Vhi claim form for consultant's fees: Direct payments

Understanding the Vhi Claim Form for Consultant's Fees

To secure direct payment from Vhi Healthcare for professional fees, private consultants in Ireland must submit an accurate claim detailing the patient's insurance details, specific procedure codes, and admission dates. Processing these claims is a central administrative task for clinical secretaries, particularly in high-volume surgical specialties like urology where multiple diagnostic and therapeutic procedures are performed weekly.

When a patient undergoes a procedure—such as a flexible cystoscopy or a transperineal prostate biopsy—the billing process begins the moment the patient leaves the clinic. For rooms to receive direct payment, the claim must align with the rules set out in the insurer's fee schedule. Navigating this process manually requires strict attention to detail, as errors or missing information can lead to significant payment delays. Understanding why health insurance claims get rejected Ireland often comes down to submission timelines and coding mismatches on the initial paperwork.

The standard process for securing direct payment relies on completing the correct vhi consultant claim form. The clinical secretary must verify the patient's plan details, input the correct e-Schedule procedure codes, and submit the claim through Vhi's secure provider portal. If a patient is undergoing a vasectomy in the consultant's private rooms, recent policy updates dictate specific billing structures. Under Vhi's Private Medical Insurance Terms and Conditions, which apply to registrations and renewals on or after 1 October 2026 (and from 1 November 2026 for five specific plans: PMI 06 10, PMI 18 11, PMI 19 11, PMI 32 12, and PMI 38 14), the vasectomy benefit is structured as a contribution toward the overall cost. For these claims, Vhi accepts one single receipt that must detail the name and date of the procedure along with any related pre- or post-operative consultation dates.

Participating vs Non-Participating: Vhi Provider Agreement Rules

Before submitting a vhi claim form for consultant's fees, a practitioner must establish their registration status with the insurer. Under the Vhi Provider Agreement, which became effective on 1 July 2025, consultants operate under one of two distinct billing classifications. This status dictates whether you can charge patients an additional fee above the insurer's covered rate.

Provider Status	Payment Terms	Patient Surcharges	Notice Period to Change Status
Participating Provider	Accepts the participating rate in the e-Schedule in full and final settlement.	Agrees not to levy any additional professional fee charges on a Vhi member under any circumstances.	Requires 60 days' written notice to Vhi to cancel or alter registration.
Non-Participating Provider	Accepts the non-participating rate in partial settlement of the fee.	Can charge an additional fee, provided the member is given advance written notice of the extra cost.	Requires 60 days' written notice to Vhi to cancel or alter registration.

For participating consultants, direct payment is made directly to the practice's registered bank account. Under the Tax Consolidation Act 1997, Vhi is legally obliged to deduct Professional Services Withholding Tax (PSWT) from these payments before they are cleared. If a consultant wishes to transition from a participating to a non-participating status, or to cancel their registration entirely, they must submit 60 days' written notice to Vhi to allow the insurer to update its directories and systems.

How to Register and Access the Vhi e-Schedule

To determine the correct codes and fee structures before processing a vhi claim form for consultant's fees, administrative staff must access Vhi's digital e-Schedule. This schedule is hosted on the Vhi Provider Portal, and access must be set up for both the consultant and their administrative team.

The registration process involves several precise steps to ensure secure access for the rooms:

1. Complete the Registration Form: The consultant must submit the formal registration document to Vhi. This form requires the consultant's professional details, medical council registration, and bank details for direct electronic fund transfers.
2. Register Administrative Staff: The registration form specifically requests the practice manager's or secretary's unique mobile number and email address. Vhi requires these dedicated details so that administrative staff can register for their own secure access to the e-Schedule.
3. Access the Portal: Once approved, staff can log in at www.vhi.ie/pvs to view the active e-Schedule, search for specific urological or surgical procedure codes, and verify the current participating and non-participating rates.
4. Verify Plan Changes: Staff should regularly check the portal for benefit updates. For example, according to the Health Insurance Authority (HIA), price and benefit changes took effect on 1 October 2026 across 55 Vhi plans, with benefit adjustments on 57 plans. Keeping track of these changes through the portal prevents billing mismatches for patients whose plans have recently renewed.

Submitting Claims via the Laya Consultant Portal

While Vhi represents a significant portion of private healthcare billing in Ireland, private rooms must also coordinate claims with the other open-market insurers. The Health Insurance Authority register of undertakings lists four open-market insurers providing inpatient health insurance cover in Ireland: Irish Life Health dac, AXA Insurance dac (trading as Laya Healthcare), Aviva Insurance Ireland DAC (branded as Level Health), and Vhi Insurance DAC.

For patients insured under Laya Healthcare, rooms do not use the Vhi systems. Instead, the laya consultant claim form and related payment statements are managed through the dedicated Laya Online Consultant/GP Portal. This secure portal acts as the primary interface between the practice and the insurer.

To submit a claim or retrieve a laya consultant claim form, the secretary must log into the portal using their registered email, Consultant ID, and password. Once logged in, the portal provides secure access to several essential resources:

• Online Provider Statements: Rooms can view and download detailed provider statements to reconcile payments directly against bank deposits.
• The Laya Schedule of Benefits: This allows staff to look up specific clinical codes and check the covered rates for consultations and surgical procedures.
• Direct Claim Forms: Staff can download, complete, and submit the necessary documentation to secure direct payments for inpatient and day-case care.

Understanding how to submit vhi claim documents alongside Laya and Irish Life Health claims is essential for maintaining a steady cash flow in a multi-insurer private practice.

Managing Your Practice Workflow and Claim Submission

For a busy specialist, such as a urologist managing prostate pathways, haematuria clinics, and theatre lists across the Beacon, Mater Private, or Blackrock Clinic, coordinating billing paperwork is a constant administrative burden. Reconciling every single vhi claim form for consultant's fees requires a structured daily workflow to prevent claims from falling behind.

Modern practices use dedicated software to manage the clinical record and schedule, while executing the actual claim submissions through each insurer's approved portal. Software like Brigid allows clinical rooms to manage their daily diary, record consult dictation directly into the patient record, and send secure payment links to patients for outstanding outpatient fees. When a patient uses the companion patient app, MyBrigid, they can complete their intake forms and securely share their insurance details before their appointment. This patient-first approach ensures that the secretary has the correct policy numbers and demographic data on hand, reducing manual entry errors when it is time to log into the Vhi or Laya portals.

To ensure your billing workflow remains efficient, the practice secretary should follow a structured checklist for every private procedure:

• Verify the patient's exact insurance provider and policy number during intake.
• Confirm if the planned procedure requires pre-authorisation by checking the rules outlined in our guide on the Vhi prior approval form: how rooms submit to Vhi Healthcare.
• Consult the active Vhi e-Schedule or Laya Schedule of Benefits to locate the correct procedure codes.
• Draft the clinical letter using dictation tools within the electronic record to ensure the clinical indication matches the billed code.
• Log into the respective insurer portal (such as www.vhi.ie/pvs or the Laya Consultant Portal) to submit the claim and track the status of the direct payment.

For a deeper understanding of how to manage multi-insurer billing, pre-authorisations, and fee reconciliation across different private hospitals in Ireland, review our comprehensive guide on how Irish insurer billing and pre-authorisation works.

To improve your practice's billing efficiency today, audit your current pending claims list. Identify any submissions older than 30 days, log into the Vhi and Laya consultant portals, and cross-reference them against your bank statements to ensure all withholding tax deductions and direct payments have been correctly reconciled.

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