External Breast Prostheses Reimbursement Program (EBPRP)
Health Services Division - Quality Operations & Technical Support
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 Policy’s approval email not attached for overrides |
It is an error when the Program 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 ECPRP 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 |
Intranet links
Enterprise Quality Framework
Expand all