Dispensing and claiming for participating public hospitals

Dispensing

When you dispense PBS medicines in a public hospital make sure you have this information.

Patient details

When you dispense a prescription, check the patient's:

• full name and address - it must match the name on their Medicare card
• valid Medicare card number - you must record all 11 digits and the expiry date
• valid entitlement number if it applies - for example, their Health Care Card and PBS Safety Net card.

Item details

When you dispense a prescription, make sure you record these details in your dispensing software:

• the item name as specified by the prescriber
• the item form as specified by the prescriber - for example tablets, capsules, ointment, suppository
• the strength as specified by the prescriber
• the quantity and number of repeats as specified by the prescriber
• the authority prescription number for each Authority required item, and
• the streamlined authority code in the case of Authority required (STREAMLINED) items.

Prescriber details

When you dispense a prescription make sure it includes:

• the prescriber name
• the prescriber signature
• the prescriber number
• the prescription date as written on the prescription.

Other requirements

You also need to:

• stick the dispensing labels in sequence on our copy of the prescription
• make sure the stickers don’t obscure any details written by the prescriber - you can place labels on the back of the form if needed
• make sure the prescription is signed and dated by the patient or patient's agent or correctly certified as supplied by the pharmacist
• make sure the prescriber handwrote the patient's name if you're using computer-generated patient labels for your patient's details
• make sure you dispense prescriptions written by dentists as a dental prescription and mark the prescription form 'for dental treatment only'.

Claiming

Following these steps to help you submit your claim correctly.

Step 1: Check claim thoroughly

Make sure you:

• check all the 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
• write 'Immediate supply necessary' on the prescriptions or repeat authorisation forms, where required under regulation 25
• include the dispensing pharmacist's signature
• enter data in the pharmacy dispensing software that matches the prescription information
• 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

• remove items from the electronic claim data list that
  • have no documentation
  • are missing prescriptions
  • are rejected prescriptions, or are not yet supplied
• generate new serial numbers and correct any details if you need to reclaim prescriptions.

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 supply statement that sums up the claim details.

Once closed the Close a Claim transaction will be sent to us for processing. We'll send a return message showing the claim closed successfully.

Using the Close a Claim transaction will get a return message showing the claim was closed successfully. You will be able to continue to make changes to prescriptions up to 90 days from the date of claim closure.

You’ll need to prepare claims separately if there’s a change to the pharmacy approval number 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

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 need to provide us with the paper prescription plus a completed and signed claim for payment form - we charge 47 cents per prescription for manual claims.

More information

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