Education guide - Claiming checklist for community pharmacies
PBS claiming checklist for community pharmacies.
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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Page last updated: 31 March 2021
This information was printed 8 June 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-claiming-checklist-community-pharmacies/33051. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.