Preliminary Newborn Enrolment Policy – at a glance

A new approach to facilitate the enrolment of newborn babieswith a GP/practice and PHO as soon as possible after birth will be rolled out over the coming months.

-Early enrolment with a GP/practice enables newborn babies to receive timely immunisation and other health checks.

-From 1 October 2012 a newborn baby may be submitted for funding before the full enrolment process is completed.

-A training toolkit is being developed for PHOs and GPs/practices.

-GPs/practices who have been chosen as the newborn’s ongoing provider and accept a National Immunisation Register (NIR) notification may enter the newborn baby into their Patient Management System (PMS) (with a new patient status code of “B”[1]) and submit that newborn baby for funding in the next quarter.

-Full enrolment (signed enrolment form) must be completed (and the patient status changed to “E”) before the second quarter of funding.

-If the baby is taken to another GP, Accident and Medical clinic or after hours service for a ‘casual’ visit, there will be no Fee-For-Service (FFS) offsets (or clawback) in the first quarter the baby is enrolled.

-Babies coded as “B” in the first quarter will be exempt from enrolment eligibility audits. The “B” patient classification will only be accepted for funding by the Ministry’s Capitation Based Funding system in the first quarter following notification of birth.

Why have a Preliminary Newborn Enrolment Policy?

There are a number of reasons to introduce this policy, which include implementing Government policy to ensure that all children are enrolled with a GP/practice at birth.

The newborn policy also supports the new Health Target for immunisation which states that 85 percent of eight month olds will be fully immunised by July 2013, 90 percent by July 2014, and 95 percent by December 2014. The immunisation schedule for infants covers three primary series of immunisations (due at six weeks, three months and five months).

Recent New Zealand research has found that an established relationship with the primary health care provider is a critical factor in the timely delivery of immunisations, and that there is a need for more effective facilitation of early engagement with a primary health care provider[2]. Data shows virtually no newborn babies are enrolled with a GP/practice and PHO by the first immunisation event at six weeks and just under half are enrolled at 12 weeks of age.

What does this policy mean?

Children are currently added to the NIR when they are born. Part of the process is to ask parents to nominate an ongoing provider (GP/practice). The NIR sends an electronic message to the nominated GP/practice asking them to either accept or decline the NIR nomination. The GP/practice then replies to the NIR that they have accepted or declined the newborn. This should happen within the first two weeks of birth.

Under the new preliminary newborn enrolment process to be introduced, GPs/practicesthataccept the NIR notification:

  1. can immediately enter the newborn into their PMS as a ‘B’ registration code(or as a regular patient if their PMS does not have embedded registration codes). The “B” registration code signifies that the newborn has been accepted for funding, but the enrolment process, including obtaining a signed enrolment form, is still to be completed;
  1. may include the newborn on the next enrolment register submitted for funding before the enrolment process is completed; and
  1. must complete the enrolment process before the newborn appears on the second enrolment register that is submitted for funding.

Why do we need a new registration code ‘B’ for newborns?

The “B” code provides the Ministry with a simple way to identify this newborn group, and manage the risk of ineligible newborns being funded for more than one quarter. The code also enables the Ministry to monitor and report on the newborn policy.

Since 2006, on average about 2% of annual births in New Zealand are not eligible for PHO enrolment. In submitting a newborn with a status of “B” for funding before fully completing the enrolment process it is inevitable that some newborns submitted for funding in the first quarterly download will be identified as ineligible during the full enrolment process. Since this is outside the control of GPs/practices, DHBs have agreed to fund these ineligible newborns for the first quarter following NIR notification of birth. However, full enrolment must then take place to ensure ineligible newborns are not then re-submitted for funding in the second quarter.

There is also a risk that GPs/practicescould overlook the need to complete the enrolment process if there is not a clear flag in their systems to alert them that the newborn needs to be enrolled. For those GPs/practices that have embedded registration codes in their systems the “B” code will alert them to the need to complete the enrolment process for the newborn.

Implementing a new registration code “B” for newborns requires system changes in the Ministry’s CBF register processing and payment system, PHO register processing systems and in some providers systems.

Will there be FFS offsets (clawbacks)?

No, for the first quarter that the newborn is funded as a “B” code the Ministry and DHBs have agreed not to offset (or clawback) General Medical Subsidy claims for newborns that may make a casual visit elsewhere.

What about audits and recovery for ineligible newborns?

Newborns coded “B” will not be included in audits as they are not required to have a signed enrolment form until the enrolment process is completed.

There will be no recovery for ineligible newborns for the first quarter that they are submitted for funding.

When will the new registration code B for newborns be ready?

The Ministry’s enrolment register processing system will be ready to accept “B” coded newbornsfor the quarter starting 1 October 2012. The Ministry expectsthat the changes to provider PMSs to support implementation of the preliminary newborn enrolment process will be completed by 1 October 2012.

Will there be more information and training in the new system?

The Ministry has commissioned the development of a toolkit for PHOs andGPs/practicesin the preliminary newborn enrolment process. The toolkit will include “B” code information specific to each of the provider’s systems currently in use. A further update will be provided on the development of this resource in the coming weeks.

If you have any queries please email the Ministry at

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[1]Most provider systems have registration codes embedded, but some do not. The vendors for the provider systems that do not have embedded registration codes will assign the B code after the provider’s enrolment register is extracted.

[2]Grant, Petousis-Harris, Turner, Goodyear-Smith, Kerse, Jones, et al: Primary care practice and health professional determinants of immunisation coverage, Journal of Paediatrics and Child Health, 47 (2011 pp541-549).