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Call enquiries for pharmacy online claiming and payments in Pharmaceutical Benefits Scheme (PBS) 012-60130000

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This document outlines details about different types of online claiming and payment enquiries received regarding PBS or Repatriation Schedule of Pharmaceutical Benefits (RPBS) telephony.

On this page:

Pharmacist enquiries on the PBS authority line

Perform a pharmacy security check

Locate a claim period or prescription claim in PBS Online

Locate a payment in the PBS Online Claims Processing System

Payment capping - request an increase to a payment cap

Pharmacist enquiries on the PBS authority line

Pharmacists enquiring about an authority approval should contact the PBS - General Enquiries Line. This section contains the process Service Officers follow when a pharmacist incorrectly enquires about an authority approval on the Pharmaceutical Benefits Scheme (PBS) Authorities line.

Table 1: describes how to respond to a call from a pharmacist on the PBS Authorities Line.

Expand table

Step

Action

1

Advise correct number to call

Tell the pharmacist the correct number to call. For contact details, see PBS - General enquires line.

Is the Service Officer trained in PBS general enquiry line calls?

2

Transfer the call

Transfer the call to the correct number. For contact details, see PBS - General enquires line.


Perform a pharmacy security check

Table 2: describes how Service Officers perform a security check to establish or confirm the identity of the caller.

Expand table

Step

Action

1

Check incoming call destination

If the call is received on the IME line, follow the authentication process in Table 1 of the Improved Monitoring of Entitlements (IME) service.

2

Confirm identity
  • Ask the caller to confirm their identity with:
    • the pharmacy approval number, and
    • their name
  • If the caller cannot provide:
    • the pharmacy approval number - tell them to phone back when they can provide the number
    • their name - tell them this is required for security purposes and if not provided, details will not be released

Has the caller confirmed their identity?

3

Check pharmacy approval number
  • Key the pharmacy approval number in the Repatriation Benefits card (RPBC) screen
  • Ask the caller the:
    • name of the pharmacy, and
    • location address of the pharmacy
  • Check the details given match Mainframe/Customer First records

Note:

4

Check the status of the approval number

If the approval number is:

  • current, go to Step 5
  • revoked or suspended, ask for the date of supply that the enquiry relates to

Is the date of supply before the date the approval was revoked or suspended?

5

Ask caller the reason for enquiry

If the call relates to a:

6

Identify the caller for a claim period or payment enquiry

Service Officers must make sure the caller is an approved or authorised person before releasing details about a claim period or payment enquiry:

  • Press [PF9] from the RPBC screen to show approved persons
  • Confirm the caller's full name

Is the caller listed as an approved person?

7

Caller not listed on Approved Persons screen

From the Approved Persons screen, press [PF9] to show authorised persons.

Note:

Is the caller listed as an authorised person?

  • Yes, escalate to LPS
  • No, tell the caller details can only be released to an approved or authorised person. Procedure ends here

Locate a claim period or prescription claim in PBS Online

Table 3

Expand table

Step

Action

1

Access PBS Online Claims Processing System
  • Launch Internet browser, access intranet home page
  • Select:
    • My Tools
    • Medicare Portal from the menu shown
    • the Source Office key relevant to work area
    • PBS Claims Processing System from the eBusiness System dropdown menu
    • Submit

2

Locating a claim period

From the PBS Online Claim Processing home screen:

  • Select Query Claim Period
  • On the Query Claim Period screen:
    • Key Approved Supplier Number (ASN)
    • Key Claim Period Number (if known)
    • Select Online in the Channel dropdown menu
    • Select Search or press [Enter]
    • Select the radio button next to the relevant claim period
    • Select Open Claim Period tab

3

Locating a specific prescription

From the PBS Online Claim Processing home screen, select Query Prescription.

On the Query Prescription screen, Service Officers can search in many ways using the fields shown.

The most efficient search is with:

  • Approved Supplier Number (ASN)
  • Claim Period Number (CPN), and
  • The prescription serial ID located on the pharmacy dispensing sticker

Other search options include ASN with:

  • payment category
  • date of supply
  • Medicare or Concession number

Note: to search for Under-Co claims, change the prescription type from Claim to Under-Co claim.

Select the relevant prescription from the search results, select Open Prescription.

Check the correct prescription has shown by asking the caller to confirm the patient and item details on this screen.

4

Determine the reason code and relevant fix instructions, if required

To navigate the system to view other prescriptions, Service Officers can use any of these methods:

  • Previous prescription tab - goes to the previous serial number in the sequence
  • Next prescription tab - goes to the next serial number in the sequence
  • Query prescription tab - goes to a new query prescription search screen
  • PBS online home tab - goes back to the PBS claim processing home screen

Locate a payment in the PBS Online Claims Processing System

Table 4: describes how to search for a payment for an approved supplier after completing the security check.

Expand table

Step

Action

1

Access PBS Online Claims Processing System
  • Launch Internet browser, access intranet home page
  • Select:
    • My Tools
    • Medicare Portal from the menu
    • the Source Office code relevant to work area
    • PBS Claims Processing System from the eBusiness System dropdown menu
    • Submit

2

Access the Query Payment screen

Select Query Payment Status.

3

Key approved supplier number

Key the approved supplier number in the Approved Supplier Number field.

4

Search for payments

Key at least one of the following search criteria:

  • payment status
  • claim period number
  • PBS payment ID
  • Payment date (date range including From and To dates)

Select Search.

The search results show a list of payments matching the search criteria.

5

Select payment for the approved supplier

Select:

  • the radio button of the payment required.
  • Open Payment Summary

6

Provide payment details to the caller

To provide payment details, from the Payment Summary screen, select:

  • Payment Line Details to view all prescriptions that make up the payment
  • Disbursement Details to view bank account details of the approved supplier and the date the payment request was made. Note: Service Officers can confirm bank account details but not release them, or
  • Claim Period Details to view all details on the selected claim period, whether part of this payment or not

Payment capping - request an increase to a payment cap

Table 5: describes the procedure that a Service Officer must complete when an approved supplier requests to increase the daily payment cap.

Expand table

Step

Action

1

Request pharmacy details

If an approved supplier requests an increase to their daily payment cap, Service Officers must:

  • complete the pharmacy security check to make sure the caller is an approved/authorised person. If the caller is not an approved/authorised person, see Table 2
  • request the following details:
    • pharmacy name
    • approval number
    • approved/authorised person's name
    • contact telephone number

2

Email pharmacy details to PBS Claiming Support

Email the above details to Pharmaceutical Benefits Scheme (PBS) - PBS Claiming Support team who will assess and action the request.

Note: include in the email:

  • subject - 'Request for daily cap increase'
  • if offered by the approved supplier, the amount the cap should increase to
  • reason the approved supplier requests the increase