PBS Online Claiming for software vendors

Benefits to vendors

Online claiming for PBS has generated a high level of interest among Australian pharmacies. Responses from a range of industry conventions have indicated that pharmacies are keen to take advantage of the greater certainty of amount of payment and the increased frequency of payment.

In addition, the Third Annual Australian eHealth Survey conducted by AC Nielsen in 2003 showed that 75 per cent of Australian pharmacies believed that the most important way that IT could assist their pharmacy was by "Improving PBS Claiming". With this high level of pharmacy interest in online claiming for PBS, vendors are encouraged to make this functionality available to their clients.

Getting started with Online claiming for PBS

To begin integrating online claiming for PBS into prescription dispensing software, a software vendor will need to request a software developers agreement from Medicare Australia. This can be done by contacting Medicare Australia's Online Technical Support Helpdesk on 1300 550 115 or emailing the Helpdesk at pbsonline@medicareaustralia.gov.au.

Once the software vendor signs and returns the agreement, an online claiming for PBS Client Adaptor Kit will be supplied.

The online claiming for PBS Client Adaptor kit contains:

• Medicare Australia Application Programming Interface (API)
• Online claiming for PBS Logic Pack
• Client Adaptor Adopter Guide
• Online claiming for PBS Logic Pack Help file
• Integration Test Management Process
• Online claiming for PBS Business Process Model document
• Online claiming for PBS Business Process Model diagram
• Hard copy Release Notes for the online claiming for PBS Logic Pack
• Medicare Australia eSignature CD
• Online claiming for PBS - minimum reporting requirements

For further information on the Medicare Australia eSignature CD and for PKI enquiries please call Medicare Australia on 132 290.

Online claiming for PBS uses software developed in-house called the Client Adaptor. The Client Adaptor is composed of an Application Programming Interface used to interface between client systems and Medicare Australia and the online claiming for PBS Logic Pack, which allows Medicare Australia to deliver business processes and functionality specific to PBS.

The Release Notes for the online claiming for PBS Logic Pack outline changes introduced in the current release of the online claiming for PBS Client Adaptor.

The Online Technical Support Helpdesk will also supply the latest reason codes to integrate into the PDS.

Testing process

The testing process involves two business units within Medicare Australia: the Online Technical Support Helpdesk and the Online Technical Support Integration Testing Team.

• the Online Technical Support Helpdesk is the first point of contact within Medicare Australia for software vendors integrating online claiming for PBS with their product. The Helpdesk can be contacted on 1300 550 115.
• the Online Technical Support Integration Testing Team conducts the testing process, including scheduling testing times for all vendors.

After the vendor has integrated online claiming for PBS with their product, the vendor should contact the Online Technical Support Helpdesk to obtain the software vendor Starter Pack for online claiming for PBS. The starter pack includes test scenarios and test data to assist with the testing of the Client Adaptor after it has been integrated into your PDS.

The vendor should then use the supplied testing materials to undertake preliminary testing with the Medicare Australia integration testing environment.

Pre testing

Medicare Australia will:

• set up the Integration Test Environment
• provide technical support to vendors if required.

Unit testing

Unit testing is completed by a software vendor to ensure that a software product functions as designed before commencing preliminary testing with Medicare Australia.

The vendor will:

• integrate the encryption and eSignature components provided with the API and online claiming for PBS Logic Pack into the PDS
• configure the PDS for the use of a Location Certificate
• ensure that messages of varying types (including how Information, Warning and Reject reason codes are displayed to the pharmacy) can be sent and accepted by the PDS
• submit a minimum of one transaction to Medicare Australia.

The vendor will agree not to commence sending test transmissions without the prior knowledge of Medicare Australia. (Note: the test instructions have details on this).

Commencement of preliminary testing

Preliminary testing ensures that the software product functions correctly and to ensure all critical issues are resolved before commencing Integration Testing.

Medicare Australia will:

• Send the Software Vendor Testing Information Pack to the vendor via email. This pack contains:
  • Product Details Form
  • vendor preliminary testing checklist
  • testing templates if required by the vendor
  • scenarios if required by the vendor
  • common known testing issues
  • declarations if required by the vendor

Note: Preliminary testing is completed remotely, not requiring the vendor to be at Medicare Australia premises.

Completion of preliminary testing

A booking should be made with the Integration Testing Team at least three weeks before coming in for integration testing. Preliminary testing should be completed one week before integration testing is due to commence.

The vendor will send the preliminary test results to the Integration Testing Team. The Integration Testing Team will use this information and information from the integration test environment to determine whether any issues exist in the preliminary testing.

