LanternPay Provider Agreement

Terms to apply to all Providers submitting claims in relation to any applicable Scheme via LanternPay from 1 March 2021. Additional PHI Provider Terms and Conditions also apply to Providers submitting claims in relation to private health insurers.

Subject to the terms of this Agreement, Lantern agrees to provide to the Provider access to LanternPay for which the Provider enrols and pays the applicable fees. 

1       Acknowledgement

The Provider agrees and acknowledges that:

(a)     LanternPay facilitates the submission of approved Invoices to relevant Schemes for payment in respect of Services provided to an Individual;

(b)     in circumstances where Lantern intermediates payment by the relevant Scheme to the Provider, Lantern is not required to make payment to the Provider unless and until Lantern has received the relevant Invoice Amount from the relevant Scheme in cleared funds; and

(c)     where Lantern does not intermediate payment by the relevant Scheme to the Provider or where Lantern intermediates payment by the relevant Scheme to the Provider but does not receive the relevant Invoice Amount in cleared funds, Lantern does not accept or assume any liability for payment of Invoice Amounts to the Provider.

2       Representations and Warranties

The Provider represents and warrants to Lantern that:

(a)     (licences and qualifications) it has obtained and maintains in full force and effect all permits, licences, consents, approvals, registrations, memberships, authorisations and qualifications required for the provision of Services to the Individual;

(b)     (Transactions)

  1. any Transactions entered into LanternPay are for Services which are entitled to be funded under the relevant Scheme and which have been provided in accordance with Applicable Laws and Scheme Guidelines;
  2. the particulars of any Transaction entered into LanternPay are true and correct;

(c)     (applicable laws) it shall comply with all applicable privacy, consumer and other laws and regulations with respect to its

  1. provision, use and disclosure of the Transaction Data; and
  2. use of LanternPay;

(d)     (power) it has all requisite corporate or other power to enter into this Agreement and to carry out the terms of this Agreement; if the Provider is a corporation, all corporate action on the part of the Provider, its officers, board of directors and shareholders necessary for the performance of its obligations under this Agreement has been taken; this Agreement constitutes its valid and legally binding obligation, enforceable against it in accordance with the terms hereof; if the Provider is a corporation, then it is a corporation in good standing in its jurisdiction of incorporation; it has read and understands the entire Agreement and desires to be bound thereby, and it has had the opportunity to consult with counsel; and

(e)     (no representations) except as expressly set forth herein, no representations of any kind or character have been made to induce it to execute and enter into this Agreement.

3       Undertakings

The Provider undertakes to Lantern to:

(a)       (Individual identification) take such steps as are reasonably necessary in order to ensure that the person to whom the Services are provided is the Individual in respect of whom Invoice Amounts are payable;

(b)       (security and authentication) ensure that its LanternPay credentials (including password details) are managed in such a manner so as to avoid any unlawful, fraudulent or improper use of LanternPay;

(c)       (compliance with laws) comply at all times with all Applicable Laws and Scheme Guidelines in the provision of Services to an Individual, in exercising its rights and fulfilling its obligations under this Agreement and in the collection, storage, use, disclosure and security practices in relation to Transaction Data;

(d)     (maintain insurances) maintain such insurances in respect of the provision of Services as are necessary and/or appropriate; and

(e)     (records) maintain adequate Records of the provision of Services (for at least 24 months or such longer period required by law) and provide to Lantern such Records and additional information as may be required from time to time to support Invoices.

4       Suspension

LanternPay may immediately suspend access to LanternPay without notice where:

(a)     LanternPay considers that there is a security or service or other integrity risk to LanternPay;

(b)     LanternPay has reason to suspect that the Provider's LanternPay credentials are being used without required authorisation or for unlawful purposes; or

(c)     LanternPay considers that it must do so in order to comply with any applicable law or Australian Government statement or request.

5       Fees and Payment Terms

In consideration for Lantern providing access to LanternPay, the Provider agrees to pay Lantern the applicable fees notified by Lantern to the Provider from time to time.  The Provider is solely responsible for the bank account information provided to Lantern and must promptly inform Lantern of any changes thereto.  Changes should be communicated to Lantern by entering the updated information through the relevant LanternPay App, the LanternPay Website or by contacting LanternPay support.  All payments shall be made in Australian dollars.  All fees are non-refundable unless otherwise explicitly stated in this Agreement. The Provider agrees to obtain its own advice in relation to good and services, sales and other taxes applicable to payments made to the Provider.  All payments due to Lantern shall be made without any deduction or withholding on account of any tax, duty, charge or penalty except as required by law in which case the sum payable by a party in respect of which such deduction or withholding is to be made shall be increased to the extent necessary to ensure that, after making such deduction or withholding, Lantern receives and retains (free from any liability in respect thereof) a net sum equal to the sum it would have received but for such deduction or withholding being required.

