Overview of claiming process
Follow these steps to claim under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS):
- Check the claim
- Complete the Close a Claim transaction
- Keep all prescriptions and claim paperwork.
Step 1 - Check the claim
- all prescriptions or repeat authorisation forms are:
- signed and dated by the patient
- signed, dated and addressed by their agent, or correctly certified as supplied by the pharmacist
- data in the pharmacy dispensing software matches the prescription information
- you enter prescriptions using these categories:
(G) General patients
(C) Concession and Safety Net concession cardholders
(E) Safety Net entitlement cardholders
(R) RPBS patients
(D) Emergency drug supplies
- you remove items that have no documentation, missing prescriptions, rejected prescriptions or unsupplied items from the electronic claim data list
- you generate new serial numbers and correct any details if you need to reclaim prescriptions
- where required under regulation 25, you write Immediate supply necessary on prescriptions or repeat authorisation forms and include the dispensing pharmacist signature.
Step 2 - Complete the Close a Claim transaction
To close a claim:
- start the Close a Claim transaction using your dispensing software program
- acknowledge the certification of supply statement that summarises the claim details.
- your software will send the transaction to us through Online Claiming for PBS
- we’ll send a return message showing the successful closure of the claim
- you can still make changes to prescriptions up to 90 days from the date of claim closure
- you’ll need to prepare claims separately if the pharmacy approval number changes during the claim period
- unless you make other arrangements with us:
- you can only lodge 1 claim per month
- the claim period should cover pharmaceutical benefits supplied for no more than 35 days.
Step 3 - Keep all prescriptions and claim paperwork
- you keep prescriptions in paper or electronic form for 2 years - this is a legislative requirement for post payment quality and audit checks
- if you’re an approved supplier and claim manually, you provide us with paper prescriptions, plus a completed and signed claim for payment form - we charge 47 cents per prescription for manual claims.
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