Vhi prior approval form: how rooms submit to Vhi Healthcare

What is a Vhi Prior Approval Form?

When a patient's treatment plan requires a specialized procedure, the first administrative hurdle is often securing a vhi prior approval form to confirm coverage. Unlike standard outpatient consultations, specific inpatient or day-case procedures require explicit confirmation from the insurer before clinical admission. This process ensures that the patient's specific policy covers the proposed procedure codes and that the consultant's fees will be reimbursed at the expected rates. In Ireland, the private health insurance landscape is regulated by the Health Insurance Authority (HIA). According to the HIA register of health benefits undertakings, there are four open-market insurers providing inpatient health insurance cover: Vhi Healthcare (Vhi Insurance DAC), Laya Healthcare (AXA Insurance dac), Irish Life Health (Irish Life Health dac), and Level Health (Aviva Insurance Ireland DAC). Each insurer has distinct pre-authorisation requirements that a medical secretary must navigate to prevent claim rejections or unexpected patient bills. For a vhi pre-authorisation consultant, understanding when prior approval is mandatory—such as for high-cost drugs, specific genetic testing, or complex surgical interventions—is vital for maintaining a predictable cash flow in private rooms.

How to Access the Vhi e-Schedule for Codes and Rates

To verify procedure codes and reimbursement rates, private rooms must consult the Vhi Schedule of Benefits for Professional Fees, commonly known as the e-Schedule. Access to this schedule is restricted to registered providers. Consultants and their administrative staff can register for access via the Vhi Provider Portal at www.vhi.ie/pvs. The registration process requires specific administrative details. According to the Vhi Consultant Registration Form, the application explicitly requests the practice manager or secretary's mobile number and email address to grant them direct access to the e-Schedule. Additionally, under the Tax Consolidation Act 1997, Vhi is legally obliged to deduct Professional Services Withholding Tax (PSWT) from all professional fee payments made to consultants. Before submitting any pre-authorisation request, the secretary must check the consultant's participating status. Under the Vhi Provider Agreement effective from 1 July 2025, a Participating Provider agrees to accept the participating rate listed in the e-Schedule in full and final settlement of the professional fee. They are strictly bound not to levy any additional professional fee charges on a Vhi member under any circumstances. Conversely, a Non-Participating Provider accepts the lower non-participating rate as partial settlement and must notify the patient in advance that they will be liable for the balance. If a consultant wishes to transition between participating and non-participating status, they must submit 60 days' written notice to Vhi. For more detail on navigating these rules, rooms can refer to our guide on the Vhi procedure codes list.

Step-by-Step: Submitting Prior Approval to Vhi Healthcare

The process of submitting a vhi prior approval form begins the moment the consultant schedules the procedure. For example, if a consultant urologist schedules a patient for a prostate biopsy or a flexible cystoscopy, the administrative team must verify the patient's exact policy details and submit the request before the hospital list is finalised. Here is the step-by-step workflow for submitting a prior approval request to Vhi Healthcare: 1. Gather Patient and Policy Details: Retrieve the patient's full name, date of birth, Vhi policy number, and the specific plan name. Note if the plan has any pending renewal dates, as rules can change. For instance, Vhi's Private Medical Insurance Terms and Conditions apply to new registrations and renewals on or after 1 October 2026, with five specific plans (PMI 06 10, PMI 18 11, PMI 19 11, PMI 32 12, and PMI 38 14) deferring these terms until 1 November 2026. 2. Identify the Correct Codes: Cross-reference the proposed clinical procedure with the e-Schedule. Ensure the primary code and any secondary codes are noted accurately. 3. Complete the Prior Approval Form: Access the Vhi Provider Portal to complete the digital request. The form requires clinical justification, which must be drafted or approved by the consultant. For certain procedures, such as a vasectomy performed in private rooms, Vhi's rules state they will accept a single receipt detailing the name and date of the procedure along with any related consultation dates. 4. Submit and Track: Submit the completed form through the portal. Note the reference number immediately in the patient's administrative record. To ensure no steps are missed, rooms can use the following pre-authorisation checklist:

• Patient's current Vhi policy number and plan name verified.
• Procedure codes selected from the active e-Schedule.
• Clinical indications and consultant signatures completed.
• Vhi prior approval form submitted and marked as 'pending' in clinic tracker.
• Approval code received, recorded in the patient file, and shared with the admitting hospital's billing department.