6       Confidential Information

Confidential Information disclosed by one party to the other party may only be used by the recipient party as necessary to perform its obligations under this Agreement.  Neither party shall disclose to any third party Confidential Information disclosed by the other party without the prior written consent of the disclosing party except to the extent that such information is:

(a)     publicly available or becomes so in the future without restriction;

(b)     already in the recipient's possession and lawfully received from sources other than a party without be subject to separate confidentiality obligations;

(c)     information that is required to be disclosed under compulsion of law, provided that notice is given to the other party in order that it may challenge such disclosure; or

(d)     disclosed confidentially by a party on a need to know basis to employees, contractors, third party service providers and/or professional legal or accounting advisers; or

(e)     information that is reasonably required by a Scheme to assess and make payment in relation to Invoices submitted by the Provider including but not limited to, the Provider’s name, Australian Business Number, any relevant Scheme identification number, address, contact information and bank account information (such as account name, account number and BSB number).

The Provider agrees that Lantern may itself or through a third-party service provider, aggregate Transaction Data and use and disclose that information in de-identified form as part of research, advice and other information products Lantern develops, including, without limitation, providing data analysis to the relevant Scheme.

7       Indemnity

The Provider indemnifies, and will keep indemnified, Lantern against, and must pay Lantern on demand, the amount of any Loss which Lantern, suffers, incurs or is liable for arising from or any costs incurred in connection with:

(a)     a misrepresentation by the Provider;

(b)     a breach of this Agreement by the Provider; and

(c)     the provision of Services by the Provider to an Individual.

8       Warranty and Disclaimer

(a)     Except as expressly set forth above and to the extent permitted by applicable law, Lantern makes no warranty of any kind, express, implied or statutory, regarding LanternPay.

(b)     To the maximum extent permitted by law, all such conditions and warranties, including without limitation the implied warranties of the suitability, fitness for particular purpose and non-infringement are hereby expressly disclaimed by Lantern, except any implied condition or warranty the exclusion of which would contravene any statute (including the Trade Practices Act 1974 (Cth)) or cause any part of this clause to be void ("Non-Excludable Condition").

(c)     Lantern's liability to the Provider for breach of any Non-Excludable Condition is limited, at Lantern's option, to refunding the price of LanternPay in respect of which the breach occurred or to providing the LanternPay service again.

(d)     The Provider acknowledges that Lantern has neither represented or warranted that LanternPay will be uninterrupted, error free or without delay or without compromise of the security systems related to LanternPay or that all errors will be corrected.

9       Set-off

Lantern may set-off any amounts owing by it to the Provider against any amounts owing by the Provider to Lantern.

10     Termination

(a)     Lantern may terminate this Agreement:

  1. with immediate effect if the Provider breaches any term of this Agreement;
  2. at any time by giving 30 days prior written notice.

(b)     The Provider may terminate this Agreement:

  1. with immediate effect if Lantern breaches any term of this Agreement;
  2. at any time by giving 30 days prior written notice.

11     Amendments

Lantern may amend this Agreement from time to time by posting a revised version of the Agreement to the relevant LanternPay App, or the LanternPay Website or sending the Provider an email notification or otherwise notifying the Provider.

By continuing to use LanternPay after any amendments to the Agreement, the Provider agrees to abide and be bound by any such changes. If the Provider does not agree with any changes made to the Agreement, the Provider must terminate the Agreement by closing the Provider's account and ceasing to use LanternPay.

12     Jurisdiction

This Agreement is governed by the law in force in New South Wales and the Provider irrevocably and unconditionally submits to the non-exclusive jurisdiction of the courts of New South Wales and courts of appeal from them.

13     GST Law

For the purposes of the GST Law, in relation to each Transaction which is a Taxable Supply, the Provider makes the Taxable Supply through Lantern as agent and the Provider has the obligation to issue a Tax Invoice relating to the Taxable Supply.

14     Assignment

The Provider may not transfer or assign any of its rights or obligations under this Agreement (including by way of declaration of trust or grant of security interest) without the prior written consent of Lantern.  Lantern may assign or otherwise transfer any rights or obligations under this Agreement at any time.

