the submission of data from the DH to the TAC. The report will include those claims returned as not processed by the TAC due to missing, incorrect or unmatched data. The report will include details of the rejected claims including a reason for rejection. Corrected claims will be resent to the TAC in subsequent monthly submission files.

Please contact TAC on 1300 654 329 for an up-to-date list of Reasons for Denial, Payment Adjustment and EDI Rejections (claims not processed).

For records where claims are not accepted by TAC, either:

• Hospitals or clients are required to transmit additional information to allow the claim to be accepted.
• Hospitals retrospectively reclassify these patients to reflect any changes in Admission Type and the preferences indicated by the patient on the form of election for admission.
• If clarification regarding TAC claim details is required, hospitals are encouraged to:
  • Check the record via Provider Online Service (POS)
  • Call TAC Customer Service on 1300 654 329
  • Email provider@tac.vic.gov.au to reach a member of the Provider team

Hospitals are expected to review rejected claims promptly and revise and resubmit claims if further information is required. Where there is no further recourse to the TAC, these records will be designated as denied on the monthly report. Hospitals should then recode these separation records as public. Hospitals are required to make changes before consolidation, otherwise funding will not be paid at either the TAC or public rate.

Ultimately, care in data entry will significantly improve and streamline the reconciliation process.

TAC payment overview

TAC NWAU throughput is uncapped. The TAC NWAU price will be adjusted annually.

Hospitals will continue to receive payments for NWAU throughput for TAC patients from DH. The specialist medical, diagnostic and imaging costs associated with these episodes will be incorporated in the TAC NWAU price from 1 July 2026 and will no longer be charged to TAC directly.

Hospitals, however, will need to continue to charge TAC directly for out-of-scope care types as listed in Tables 2-9. NWAU will be paid at the TAC-specific payment rate shown in Table 1.

Payment rates

For queries relating to the fees in the tables below please contact abf@health.vic.gov.au.

TAC activity types

Emergency, emergency admitted, acute admitted, sub-acute and non-admitted activity

For emergency, emergency admitted, acute admitted, sub-acute and non-admitted episodes of care, the payment rate for TAC separations is per National Weighted Activity Unit (NWAU).

Table 1: TAC NWAU price

The TAC should no longer be billed separately for diagnostic and medical services.

Out-of-scope services

The below services are out-of-scope of the NWAU framework for TAC patients.

These services will continue to be paid at a fee-for-service rate and will need to be billed directly to the TAC.

Table 2: Urgent Care Centre-only presentation

Table 3: Victorian Virtual Emergency Department

Table 4: Community mental health

Table 5: Small rural health services: Non-admitted patients

Table 6: TAC requested medical reports

Table 7: Discharge and non-admitted medicines

Table 8: Aids and equipment

Table 9: Diagnostics

Hospital resource section on the TAC website

The TAC has developed a Hospital Resource section for all hospital staff working with TAC clients, which allows easy access to information regarding:

• TAC Clinical Framework and Outcome measures
• Discharge planning
• Aids & Equipment: Forms and instructions for ordering
• TAC invoicing requirements (for out-of-scope services).

To access this resource, visit the TAC website - Provider Dashboard: Hospitals: Public.

For more information about TAC policies and fees contact the TAC on 1300 654 329.

Prices are published annually in the Policy and Funding Guidelines available at Policy and funding guidelines for health services.