Contact details
External Breast Prostheses Reimbursement Program (EBPRP)
Quality and Skill Tags
Error-free status code for EBPRP quality checking
Table 1
Error-free status code | Definition | Processing Tip |
EB01 | Error-free | Quality check did not detect errors |
Document (claim form) error status codes for EBPRP quality checking
Table 2
Error status codes | Definition | Processing tip |
EB04 Critical | Prosthesis/prostheses information incomplete or omitted on the form | It is an error when the prosthesis/prostheses information is omitted or incomplete and there is no evidence to support action taken |
EB05 Critical | Bank Account details incomplete or omitted on form when appropriate | It is an error when the - BSB number
- account number
- account name
is omitted or incomplete from the claim form, bank account details have not previously been provided, and there is no evidence to support action taken |
EB06 Critical | Claim form not signed | It is an error when the application form is not signed, and the form has been actioned |
EB07 Critical | Supporting documentation not attached or insufficient | It is an error when the receipt does not include the: - description of item
- amount paid
- supplier details
- date of purchase
and there is no evidence to support action taken |
EB30 Critical | Verification of details not recorded on file note | It is an error when the details have been verified on the phone, and they have not been notated on the file note |
EB31 Critical | Program Management policy’s approval email not attached for overrides | It is an error when the Program Management policy’s approval mail is not printed and attached to front of claim |
EB32 Critical | Claimant cannot be uniquely identified from details supplied | It is an error when the claimant details section does not have sufficient information to uniquely identify the claimant, and there is no evidence that contact was made by the Service Officer |
Processing error status codes for EBPRP quality checking
Table 3
Error status codes | Definition | Processing tip |
EB09 Non-Critical | Address details incorrect | It is an error when the address details do not match the application on Personal and Group and there is no evidence contact was made by the Service Officer |
EB10 Non-critical | Contact details not updated or incorrect | It is an error when the contact details do not match the application form |
EB11 Critical | Bank account details incorrect | It is an error when the bank account details do not match the application form and there is no evidence to support action taken |
EB12 Non-critical | Comments omitted incomplete or incorrect | It is an error when the comments have not been updated, or updated incorrectly, upon the receipt of the claim |
EB13 Critical | Claim processed against incorrect claimant | It is an error when the claim has been processed against the incorrect person |
EB14 Non-critical | Date of Lodgement incorrect | It is an error when the date of lodgement has been keyed incorrect in the General Payment Parameter System (GPPS) |
EB15 Critical | Prosthesis/prostheses type (left/right) keyed incorrectly | It is an error when the prosthesis/prostheses type is keyed incorrectly in EBPRP within GPPS |
EB16 Critical | Date of purchase keyed incorrectly | It is an error when the date of purchase is keyed incorrectly in EBPRP within GPPS |
EB17 Critical | Amount Claimant has paid keyed incorrectly | It is an error when the total amount the claimant has paid for their prosthesis/prostheses, including any Private Health Care reimbursement amounts, has been keyed incorrectly |
EB18 Critical | Overrides keyed incorrectly | It is an error when the override is: - performed when not authorised
- not performed when authorised
in EBPRP within GPPS as per supporting documentation |
EB19 Critical | Authorisation number or reason for rejection incorrectly keyed in GPPS comments or not keyed | It is an error when the comments in the EBPRP claim screen for - Authorisation number
- Reason for rejection
are not keyed in EBPRP within GPPS as per supporting documentation |
EB20 Critical | Non-external Prosthesis/Prostheses processed in error | It is an error when a non-external Prosthesis/Prostheses item has been processed (for example a bra, swimwear, internal prostheses) |
EB22 Critical | Claim rejected in error | It is an error when the claim is deemed payable but has been rejected in error by the Service Officer |
EB23 Critical | Claimant indicated a private health fund rebate, but amount omitted or incomplete | It is an error when a claimant has indicated that they received a private health fund rebate/other financial assistance, however the amount was omitted or incomplete and there is no evidence that contact was made by the Service Officer |
EB33 Non-critical | PaNDA naming convention not complete or incorrect | It is an error when the PaNDA naming convention is not complete or incorrect |
EB34 Critical | Work items closed in PaNDA but item not processed | It is an error when the work item is closed prior to the item being processed |
EB35 Critical | EBPRP letter not uploaded to PaNDA or incorrect letter uploaded | It is an error when EBPRP letter has not been uploaded to the work item in PaNDA or uploaded incorrect letter |
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See Service Delivery Quality and Evaluation for a link to the Enterprise Quality Framework.
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