15     Dictionary

In this Agreement:

'Agency' has the meaning given to that term in the NDIS Act;

'Agency Guidelines' means any guidelines issued by the Agency (including price guides);

'Agreement' means the agreement between the Provider and Lantern including the Provider's enrolment in LanternPay, the LanternPay User Agreement, the Policies and these terms and conditions;

'Applicable Laws' means all legislation and subordinate legislation in force from time to time in Australia (including common law and equity as applicable from time to time) and relevant to the provision of the particular Services to Individuals (including, in relation to the NDIS, the NDIS Act and the NDIS Rules and,, in relation to the TAC, the Transport Accident Act 1986 (Vic));

'Australian Government' means the Government of the Commonwealth of Australia or any State or local government;

'Authority' means any national, state, provincial, regional, territorial, local or municipal government, ministry, governmental department, commission, board, bureau, agency, instrumentality, executive or administrative body;

'Confidential Information' means information provided by one party to the other relating to the disclosing party's business, operations or strategies, intellectual or other property, or actual and prospective customers, suppliers or competitors but excluding, for the avoidance of doubt, Transaction Data which will be handled in accordance with any agreement between the Individual and LanternPay and otherwise in accordance with the LanternPay Privacy Policy;

'GST Law' has the meaning given to that term in the A New Tax System (Goods and Services Tax) Act 1999 (Cth);

'Individual' means a person who is a participant or client in the relevant Scheme and, in relation to the NDIS, has the meaning given to the term 'participant' in the NDIS Act;

'Invoice' means a request for payment in respect of Services provided by the Provider to the Individual;

'Invoice Amount' means an amount paid under a Scheme in respect of the provision of Services to an Individual (including, in relation to the NDIS, an NDIS Amount);

'Lantern' means Lantern Claims Pty Ltd ABN 28 606 978 796;

'LanternPay' means the service offered by Lantern as described in the Agreement including use of the relevant LanternPay App and the LanternPay Website;

'LanternPay App' means each of the LanternPay applications for use on a device;

'LanternPay Privacy Policy' means the privacy policy relating to LanternPay available as at the date of this Agreement at https://www.lanternpay.com/lan... as updated or amended from time to time;

'LanternPay User Agreement' means agreement described as such between the Provider and Lantern in relation to the use of LanternPay generally;

'LanternPay Website' means the Lantern website located at www.lanternpay.com;

'Loss' means any loss, damage, liability, charge, expense, outgoing or costs (including all legal and other professional costs on a full indemnity basis) of any nature or kind;

'NDIS' has the meaning given to the term 'National Disability Insurance Scheme' in the NDIS Act;

'NDIS Act' means the National Disability Insurance Scheme Act 2013 (Cth);

'NDIS Amount' has the meaning given to the term in the NDIS Act;

'NDIS Rules' means the legislative instruments made under the NDIS Act;

'Provider' means the organisation who has applied to access LanternPay as a provider;

'Records' means records of the provision of Services including treatment plans, appointment schedules, signed receipts and other supporting documentation;

'Scheme' means a scheme funded by any Australian Government or Authority or any other care or entitlement scheme in relation to which Invoices may be submitted through LanternPay;

'Scheme Guidelines' means any guidelines, policies or directives issued by the relevant Scheme or any authorised body on behalf of the relevant Scheme (including, in relation to the NDIS, the Agency Guidelines);

'Services' means the goods and/or services provided by the Provider to an Individual (including, in relation to the NDIS, Supports);

'Supports' has the meaning given to that term in the NDIS Act;

'TAC' means the Transport Accident Commission;

'Taxable Supply' has the meaning given to that term in the GST Law;

'Tax Invoice' has the meaning given to that term in the GST Law;

'Transaction' means the submission of an Invoice in respect of the provisions of Services by the Provider to an Individual by means of LanternPay; and

'Transaction Data' means, in relation to a Transaction, any information in relation to an Individual and/or information about the nature of the treatment, services or goods provided by the Provider to an Individual in respect of which an Invoice has been submitted.


Last updated 1 March 2021

LanternPay PHI Provider Terms and Conditions

Background

A.       The following additional LanternPay PHI Provider Terms and Conditions apply to Providers using LanternPay in relation to the private health insurance companies named in this document. The private health insurance companies listed therein are known as “Funds” or a “Fund” for the purpose of these LanternPay PHI Provider Terms and Conditions.

B.       These LanternPay PHI Provider Terms and Conditions to apply to all Providers submitting claims in relation to any applicable Fund via LanternPay from 1 March 2021, your submission of a claim in relation to any applicable Fund via LanternPay will be deemed as your acceptance of these LanternPay PHI Provider Terms and Conditions.

C.       These:

  • LanternPay PHI Provider Terms and Conditions;
  • any further agreement between yourself and Lantern in relation to a particular use of LanternPay including the LanternPay Provider Agreement; and
  • the policies applicable to LanternPay (including the Lantern Privacy Policy made available on the LanternPay App and/or LanternPay Website (as updated or amended from time to time); constitute a contract between you and Lantern.

Your use of LanternPay constitutes acceptance of that contract.

1       Interpretation

1.1    Definitions

The following terms shall have the following meanings unless the contrary intention appears:

Approved Modality for a Fund means a health modality in which the Fund has agreed to accept transactions through the Network in relation to claims for health services.

Business Day means any day other than a Saturday, Sunday or a national or State public holiday.

