Referring our members to you

  • We trust providers to offer clinically appropriate care to our members – their patients.  
  • We also do our utmost to act in the best interests of our members. ‘Member first’ is our guiding principle. 
  • We believe we best serve our members’ interests by offering them access to treatment by providers who adhere to ‘norms of practice’ (see section below).
  • We understand these norms are different for each specialism and sub-specialism and are also affected by your practice’s geography and patient demographic. 
  • We also know that employing pathways such as Virtual LucyTM increases referral efficiency when compared with other routes. 
  • We take these factors into account when we analyse our claims data. This helps us compare specialists with their peers. 

  • We analyse all the ‘tickets of service’ providers create when they treat our members. 
  • These may include details of the number of consultations offered, propensity to operate and surgical episode costs.  
  • We compare the activity of providers working in the same specialism, sub-specialism and geographic location. 
  • We take into account patient numbers and case complexity, and the efficiency of the referral route. 
  • This generates data that show us where the norms of practice lie for most providers in a certain sub-specialism and region. 
  • We use this information to identify providers whose practice comes within these norms. 

We also look at: 

  • whether the provider has accepted our commercial agreement 
  • availability for referrals (we can’t offer you to our members if we can’t contact you) 
  • availability for work (your private practising hours may not fit a member’s availability) 
  • available information (if we don’t know your sub-specialty you may miss out) 
  • location (members generally choose specialists conveniently located for home or work) 
  • the facility/ies where the provider works (members value ease of access, travel distance and parking availability when choosing treatment) 
  • the range of services offered. 

  • Some of our plans offer members a defined pathway to treatment, which includes a list of selected specialists available to them.  
  • We ask Health-on-Line members to pay 40% of their treatment costs if they choose to see a specialist outside this list.  
  • These members’ plans have lower premiums: our members know this when they buy them. 
  • We select the list of providers according to the criteria above (‘Selecting providers to see our members’) 
  • We allow specialists who are newly recognised by AXA Health to see members on these plans for 12 months after recognition, after which we review their practice data to see if they continue to qualify to see members on these plans.  

Information about our ranking criteria, the benchmark measures and where individual providers lie within our rankings is commercially sensitive. We calculate and make changes to these rankings as part of our internal business operations. We’re currently looking at how we can share this information with AXA Health-recognised providers in a way that does not breach data protection regulations or adversely affect our mutual commercial interests. 

 You may wish to consider ways to improve: 

Your data 

We want to work more closely with providers who share our aims of improving healthcare. We believe this means consistently offering appropriate, clinically evidenced care. You may wish to consider modifying the tickets of service you produce when treating our members. 

Your details 

If we don’t have the right details for you, we can’t accurately compare your practice with the practice of your peers in the same sub-specialty. 

We want to know more about the treatment you offer to your patients, to help us better understand your practice. 

We know our claims data don’t tell the whole story of your practice, and we’re working to include data from other sources, such as registries, to improve our understanding. Ensuring your data are uploaded to an appropriate registry will help to improve practice in your specialism and in healthcare generally. 

We strongly advise you to ensure your profile on Healthcode’s Private Practice Register is up-to-date, accurate and as detailed as possible. 

This includes your specialty and sub-specialty; where you work and the best way to contact you for bookings.  

Your contract 

We prefer to work with providers we contract with: if you haven’t yet accepted our agreement, you can do so here: Specialist Agreement | AXA Health 

  • We aim to review our claims data as regularly as possible.  
  • While the COVID-19 pandemic disrupted normal elective care and data patterns, we nevertheless intend to re-review all our data, and our benchmark measures, within the next 18 months. 
  • We’ll take into account the disruption to care during the pandemic.  
  • This may affect the number of AXA Health members we refer to you.  
  • You may wish to consider how you might change your practice during this time. 
  • We appreciate that some cases are complex and that some specialties and sub-specialties are more likely to see an increased number of complex cases.  
  • We also appreciate that some providers see more patients than others. 
  • We take this weighting into consideration when setting our benchmarks. 
  • If you have any questions about your referral rate at the present time, please contact our support team on 01892 503030, 9am-5pm, Monday to Friday. 

Following these pointers will help our Personal Advisers refer patients smoothly to you. Please ensure you:

  • are in contract with us
  • have registered your practice on the Private Practice Register (PPR)
  • update your PPR details at least every 12 months
  • include full details on PPR of your specialism and sub-specialism
  • include full contact and practice location details either for you, or for the people who handle billing and administration for you.

We also expect providers to follow guidance from their professional bodies and NICE in offering appropriate and evidence-based treatment.

We want to avoid unnecessary or unwarranted treatment, overtreatment, overdiagnosis and unnecessary diagnostics requests.

Where appropriate, we look to providers to upload their procedure details to the relevant national registry.