Referrals

• We trust providers to offer clinically appropriate care to our members – your 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 managed, digital-first pathways (for example, in MSK routeing and treatment)  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 you to keep your practice details on Healthcode’s Private Practice Register (PPR) - and to check these are up-to-date and accurate.

If you list too many sub-specialisms, for example, we may not have a clear view of your main practice. If we don't know the best way to contact you or when you're available it's harder for our Personal Advisers to make bookings for our members.

We chose to work with PPR as a solution which helps you keep your details up to date across the private medical insurance industry.

Your fee status

We prefer to work with fee-approved specialists. If you currently work with us as a fee-limited provider:

• we won’t refer patients to you through our specialist appointment booking service
• your fees will be 20% lower than those of fee-approved specialists
• you won’t be able to see all our members, as certain plans ask that patients see fee-approved doctors
• it will be your responsibility to recover any fee shortfall from patients
• when your patients seek to authorise your proposed procedures, our Personal Advisers will offer them the choice of seeing a fee-approved specialist, who won’t make them pay a fee shortfall.

If you’d like to accept our agreement, and follow our Schedule of Procedures and Fees, please click below. 

Accept our agreement

Please note that this link is for AXA Health recognised physicians and surgeons who wish to come into contract. If you are a practitioner or a psychiatrist please visit our recognition page.

• We aim to review our claims data annually, taking into account the disruption to care during the pandemic.  
• 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, please contact our support team on 01892 503030, 9am-5pm, Monday to Friday.