Claim Cancellation means an electronic message sent to a Fund through the Network by You for cancellation of a prior Transaction Request.

Confidential Information means the terms of this agreement and any data or information about a party's business, operations or customers supplied to, or acquired by, another party under this agreement or during the negotiations preceding this agreement by any director, employee, agent, adviser or officer of the second party and includes, without limitation, as confidential information of a Fund any data or information developed, collated or obtained by or for You pursuant to, for the purposes of or in connection with this agreement including, without limitation, information about Quotations and Transactions processed for a Fund through the Network but does not include Transaction Data.

Funds means each of the private health insurance companies with whom Lantern has entered into an agreement, as described above.

Fund Agreement means an agreement between a Fund and Lantern relating to the provision of LanternPay to the Fund for the purposes of that Fund.

Fund Contact Point means a telephone, or similar immediately available communication modality, operator acting as a central point of contact for general problem assistance for Lantern and a Health Service Provider in relation to the Network so far as it relates to the Fund's participation in that service.

Fund Host System means the computer hardware and software, including, without limitation, front end processors and all releases, updates and amendments to the computer hardware and software provided by a Fund for the purposes of processing Quotations and Transactions in accordance with this agreement.

Goods means goods provided to a Member by You in your capacity as a Health Service Provider.

Health Service means a service provided to a Member by You in your capacity as a Health Service Provider.

Health Service Provider means a person practising as, a dentist, physiotherapist, chiropractor, pharmacist, psychologist, ambulance provider, optometrist, or any other person practising a health or health-related service or dispensing products and/or services in respect of whom a Fund may pay a benefit for a particular service or product rendered by that person or an entity that has entered into such an agreement for that purpose.

Important Declaration means the declaration that:

(a)     states that the products and services provided by the Health Service Provider:

  1. are not subject to any other form of compensation or reimbursement;
  2. do not breach any Fund rules; and
  3. where relevant are based on relevant clinical prescriptions; and

(b)     authorises the Fund to pay proceeds directly to You and to verify any aspect of the claim.

Insolvency Event means the happening of any of these events in relation to a party:

(a)     an application is made to a court for an order or an order is made that the party be wound up; or

(b)     an application is made to a court for an order appointing a liquidator or provisional liquidator in respect of the party, or one of them is appointed, whether or not under an order; or

(c)     except to amalgamate while solvent the party enters into, or resolves to enter into, a scheme of arrangement, deed of company arrangement or composition with, or assignment for the benefit of, all or any class of its creditors, or it proposes a reorganisation, moratorium or other administration involving any of them; or

(d)     the party resolves to wind itself up, or otherwise dissolve itself, or gives notice of intention to do so, except to reconstruct or amalgamate while solvent or to transfer its business as an ongoing concern to another person; or

(e)     the party is or states that it is insolvent; or

(f)     as a result of the operation of section 459F(l) of the Corporations Law, the party is taken to have failed to comply with a statutory demand; or

(g)     the party is or makes a statement from which it may be reasonably deduced that the party is the subject of an event described in section 459C(2)(b) or section 585 of the Corporations Law; or

(h)     the party takes any step to obtain protection or is granted protection from its creditors, under any applicable legislation or an administrator is appointed to a body corporate; or

(i)     anything analogous or having a substantially similar effect to any of the events specified above happens under the law of any applicable jurisdiction.

Lantern means Lantern Claims Pty Limited (ABN 28 606 978 796).

Lantern Provider Agreement means the LanternPay Provider Agreement, and any agreements incorporated by that Agreement, accessible on the LanternPay Website.

LanternPay means the LanternPay claim payment processing platform provided by Lantern, which includes, without limitation all interfaces, the LanternPay App and LanternPay Website, all releases, updates and amendments to the software provided for the purposes of Providers initiating and processing Transactions, facilitating Quotations and receiving in accordance with this agreement.

LanternPay App means each of the LanternPay applications for use on a device.

LanternPay Registration Form means the form on the LanternPay Website that Providers are required to use to submit required account and contact information to Lantern, for the purpose of creating a LanternPay account.

LanternPay Registration Information means the information You receive from Lantern, identifying Your location address as registered with LanternPay and the associated Provider Number issued by Lantern

LanternPay User Guide means a guide to using LanternPay provided by Lantern to You.

LanternPay Website means the Lantern website located at www.lanternpay.com.

Member means a member of a Fund or a person designated by a Fund as a patient who has been allocated a Member Number by the Fund and may be entitled to benefits from the Fund in respect of Goods or a Health Service.

Member’s Representative means a Member’s guardian, financial manager, care co-ordinator, plan manager, attorney, nominee or other representative.

Member Number means the identification number that is allocated by a Fund and corresponds to an individual Member of that Fund, which is used as a way of uniquely identifying Members within a particular Fund.

