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PBS manual pharmacy claims quality checking in QST 111-21031518

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Services Australia website

PBS for pharmacists

External websites

Department of Veterans’ Affairs - Reducing medicine costs under the Safety Net Scheme

Department of Health and Aged Care - Pharmaceutical Benefits Scheme (PBS)

Privacy and Secrecy

Enterprise Quality Framework

Letters

Pharmaceutical Benefits Scheme (PBS)

Forms

Privacy Incident Portal

Contact details

Health Service Delivery Division - Quality Operations & Technical Support

Medicare and Aged Care - Local Peer Support (LPS)

Error codes - error free

Table 1

Error codes

Error definition

A00

No errors.

Error codes - B status codes - System errors

Table: for processes, see:

  • Register manual or manual under co-payment (UCP) claim package in pharmaceutical Benefits Scheme (PBS) claims Processing System
  • Online claiming for PBS

    Error codes

    Error definition

    B01C

    Critical

    SYSTEM claim registration error.

    • Registered against the incorrect supplier
    • Incorrect date of lodgement

    B02C

    Critical

    SYSTEM claim transaction error.

    Incorrect:

    • reference number or claim period
    • payment category level
    • first prescription or last prescription serial number

    B03C

    Critical

    SYSTEM prescription detail error.

    Incorrect:

    • serial number
    • form type
    • prescriber ID
    • Medicare or entitlement number
    • patient details
    • date of prescribing or supply
    • item name
    • quantity and repeats
    • previous supplies
    • Authority number
    • streamline code

    B04C

    Critical

    SYSTEM reason code error.

    • Incorrect reason code applied
    • Ignored reason code rejection warning

    B05C

    Critical

    SYSTEM adjustment error.

    Incorrect adjustment amount.

    B14C

    Critical

    SYSTEM record not updated error.

    • Missed prescription
    • Failure to complete or save

    B18C

    Non-critical

    SYSTEM comments error.

Error codes - C status codes - application form errors

Table 3: for processes, see Register manual or manual under co-payment (UCP) claim package in pharmaceutical Benefits Scheme (PBS) claims Processing System.

Error codes

Error definition

C01C

Critical

FORM incomplete or not provided.

Required form not provided:

  • Manual claim - Approved Supplier Manual Payment Reconciliation (PB242)
  • Manual prescription processing fee for pharmaceutical benefits Bureau service deduction authority (PB259) to avoid charge
  • Illegible form

Missing information:

  • pharmacy or supplier details
  • prescription claim details
  • declaration details or signature

Error codes – D status codes – letter errors

Table 4: for processes, see:

Error codes

Error definition

D01C

Critical

LETTER address error.

Letter sent to the correct recipient, but used an incorrect address.

D02C

Critical

LETTER attachment error.

The wrong prescription is included with the letter.

D03C

Critical

LETTER type or information error.

  • Incorrect standard letter or wording
  • Incorrect information
  • Critical information is missing

D05C

Critical

LETTER recipient error.

Letter sent to the incorrect recipient.

D06C

Non-critical

LETTER minor message error.

  • Administration reference information is missing or incorrect
  • Spelling errors in free text areas

Error codes - E status codes - assessing errors

Table 5 contains assessing errors that relate to an incorrect determination of entitlement. For example, failure to calculate the correct amount or exclude ineligible prescriptions.

Note: if it is a recording error see Table 2 B system errors.

For processes, see:

Error codes

Error definition

E01C

Critical

ASSESSING entitlement error.

Rejected or approved incorrectly.

E02C

Critical

ASSESSING calculation error.

Incorrect adjustment calculation.

E03C

Critical

ASSESSING escalation error.

Not escalated to the PBS Help Desk or Local Peer Support (LPS) when required.

Error codes – F status codes – PaNDA errors

Table 6: for processes, see:

Error codes

Error definition

F01C

Non-critical

PaNDA program or work type classification error.

Work is incorrectly classified.

Note: includes work incorrectly named, if also incorrectly classified.

F02C

Non-critical

PaNDA naming error.

Classified correctly, but naming conventions not applied or incorrect.

F03C

Non-critical

PaNDA comment error.

Required comments omitted or incorrect.

F04C

Non-critical

PaNDA documentation missing.

Sent letter or email not uploaded to the Work Item or page/s missing in documentation.

Rejection information not uploaded or uploaded with incorrect or missing information.

F05C

Non-critical

PaNDA Work Items not merged.

Connected Work Items not merged into one.

F06C

Non-critical

PaNDA Work Items not separated.

Did not separate multiple Work Items in PaNDA or extract a different Work Type for separate processing.