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Remote Area Aboriginal Health Services (RAAHS) quality checking in QST 111-22180000

This document outlines the quality checking process using the Quality and Support Tool (QST) for RAAHS.

RAAHS program and pre-check quality checking

Table 1: process Quality Checkers must follow when undertaking quality checks for RAAHS Pharmacy claims or adjustments.

Step	Action
1	Select a RAAHS work item for checking from the Quality and Support Tool (QST) Open the QST. The work item selected for checking is opened in PaNDA.
2	Locate the work item in the PBS Claims Processing System Open the PBS Claims Processing System and query the AHS claim number shown in the work item. The matching AHS claim number should display. Select Claim Details to see the claim information.
3	Check claim registration information Check the: pharmacy approval number community name and registration number date of supply signatures and names appear on the form claim reference number date of lodgement
4	Check claim transaction details Check the: item code numbers and brand codes match the description quantity supplied total supply Patient Specific Medicine Supply Fee (PSMSF) comments, if required required document uploads have been generated in PaNDA A second Payment ID is generated when an adjustment is actioned. It indicates the adjusted dispensed price to pay or recover. Exception For large claims only: When initial checks in the above steps have been completed. Quality checkers must check the transactions from the claim transactions details, for a maximum of 30 minutes. Note: this gives a sample of the claims quality If the claim has been actioned by multiple operators, only the last operator should be checked. Check PaNDA comments to see where each Service Officer started and finished processing
5	Check AHS Claim Summary Statement (CSS) Open the AHS CSS on the team share drive. Locate the nominated journal and look for the relevant AHS claim number (this is the number generated by the system once a new claim is registered). Check the: approval number registration number date of supply AHS claim number claim total (the total dispensed price excluding GST) total items paid and rejected duplicate payment IDs and items The adjusted AHS CSS shows adjusted item code numbers and quantities.
6	Check AHS Journal database Open the AHS Journal database on the team shared drive. Check the: database entries matches the Claim Summary Statement details Patient Specific Medicine Supply Fee (PSMSF) total matches the finalised claim. The PSMSF must: account for any reductions due to rejected items match the 2nd copy of the claim document uploaded by the processing officer
7	Provide quality checking feedback Provide quality checking feedback to the Service Officer using the Quality and Support Tool, including any errors identified. The outcome of the quality check is only provided to the Service Officer who finalised the claim and based on their work only. Provide feedback only, to any errors made in processing by earlier Service Officers. If errors are identified: make sure corrective action is taken if needed, provide learning support Note: If errors are identified in the AHS CCS make sure they are included in the feedback.