Network means LanternPay when it acts together with the Fund Host System, for the purpose of initiating, processing and responding to Quotations, Eligibility Checks and Transactions initiated by a Health Service Provider.

Provider Number means the identifier registered with Lantern for the Registered Provider Location, which is specified in the LanternPay Registration Information.

Provider means any person, or entity on whose behalf You have entered into this agreement.

Quotation means a Quotation Request and Quotation Response.

Quotation Request means an electronic request to a Fund given through the Network by a Health Service Provider for an estimate of the Member's available health insurance benefits through membership the fund to satisfy (in whole or in part) the cost of the Goods or Health Services identified in the request for that Member.

Quotation Response means an electronic response given through the Network by, or on behalf of, the Fund to a Quotation Request.

Records means records of the provision of Health Services including treatment plans, appointment schedules, signed receipts, copies of Tax Invoices, and other supporting documentation.

Registered Provider Location means the location address specified in the LanternPay Registration Information.

Relevant Laws means any legislation, code of practice, guidelines or standards issued by relevant regulators or industry bodies in so far as they relate to this agreement, a Fund, You, the Goods or Health Services or the Lantern System.

Reversal Request means an electronic message to a Fund given through the Network by a Health Service Provider for cancellation of a prior Transaction Request (other than the last Transaction Request made through the Terminal from which the message is sent).

Tax Invoice means a tax invoice within the terms of subsection 29-70 of the A New Tax System (Goods and Services Tax) Act 1999 as amended from time to time, printed or electronically distributed, and includes (without limitation) the following information:

(a)     provider number,

(b)     provider name,

(c)     appropriate item numbers and associated item descriptions,

(d)     itemised charges, itemised benefit amounts (where a benefit was paid by a Fund),

(e)     any discounts,

(f)     application date of service per item,

(g)     item and transaction level response codes and descriptors,

(h)     patient name and patient ID, and

(i)     system data required for Transaction verification, including system date and time and retrieval reference number.

Transaction means a Transaction Request or Cancel Request.

Transaction Data means in relation to a Transaction:

(a)     any identification of a Member for whom a health insurance claim is or has been made in the Transaction; and

(b)     information about the nature of the treatment, services or goods provided by You to a Member for whom a health insurance claim is or has been made on a Fund in the Transaction; and

(c)     information related to the identification of the Health Service Provider, including but not limited to the Provider Number.

Transaction Request means an electronic request to a Fund given through the Network by a Health Service Provider for authorisation of a health insurance claim on a Fund.

You or Yourself means the person or persons named in the LanternPay Registration Form (and shall include Providers, if relevant), and if there are more than one, means each of them separately and every two or more of them jointly.

1.2    Interpretation

In this agreement unless the contrary intention appears:

(a)     a reference to this agreement or another instrument (including, without limitation, the LanternPay User Guide) includes any variation or replacement of them;

(b)     a reference to a Member includes a contributor or any other person, regardless of how designated by a Fund, who pays premiums to the Fund for health insurance.

1.3    Operation

This agreement is intended to operate as a separate agreement between You and a Fund.  Accordingly, the rights, obligations and liabilities of a Fund pursuant to this agreement are several and are not joint or joint and several with any other Fund.

1.4    Application to Health Service Providers

If You have entered into this agreement on behalf of one or more Health Service Providers, then (unless the contrary intention appears) this agreement is to be read as follows:

(a)     where the agreement relates to the provision of treatment, Goods or Health Services to a Member or the processing of a Transaction or Quotation, references to You also include the Health Service Provider who has provided the relevant treatment, Goods or Health Services (jointly and severally with You); or

(b)     other references in this agreement to You also include each of the Health Service Providers (jointly and severally with You).

You are responsible for ensuring that each Health Service Provider on whose behalf you have entered this agreement is bound by, and complies with, the terms of this agreement to the extent that they apply to that Health Service Provider as set out in this clause 1.4.

2       Conditions Precedent

This agreement will not come into force until Lantern has made LanternPay available to You and a Fund.

3       Lantern System

(a)     A Fund will at its own discretion, decide from time to time:

  1. whether it will make LanternPay available to its Members and Health Service Providers; and
  2. the Approved Modalities in respect of which it will transact with its Members and Health Service Providers using the Network.

(b)     A Fund agrees to settle health insurance claims initiated by You through the Network in accordance with this agreement, except that:

  1. a Fund does not agree to settle health insurance claims or respond to Quotation Requests through the Network using LanternPay if that method of transacting is not made available by that Fund;
  2. a Fund does not agree to settle health insurance claims or respond to Quotation Requests through the Network for Goods or Health Services that are not within an Approved Modality; and
  3. this agreement does not impose any obligations on a Fund in relation to:
    (A) health insurance claims or Quotation Requests submitted using LanternPay if that method of transacting is not made available by that Fund; or
    (B) Goods or Health Services outside the Approved Modalities.

