PBS Reason Codes Claims processing
New Streamlined Authority Number Initiative reason codes
From 1 December 2011 Medicare Australia is introducing four new Online Claiming for PBS reason codes for PBS and RPBS - 617, 636, 637 and 639. The new reason codes are required to identify prescriptions with a Streamlined Authority Number. These reason codes will be implemented with an effective date of 1 December 2011.
Reason codes - Added
Reason Code 617 (Reject) The Streamlined Authority Number is invalid
Reason code 617 will be returned to pharmacy as a reject code. This message advises the pharmacist that the Streamlined Authority Number sent in the transmission is not valid .
Reason Code 636 (Warning) The Streamlined Authority Number was not provided
Reason code 636 will be returned to pharmacy as a warning code. This message advises the pharmacist that the streamlined authority number is required for the streamlined authority item.
Reason Code 637 (Information) A Streamlined Authority Number is not required for this item
Reason code 637 will be returned to pharmacy as an information code. This message advises the pharmacist that the streamlined authority number is not required for non streamlined authority items.
Reason Code 639 (Reject) The Streamlined Authority Number provided does not match to the authority item
Reason code 639 will be returned to pharmacy as a reject code. This message advises the pharmacist that the streamlined authority number provided does not match to the streamlined authority item.
- PBS reason codes for non-online pharmacies (CTS and paper-based) [PDF, 607Kb]
- PBS reason codes for online claiming for PBS pharmacies [PDF, 600Kb]
New Chemotherapy Initiative reason codes
From 1 December 2011 Medicare Australia is introducing one new Online Claiming for PBS reason code for PBS and RPBS - 656. The new reason code is required to identify the quantity supplied is greater than allowed for Chemotherapy items. The reason code will be implemented with an effective date of 1 December 2011.
Reason Code 656 (Reject) The quantity supplied is not allowed for this chemotherapy item – too many times the maximum amount has been supplied
Reason code 656 will be returned to pharmacy as a reject code. This message advises the pharmacist that the quantity supplied is greater than allowed for the chemotherapy item.
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Last updated: 20 December, 2011