What's new?

May 2013

The Healthcare Identifiers Service Licensed Materials for the May 2013 release are now available.

January 2013

New eligibility requirements for the PIP eHealth Incentive start 1 February.

The Department of Human ServicesÂ’ Compliance Program 2012—13 is now available.

The 2013 Medicare Teen Dental Plan voucher is valued up to $166.15

The Medicare Safety Net threshold figures for 2013 are now available.

PBS Claiming

Medicare Australia uses Online Claiming for PBS and the Claims Transmission System (CTS) to collect PBS and RPBS data for processing claim payments to approved pharmacists. When making a claim for payment the pharmacist must make sure that each pharmaceutical benefit item claimed is supported by the relevant prescription documentation. Complete and accurate information in the PBS/RPBS claim makes sure that timely payments are made.

In particular, pharmacists should:

  • make sure that the patient's PBS/RPBS eligibility is recorded correctly (i.e. Medicare or repatriation card number and if applicable, concession or Safety Net card number)
  • make sure the correct prescriber number and date of prescribing are entered when dispensing
  • for 'urgent supply' prescriptions, the date of the telephoned prescription is the actual date of dispensing, rather than the date on the prescription form or the date the prescription was received
  • reconcile prescriptions in the actual prescription claim against the 'missing script' report
  • delete prescription serial numbers from the computer claim corresponding to uncollected or missing prescriptions and
  • reserialise prescriptions that are present but listed as missing.

When using CTS, before creating the claim disk:

  • make sure the disk is correctly formatted (some 'update disks' are not suitable to be reformatted for PBS/RPBS claiming and using a new disk for each claim will minimise the likelihood of problems occurring);

Before sending the claim:

  • make sure the claim form is completed correctly, including the signature of the approved or authorised person and the date (Claim for Payment forms are available from Medicare Australia by calling 132 290*)
  • attach any hand-serialised prescriptions to the claim form and
  • make sure that Safety Net claims are sent to Medicare Australia under a separate cover using the pre-addressed, pre-paid envelope provided in the Safety Net kit distributed before January each year.

Finally, pharmacists should make sure:

  • the claim form is completed correctly and signed
  • all items claimed have a prescription form included
  • any missing prescriptions have been deleted from the claim
  • prescriptions are bundled according to their category and are sorted sequentially
  • each document bears the name and approval number of the approved person and
  • if a change in approval number has occurred, separate claims have been prepared.

Last updated: 19 March, 2010