(c)     A Fund is not responsible for ensuring the availability of LanternPay to You.

(d)     You must do the following:

  1. not disadvantage a Member, such as by charging a fee, solely because a health insurance claim is to be processed through the Network in respect of Goods or a Health Service;
  2. provide the Goods or Health Service to a Member to which a Transaction Request relates prior to initiating the Transaction Request;
  3. not make any representation in connection with Goods or a Health Service which may bind a Fund;
  4. stop accepting a Member Number in respect of a Fund if:
    (A) acting in accordance with its legitimate business interests, the Fund tells You to do so; or
    (B) this agreement terminates in respect of that Fund;
  5. immediately stop using the Network to process health insurance claims using a Transaction Request and request quotations using a Quotation Request in respect of a Fund when the Fund requests You to do so in circumstances where (but not limited to) the Fund reasonably suspects that there has been inappropriate activity and/or You are in breach of this agreement;
  6. notify Lantern of the name and Provider Number of any Health Service Provider who may use LanternPay in respect of this agreement and use reasonable endeavours to notify Lantern immediately of any change in those details including the removal or addition of any such Health Service Provider;
  7. where a Member requires a Quotation and the Fund has agreed to process Quotation Responses via LanternPay, ensure that a Quotation Request is forwarded to the Member’s Fund and a Quotation Response is received by return before the Goods and/or Health Service the subject of Quotation is provided to that Member. Quoting must only be done at the request of the Member once the Goods or Health Service has been determined and agreed to by the Member. The details in the Quotation must be accurate, true, and supported by relevant evidence which must be provided to the relevant Fund upon request;
  8. not process a Transaction Request health insurance claim unless;
    (A) specifically authorised by Relevant Laws and Scheme Guidelines; and;
    (B) You reasonably believe that each claim is valid.
  9. only process Transactions and submit Quotation Requests for the provision of Goods or Health Service(s) performed (or, in the case of Quotation Requests, to be performed) at the Registered Provider Location, except where a Fund authorised the provision of Goods or Health Service(s) and processing of Transactions at a location other than the Registered Provider Location; and
  10. where applicable, ensure that the identifier of any Goods or Health Service(s) contained in any Quotation Request or Transaction Request is in accordance with any applicable agreement or understanding between Funds and the relevant professional association about the descriptions of services for which private health insurers will pay health insurance claims.

(e)     A Fund must establish and maintain a Fund Contact Point for the term of this agreement which must be made available during the Fund’s normal business hours.

4       Handling Transactions

(a)     You must comply with the LanternPay User Guide when processing Transactions and Quotations.

(b)     In relation to a health insurance claim to be made on a Fund, You must do the following:

  1. process the claim through LanternPay in a Member’s or Member’s Representative’s presence as soon as reasonably practicable after the related Goods and/or Health Service has been provided to the Member;
  2. only process the claim through LanternPay using a Member Number;
  3. use reasonable care to detect identity fraud and, in particular, use reasonable endeavours to verify the identity of a Member independently from the Member Number;
  4. require the Member or Member’s Representative to review and sign the receipt, certifying the Important Declaration, generated by LanternPay where a Transaction Request, or Cancel Request is made;
  5. give the Member or Member’s Representative a copy of the signed receipt referred to in paragraph (iv) and retain the original signed receipt referred to in paragraph (iv) for at least 24 months or any longer period required by law after the Transaction Request has been processed through LanternPay;
  6. ensure that the signed receipt referred to in paragraph (iv) accurately describes the Goods and/ or Health Service(s) that have been provided to the Member and that such a description is consistent with the identifier of the Goods and/or Health Service(s) used in the Transaction Request;
  7. provide a Fund with Records as requested, by the Fund acting reasonably, of a Transaction processed for the purposes of that Fund within 10 Business Days of the Fund requesting that evidence or such reasonable period requested by the Fund;
  8. provide Lantern with Records as requested from time to time to support Transactions and Quotations;
  9. retain other documentation referred to in paragraph 4(b)(vii) for at least 24 months or any longer period required by law.
  10. where Goods that have been claimed in a Transaction are returned to You and You have agreed to process a refund or provide alternative replacement Goods, and where the claim for those would differ from the original claim, agree a process with the Fund for reversing or adjusting the claim for Goods within 10 Business Days or other period reasonably agreed with the Fund.

(c)     Where You initiate a health insurance claim on behalf of a Member, You must take all reasonable steps to satisfy Yourself that:

  1. all particulars are true and correct including, without limitation, all item numbers and codes that are included in a Transaction Request represent an accurate description of the Goods and/or Health Service delivered;
  2. the Transaction Request will be valid and acceptable;
  3. the relevant Member is not disputing liability for the Goods and/or Health Service the subject of the Transaction Request; and
  4. the Goods and/or Health Service(s) in the Transaction were performed or supplied at the Registered Provider Location unless authorised by the Fund.

