Many UK physiotherapy clinics rely on a mix of self-pay and private medical insurance (PMI) from Bupa, AXA Health, Aviva, WPA, Vitality and others. Each insurer requires provider recognition and specific invoicing processes. Electronic billing for most of the market routes through Healthcode, the UK's trusted platform for secure online billing between providers and insurers. Clinics must register via the Healthcode Private Practice Register (PPR) to be recognised and to bill electronically. This article sets out the practical requirements and the software implications.
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To bill PMI patients, you generally need to be a recognised provider with the insurer. The major insurers now use the Healthcode Private Practice Register, or strongly prefer it. Bupa, AXA Health, Aviva, WPA and Vitality. It holds provider information, recognition applications and shared documents. Over 54,800 practitioners and 300+ private hospitals are already on it.
Registration is not automatic. You send practising information, qualifications, indemnity details and other documents. Once recognised, your details appear in the insurer's provider search and you can bill electronically. Aviva, for example, states it is only accepting new registrations through Healthcode PPR.
Paper invoices are being phased out or heavily discouraged. Electronic billing through Healthcode sends claims with the correct codes. It tracks authorisations. Where your system is connected, it also posts the remittances back.
Clinics with high PMI volume benefit enormously from native or tight integration: the same clinical record that documents the treatment generates the claim. No (or minimal) re-keying of patient details, treatment codes or fees. Shortfalls are automatically calculated and can generate a patient invoice. Remittances are matched to the original invoices.
Where a PMS does not have native Healthcode support, clinics use a third-party bridge or submit directly via the Healthcode portal. This works but adds another system, another potential source of data mismatch, and admin time.
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A system that handles UK PMI well does more than print invoices:
Some systems have good Healthcode support built in or connected. WriteUpp, PPS, Nookal in some setups, and Jane in its test flows. The work is then much cleaner. Where it does not (Cliniko users often use a third-party tool or direct submission), the admin overhead and risk of mismatch increase.
Physiotherapy provided by an HCPC-registered physiotherapist is a VAT-exempt supply of medical care under HMRC VAT Notice 701/57. This applies to the treatment itself. Check your own position with your accountant, including any mixed services. The exemption matters in UK physio billing, and your software should not make it harder.
A treatment produces two pieces of paper. A claim for the insurer, and an invoice for the patient. Both describe the same appointment.
They come apart because each side names things differently. Your notes hold a treatment. Healthcode wants a code. The insurer holds a policy, an excess and a fee schedule. A person joins the three, and does it again for every appointment.
We build clinic systems on engage.re. Every record type is declared in one shared dictionary, so a treatment, a fee and a patient mean one thing across the whole system. The claim and the invoice are then two views of one record, and not two pieces of work.
We explain why a gateway carries a message without carrying its meaning in MCP and A2A move messages. We compare the ways to record meaning in semantic layer, ontology or knowledge graph.
A system of your own produces claims and patient invoices straight from the treatment record. It uses the exact insurers and fee schedules you work with. Remittances post back automatically. Shortfalls are handled in the same place. No separate billing portal, no re-keying, and the clinical data and the financial data are the same data. You own it, so if an insurer changes a code or process, you adapt without a vendor change request.
If you want to see what unified clinical + insurance billing looks like, ESRE's live physiotherapy demo opens without a login. Sign in as reception or owner and process a PMI case through to remittance. See the physiotherapy software hub for the demo and more.
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