Education guide - Claiming checklist for community pharmacies - Health professionals

Overview of claiming process

Follow these steps to claim under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS):

Make sure:

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.

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.

Once closed:

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.

Make sure:

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.