5       Settlement of Transactions

(a)     You and a Fund acknowledge that the Fund is solely responsible for verifying the details of a Transaction Request, or Claim Cancellation and for approving or rejecting the Transaction Request or Claim Cancellation. A Fund is under no obligation to authorise a Transaction Request or Claim Cancellation.

(b)     Where a Fund authorises a Claim Cancellation, the Transaction Request to which the Cancel Request relates is immediately cancelled.

(c)     A Transaction Request is not valid if:

  1. the Transaction Request is illegal or any particulars of a health insurance claim are not true;
  2. the Transaction Request is not authorised by a Member ;
  3. You have not provided the Goods and/or Health Service(s) to the Member to which the Transaction Request relates before processing the Transaction Request;
  4. another person provided the Goods and/or Health Service(s) to which the Transaction Request relates;
  5. the Member or Member’s Representative does not confirm that each claim is certified by the Member or Member’s Representative in accordance with clause 4(c) of this agreement;
  6. in the Fund's reasonable opinion, you have breached either clause 3(d) or 4(c) of this agreement; or
  7. this agreement was terminated in respect of that Fund before the date of the Transaction Request;

and this clause applies even if a Fund has authorised the Transaction Request.

(d)     A Transaction Request is not acceptable if the Member disputes liability for the Goods and/or Health Service the subject of the Transaction Request at any time for any reason and this clause applies even if a Fund has authorised the Transaction Request.

(e)     Subject to clause 5(g), where a Fund authorises a Transaction Request or Claim Cancellation, it must calculate for each day the following:

T-R

where:

T = the total of amounts the Fund has authorised for payment as a result of each Transaction Request made on the relevant day;

R = the total of amounts the subject of each Claim Cancellation which is authorised by a Fund and which has not previously been the subject of settlement under this clause.

(f)     Each Fund must pay to You the amount calculated for the purposes of clause 5(e) within 10 Business Days of the day for which the amount is calculated or other period reasonably agreed with You, if that amount is a positive amount.  If the amount is a negative amount then it must be paid by You to the Fund within 10 Business Days of the day for which the amount is calculated in the manner agreed between them or other period reasonably agreed with the Fund.

(g)     A payment to You under clause 5(f) must be made by the Fund by direct credit to the bank account nominated by you or as otherwise agreed.

(h)     You must not withhold any payment under this agreement or make a deduction from it for any reason including because you claim to have a set off, counterclaim, or other right against a Fund or any other person.

(i)     You acknowledge and agree that you must promptly advise Lantern of your bank account details on registration for LanternPay and keep Lantern informed of any changes to your bank account details. Any failure to do so means that the Fund will not be able to make payments to your bank account in accordance with this agreement.

(j)     A Fund must establish a fair policy for dealing with disputes about Transactions.

(k)     You acknowledge and agree that Lantern will give a Fund details of your Business that You have provided, including but not limited to the Provider Number, for the purpose of processing Transactions.

6       Confidential information

(a)     Subject to the remainder of this clause:

  1. all Confidential Information relating to a party is passed to and received by the other party in the strictest confidence; and
  2. a party holding Confidential Information of the other party must not disclose, divulge or grant access to such Confidential Information other than to its directors, employees, agents, advisers or officers and shall not permit any of the directors, employees, agents, advisers or officers to disclose, divulge or grant access to such information to other persons except to the extent  required by law. A party who has received Confidential Information from another party under this agreement must, at the request of the other party, have delivered to that party all documents or other materials containing or referring to that Confidential Information which are in its possession, power or control or in the possession, power or control of any other person who has received that information from the party to whom the request is directed.

(b)     Without limitation to the remainder of this clause, each party agrees:

  1. to use Confidential Information of the other party only for the purposes of fulfilling its obligations under this agreement;
  2. not to disclose Confidential Information of the other party without the written authority of that party except for the purpose of fulfilling its obligations under this agreement;
  3. to immediately notify the other party where it becomes aware that disclosure of Confidential Information may be required by law;
  4. not to transfer Confidential Information outside Australia, or allow a person outside Australia to have access to it, without the prior approval of the other party;
  5. to ensure that any person requiring access to Confidential Information (including, without limitation, any employee or approved sub-contractor of the other party) makes an undertaking not to access, use, disclose or retain Confidential Information except in performing their duties to the party and is informed by the party that failure to do so may lead to the party taking action against the relevant person;
  6. to immediately notify the other party where it becomes aware of a breach of its obligations of confidentiality under this agreement by itself or as a result of the actions of any other person; and
  7. to take all reasonable measures to ensure Confidential Information is protected against loss, and against unauthorised access, use, modification, disclosure and that only authorised personnel have access to Confidential information.

