Before you have your healthcare in Northern Ireland:
- make sure you are eligible for the NIPHS
- consider applying for prior authorisation
- check what medical records to bring with you
Check that you have followed the correct process to access healthcare under the Northern Ireland Planned Healthcare Scheme (NIPHS). If you do not follow the correct process, you may have to pay the full costs of your healthcare.
Getting prior authorisation for your healthcare
Prior authorisation is an optional process to confirm that you:
- have followed the correct process to access healthcare under the NIPHS
- will be eligible to claim repayment towards the cost of your healthcare
We usually take about 20 working days to decide on your application.
You must pay for any healthcare that you get with a private provider in Northern Ireland. But if you get prior authorisation, you’ll know around how much you can claim towards the cost and if there is a difference that you must pay.
When to get prior authorisation for NIPHS
Prior authorisation is optional. But we recommend that you apply for it if you need inpatient care (an overnight stay in hospital).
You do not need prior authorisation for day-case healthcare.
Your treatment plan may change after you apply for prior authorisation. If this happens, you can only claim repayment for the healthcare you receive.
Applying for prior authorisation
To apply for prior authorisation you must send:
- a valid referral
- a completed application form
- proof that you have travelled to Northern Ireland for your first appointment with the consultant
Send the form and the supporting documents to:
Northern Ireland Planned Healthcare Scheme,
St Canice’s Hospital,
Completing the application form
You and your consultant in Northern Ireland must complete and sign the form before you have your inpatient treatment.
The consultant must enter the correct DRG (Diagnosis-Related Group) code for the treatment you are getting.
You can download a list of costs and DRG codes for inpatient healthcare in Ireland.
If you had your treatment on or after 1 July 2022, use:
If you had your treatment before 30 June 2022, use: