Types of PBS general enquiries
Table 1: lists the main general enquiry types and usual callers from which those enquiries are received.
Enquiry type | Approved Supplier | Members of the public | Doctor | Medicare Service Centres | If unable to be resolved by Service Officer, refer call to |
Release of Entitlement number | Yes | | | | Local Peer Support (LPS) |
Authority detail clarification | Yes | | | | LPS |
PBS payments | Yes - escalate to LPS | | | | LPS |
Claim period status | Yes - approved or authorised person only | | | | LPS |
Pricing - not related to a submitted claim / prescription | Yes | Yes | | | PA |
Script claim warnings or rejections | Yes | | | | LPS |
PBS Safety Net | Yes | Yes | | Yes | LPS |
Stationery | Yes | | Yes | | LPS |
Claiming advice | Yes | | | | PA |
RHCA | Yes | Yes | Yes | | LPS |
PBS patient refunds | | Yes | | Yes | LPS |
PBS status of medication | Yes | Yes | Yes | | PA |
Schedule listings | Yes | Yes | Yes | | LPS or PA |
Statements | Yes | | | | LPS |
Prescription writing procedures and legislative requirements | Yes | | Yes | | LPS |
Prescription shoppers | Yes | Yes | Yes | | LPS who may refer warm transfer to Prescription Shopping Information Service |
Claim period status field
Table 2: describes the current status of the claim shown in the Claim Period Status field of the PBS Online Claiming System.
Claim period status | Description |
In progress | Approved supplier sending prescription claim transactions for that claim period. |
Abandoned | When all of the prescriptions in a claim package have been cancelled. |
Generate statement | Indicates payment request and the statement generation process can start. |
Statement generated | Statement details have been generated for that claim period. |
Complete | All processing has been completed and record is ready for auto-culling. |
Ready for Culling | Indicates data is ready to be auto-culled. |
Culled | Indicates data has been culled from the tables. |
Culling exempt | Indicates data cannot be auto-culled. |
Auto Abandoned | Indicates this claim encountered an error during processing and has not been assessed. |
Payment status in PBS Online Claims Processing System
Table 3: describes the payment status fields in the PBS Online Claims Processing System.
Payment status | Description |
Ready | Claim period is ready to be compiled into a payment request. |
Payment requested | A request has been sent to the Payment Utility (PU) system for payment and the External Payment ID is populated in the PBS Online Claims Processing System. |
Withhold | Claim period is not to be paid. |
Example responses to handle death related questions in the PBS
Table 4: details typical enquiries and appropriate responses Service Officers may provide to death related enquiries in PBS.
Example | Questions and answers |
1 | There are other warning reason codes with the same details, why is this a reject? Release of entitlement details for the patient is restricted under the secrecy provisions. I can only confirm that the claim was assessed against Services Australia's records and the rejection was based on the patient's ineligibility at the date of supply provided. |
2 | Is there any other details you can provide? I can confirm that the patient does not hold valid entitlements to PBS subsidised medications. |
3 | Why cannot you provide further details? Due to the secrecy provisions outlined in the National Health Act 1953 and the Health Insurance Act 1973, there is no authority to release further details. |
4 | I have the patient in my pharmacy with me right now, what should I say to them? Advise the patient to visit a service centre or contact Services Australia to confirm their Medicare eligibility and current details. |
Contact details
Pharmaceutical Benefits Scheme (PBS) - general enquiries
Pharmaceutical Benefits Scheme (PBS) - Authority approvals
External websites
Department of Health, Disability and Ageing - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers
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