Managing Pre-Authorisations for Laya and Irish Life Health

Managing pre-authorisations across multiple insurers requires strict attention to differing rules and submission deadlines. While Vhi processes approvals through its e-Schedule portal, Laya Healthcare and Irish Life Health operate under separate frameworks. For Laya Healthcare (AXA Insurance dac), rooms must complete a laya pre authorisation form or submit the request via their online provider portal. Similarly, Irish Life Health dac requires an irish life health pre approval form or portal submission for restricted or high-cost procedures. Under the Irish Life Health 2026 General Ground Rules (applicable to admissions on or after 17 June 2026), consultants who participate in the full cover scheme agree to accept the participating benefit as full and final settlement. They are not permitted to balance bill the patient. Furthermore, Irish Life Health's consultant terms dictate that all professional fee accounts must be submitted within 36 months of the patient's discharge. Late submissions are not payable, and the member cannot be billed unless there is a proven case of genuine error or hardship, reviewed on a case-by-case basis. This strict timeline highlights the importance of timely submissions, as detailed in our analysis of why health insurance claims get rejected in Ireland. To illustrate the financial impact of participating status under these rules, consider the following code comparisons from the Irish Life Health 2026 Urology Schedule of Benefits:

Code / Description	Participating Rate	Standard Rate
Code 855: Primary TURBT (Surgeon)	€928	€280
Code 855: Primary TURBT (Anaesthesiologist)	€468	€90
Code 906699: Private Rooms Technical Fee	€96	N/A

Additionally, Irish Life Health may amend its Schedule of Benefits in September, December, March, and June each year, publishing updates on its website. Continuing to submit claims after an update is legally treated as acceptance of the amended rates.

Level Health Pre-Authorisation: Portal and Email Channels

Level Health (Aviva Insurance Ireland DAC) represents the fourth open-market insurer in Ireland. For private rooms, establishing a clear pre-authorisation route with Level Health is essential as more patients select their plans. According to Level Health's provider information, the insurer provides its schedule of benefits and reimbursement rates to consultants upon registration, a process that typically takes one week to complete. Level Health supports third-party billing providers and offers access to a dedicated provider portal. For pre-authorisations, rooms can submit requests either through the online provider portal or by emailing the dedicated address at preauthorisation@levelhealth.ie. Understanding these distinct insurer-specific channels is critical for managing the administrative overhead of private practice, particularly when coordinating care across multiple private hospitals. For a broader overview of managing these administrative steps, consultants can review how Irish insurer billing and pre-authorisation works.

How Ask Brigid Supports Your Manual Billing Workflows

Managing pre-authorisations, tracking approvals, and coordinating billing across Vhi, Laya, Irish Life Health, and Level Health introduces significant administrative overhead for private consultants. While the actual submission of a prior approval or claim must be completed manually through each insurer's designated portal or email channel, practice management software can centralise the clinical and administrative records that support these workflows. The practice management platform, Brigid, helps rooms organise patient data, schedule procedures, and manage clinical documentation. Automated insurer eligibility checks, claim or pre-authorisation submission and reconciliation (VHI, Laya, Irish Life, Level Health, PCRS/GMS) are not in the launch release; staff use each insurer's normal channels. It provides a secure, centralized electronic record hosted in AWS Dublin (eu-west-1). This ensures that all patient details, procedure codes, and consultant notes are instantly accessible when completing insurer forms manually. Furthermore, patients can manage their administrative journey through MyBrigid, the companion patient app. MyBrigid is designed to put patients in control of their care, allowing them to complete digital intake forms, view their results and letters, and pay their bills securely via payment links. If a patient receives care across multiple clinics using the platform, they can use a single account to selectively share specific categories of their records with each practice, maintaining full control over their personal health information. This patient-led administration reduces the coordination burden on busy medical secretaries, allowing rooms to focus on clinical delivery and manual insurer submissions. To improve your practice's administrative efficiency today, review your current tracking sheet for outstanding pre-authorisations and ensure that all temporary codes are cross-referenced with the active e-Schedules for Vhi, Laya, Irish Life Health, and Level Health.

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