If issues are identified, the Integration Testing Team will contact the software vendor explaining the issues and how to rectify the problems. Once these issues are fixed testing will continue.

The Integration Testing Team will confirm the successful completion of preliminary testing, and make arrangements for integration testing to commence.

The vendor should organise for documentation on the use of their system in a pharmacy environment to be sent to Medicare Australia's Online Technical Support Helpdesk. This documentation should include:

• installation instructions
• a copy of the product's user support documentation
• screen prints of the application in use, particularly how Information, Warning and Reject reason codes are displayed to the pharmacy

Commencement of integration testing

Integration testing ensures that all critical issues found during the preliminary testing have been resolved and to confidence test the product. Upon successful completion of this stage of testing, a Notice of Integration (NOI) is issued indicating the product is ready for production.

• The Integration Testing Team will notify the software vendor to confirm that integration testing will commence on the date arranged.
• The vendor should bring in their own machine when conducting integration testing. Alternatively the vendor can install their PDS on a Medicare Australia standalone PC. If the vendor intends to use Medicare Australia hardware, they will need to discuss their hardware and operating system requirements with the Integration Testing Team ahead of time. If the product supports multiple platforms, only one primary platform will be tested at Medicare Australia. Additional platforms will require less rigorous testing and can be tested remotely.
• The Integration Testing Team will test using the same set of test scenarios that were issued to conduct preliminary testing.
• The Integration Testing Team may identify two types of issues: mandatory fixes and advisements. Advisements represent changes that Medicare Australia believes would improve the product, but that do not prevent issuance of a NOI. Mandatory fixes will prevent issuance of a NOI until rectified.
• A NOI will not be issued until the Integration Testing Team are satisfied that all mandatory fixes have been corrected.

Completion of integration testing

The following test exit criteria must be satisfied by a vendor before Medicare Australia can be confident the vendora™s product can support online claiming for PBS:

• All message fields are populated correctly.
• Claim, batch claim (after communication failure), cancel and statement transactions can be sent and accepted and are formatted appropriately.
• Messages returned from Medicare Australia can be received and are formatted appropriately.
• Transactions are encrypted, signed and transmitted successfully and in accordance with Medicare Australia's encryption and signature process.
• Information, Warning and Reject reason codes are correctly presented to the user.
• Reconciliations are correctly processed and displayed.
• Processing is in accordance with the provided business model.

Notice of integration

Integration testing will cease when all tests have been successfully completed. The Integration Testing Team will notify the Online Technical Support Helpdesk once this is done.

A vendor cannot send in production transmissions to Medicare Australia until testing has been successfully completed and the NOI issued.

The Medicare Australia Online Technical Support Helpdesk will issue a NOI for the PDS tested.

The vendor should receive their NOI within five working days from the date the Online Technical Support Helpdesk was notified of the successful completion of testing.

Benefits to pharmacy

Online claiming for PBS will give pharmacies faster and better ways to claim by:

• flagging potential rejections at the point of dispensing, allowing any errors to be corrected before the customer leaves the pharmacy
• giving pharmacies more certainty of the amount that Medicare Australia will pay before the medicine is supplied to the customer
• paying pharmacies more frequently
• sending electronic statements that are automatically reconciled by the dispensing software.

Participating vendors

Nine software vendors have already integrated online claiming for PBS into their products for use by pharmacy:

• Simple Retail with Aquarius Dispense
• Corum Health Services with Amfac Windows Dispensing
• Corum Health Services with Lots Dispense
• Corum Health Services with QuickScript
• Corum Health Services with Dispense 3
• iSoft with iPharmacy
• Phillips and Phillips
• PCA NU Systems with Winifred
• Pharmhos with Merlin
• Minfos with Minfos Dispense
• Phoenix with Rex
• Healthsoft with PharmacyPro

When will Online claiming for PBS be available more widely?

As the recommendations from the pilot evaluation have been successfully implemented, online claiming for PBS is now available for all interested pharmacies. If pharmacies are interested to move to online claiming for PBS to gain the benefits of better and faster ways to claim, they can register for online claiming for PBS at any time.

Once the above has been completed, pharmacies are being advised to contact their software vendor to arrange for online claiming for PBS to be installed.

More information

For more vendor-related information on online claiming for PBS, please call the Online Technical Support Helpdesk on 1300 550 115 or email the Helpdesk at pbsonline@medicareaustralia.gov.au.

Pharmacists can find more information on online claiming for PBS by calling Medicare Australia on 132 290.

Online claiming for PBS information brochure

This information brochure provides an overview of Online claiming for PBS [PDF, 125Kb]

Some documents on this page may require the free Adobe PDF reader.

Last updated: 18 March, 2010

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