(c)     The obligations of a party under this clause do not apply to any data or information which the party demonstrates:

  1. was in widespread use and generally available at the time of the use or disclosure;
  2. was already in the party's possession at the date of this agreement; or
  3. was subsequently developed, collated or obtained by the party wholly independently of this agreement and without any breach of any obligation of confidence owed to the other party.

(d)     Notwithstanding any other clause in this agreement, unless You advise otherwise, You agree that Lantern and the Fund may, acting reasonably, publish contact details of your business that You have provided (including, but not limited to business name, Registered  Provider Location, telephone number, facsimile number, email address and website) to promote LanternPay, including publishing details of Health Service Providers that use LanternPay in any format (including searches and maps).  Where You have entered into this agreement on behalf of any other Providers, You confirm and warrant that those Providers have provided  You with their prior authorisation to enter this agreement on their behalf, including that You have their authorisation to agree on their behalf that Lantern or the Fund may acting reasonably publish contact details of those Providers' business (including, but not limited to business name, Registered Provider Location, telephone number, facsimile number, email address and website) to promote LanternPay, including publishing details of Providers that use LanternPay in any format (including  searches  and  maps).

(e)     You declare that where Personal and/ or Business Information (including, but not limited to business name, Provider Number, Registered Provider Location, telephone number, facsimile number, email address and website) has been or will be provided in the LanternPay Registration Form or is otherwise provided as a result of the ongoing use of LanternPay, the applicant has made or will make each such individual aware of the fact and:

  • that their Personal and/or Business Information has been collected by Lantern for the purpose of managing, administering and processing Transactions, and protecting against fraud;
  • that their Personal and/or Business Information (including, but not limited to business name, Provider Number, Registered Provider Location, telephone number, facsimile number, email address and website) may be disclosed to other organisations involved in the provision, management, administration and processing of Transactions, or as required by law, or with their consent;
  • that the applicant may not be able to obtain LanternPay if that individual’s Personal and/or Business Information is not provided by way of the LanternPay Registration Form;
  • that the individual can gain access to their personal and/or Business information by contacting Lantern.

(f)     We respect your privacy and your information will be handled by LanternPay in accordance with the privacy policy of Lantern. For more information please see the Privacy Statement on the Lantern Website go to https://www.lanternpay.com/privacy-policy

7       Termination

(a)     This agreement automatically ends:

  1. on the giving of 30 days’ notice to You if it has been more than 2 years since You processed a claim through LanternPay;
  2. to the extent that it relates to a Fund, upon termination of a Fund Agreement between Lantern and that Fund; or
  3. with immediate effect if You breach any term of this Agreement, or the Lantern Provider Agreement. 

(b)     You or a Fund may end this agreement to the extent that it relates to that Fund immediately if:

  1. the other party commits a material breach of its obligations under this agreement which breach is not remedied within 60 days of receipt of a notice in writing requesting the breach be remedied or is not remedied within that period to the satisfaction of the party giving the notice; or
  2. an Insolvency Event has occurred in relation to that other party.

(c)     A Fund may also end this agreement to the extent that it relates to that Fund on the giving of 60 days’ notice to You.

(d)     The ending of this agreement or any part of it to the extent that it relates to a Fund does not affect a party’s rights and obligations which arose before it ended and, if the party terminating this agreement is a Fund, that termination does not affect the continued operation of this agreement so far as other Funds are concerned.

8       Costs and Expenses

(a)     Each party shall bear its own costs and expenses in connection with the preparation, negotiation and execution of this agreement except for stamp duty.

(b)     You agree to pay any stamp duty payable or assessed in connection with this agreement.

9       Jurisdiction

(a)     This agreement and the transactions contemplated by it are governed by the laws in force in New South Wales.

(b)     The courts of New South Wales, including for the avoidance of doubt, the Federal Court of Australia sitting in New South Wales shall have non-exclusive jurisdiction with respect to any dispute or legal proceedings in connection with or arising out of this agreement.

10       Miscellaneous

10.1    Assignment

(a)     A party may not assign its rights under this agreement.

10.2    Subcontractors

(a)     A Fund may appoint a sub-contractor to perform all or part of its obligations under this agreement and on the basis that the Fund, by sub-contracting, shall not be relieved of any of its obligations under this agreement.

10.3    Relevant Laws

(a)     Each party must comply with all Relevant Laws:

  1. in exercising its rights and fulfilling its obligations under this agreement; and
  2. governing the collection, storage, use, disclosure and security practices in relation to Transaction Data.

10.4    Discretion

(a)     Any discretion conferred on a Fund under this agreement will be exercised reasonably and in accordance with the Fund’s legitimate business interests.


Last updated 1 March 2021