Process claims in the Australian Immunisation Register (AIR) 011-10100000

Check the Source Location for the form on the PaNDA work item.

If received via:

• HPOS, go to Step 2
• Email or SOC (Scanning Operations Centre), go to Step 5

PaNDA work types configured to receive items from HPOS will display an Open in HPOS button in the top right-hand corner of the Work Item and Document Details screen.

In the PaNDA work item:

• Select Open in HPOS in top right corner of work item
• Check Sent for details in Text to see who sent the form:
• Provider/Doctor - provider's name shows in Sent by
• Delegate - shows as Sent for provider's name, by delegate's name
• Organisation - shows as Sent for organisation's name, by delegate's name
• Unidentified - name in From/Sent by matches patient's name on form or another HPOS user (check this by opening the attachment under File Name)

If the form was sent by:

• provider, delegate acting on behalf of the provider or organisation, see Table 2
• unidentified, go to Step 3
• patient, go to Step 7

Service Officers must:

• not process AIR Forms submitted by:
• an individual other than the provider/doctor, or
• a delegate on behalf of the provider/organisation
• make 1 attempt to contact the practice

If contact with the practice was:

• successful, go to Step 4
• unsuccessful, go to Step 5

Do not process the form.

For outbound calls, Service Officers must use the script in Table 2, Step 4 in the Authentication and release of information for Australian Immunisation Register (AIR).

"Hello this is <first name> from Services Australia. Before we proceed with this call, I need to inform you the call may be recorded or listened to for quality and coaching purposes."

Tell the practice:

• the form submitted via HPOS by <Sender Name in HPOS> cannot be processed
• AIR forms lodged via HPOS can only be accepted if submitted by:
• the provider that signed the form
• a nominated HPOS delegate, acting on behalf of the provider who signed the form, or
• an individual acting on behalf of a PRODA organisation
• to resubmit via Provider/Delegate/Organisation

After successfully contacting the practice, go to Step 6.

Do not process the form:

• Reply to the individual via HPOS message
• Go to Step 6

To reply to the individual:

• Select Open in HPOS in top right corner of PaNDA work item
• Select Reply
• Open the Z2924 HPOS text template (Notepad document)
• Copy the message into the Text field
• Add the individual's (sender’s) name and relevant form number

Attach infographic (see the Resources page for the AIR form upload infographic)

• Save the infographic to desktop (or a file of choice)
• Select Choose File and go to where the letter was saved
• Select Open - file can be seen next to 'Choose File'
• Select Add File - make sure the correct file is attached, if not, select Remove and search again

Finalise Message

Double check the attachment, message and names are correct:

• If not correct:
• Select Cancel
• Confirm cancellation
• Start again
• If correct - Select Send

Add comments in PaNDA:

"IM011 form submitted by <person name> has been returned as not sent via correct delegation channel.
<< Called practice and spoke to <name> and advised to resubmit using correct HPOS delegation.
<< Attempted to contact practice/provider on <date/time> no answer. Returned form via HPOS messages ref <HPOS reference number from PaNDA (for example, 123456789-1)"

Mark the work as complete in PaNDA.

Procedure ends here.

Do not process the form.

• Send the form back to the patient with Z2334 standard letter
• Add comments in PaNDA and mainframe. 'Form submitted by (patient/unknown person), returned with letter'
• Check the correct Medicare number and provider number have been saved on the PaNDA work item
• Upload/Add letter to PaNDA work item
• Complete the work item in PaNDA

Procedure ends here.

Service Officers must:

• Make 1 attempt to contact the practice
• For outbound calls, use the script in Table 2, Step 4 in the Authentication and release of information for Australian Immunisation Register (AIR)

If contact is:

• successful, go to Step 9
• unsuccessful, go to Step 11

Advise the practice contact person, when manual forms are received, Services Australia contact them to confirm if they sent the form.

Use this time to promote digital options.

If the Service officer is:

• internet trained:
• promote the AIR digital options available
• if the contact person is not available, arrange another time to call back
• not internet trained:
• offer to transfer them to the AIR Internet helpdesk, or
• give the practice the phone number

If the promotion of digital options generates a negative response, complete a Local Peer Support (LPS) referral form and request that an AIR Business Development Officer (BDO) contacts the practice.

Include in referral form:

• It is a Manual Lodgement of form, (email/SOC)
• Provider Number
• Name of practice
• Name of the contact person the Service Officer spoke to
• Initial conversation/outcome
• Reason for not submitting digitally
• Attach a copy of the form received, that prompted the call

Did the practice contact confirm that they sent the form?

• Yes, go to Step 10
• No, go to Step 11

Has the provider signed the form or completed the declaration section in full?

• Yes:
• Add comments in PaNDA and mainframe - 'Confirmed with <name> (doctor/nurse/receptionist) form sent by practice'
• Process the form, see Table 3
• No:
• Confirm it was completed by a provider and sent manually
• Add comments in PaNDA and mainframe - 'Spoke to <name> (doctor/nurse/receptionist) and confirmed form completed and sent by practice'
• Process the form, see Table 3

Note: if the form is:

• received via email and it is clear the practice sent it, see Table 3
• only for notifying of hepatitis B birth dose, see Table 2

If the Service Officer is unable to determine if the practice sent the form:

• return the form to the patient with Z2334 standard letter
• add comment in PaNDA and mainframe - Unable to confirm who sent the form, returned with letter to patient
• check the correct Medicare number and provider number have been saved on the work item
• complete work item in PaNDA. See Work Optimiser for staff

If the notification of a Hep B birth dose is:

• by an individual, go to Step 2
• on a form, go to Step 3

If an individual requests that the vaccination be shown on an immunisation history statement and the Hep B birth dose flag on AIR mainframe is:

• already recorded, Service Officers can use the information shown in the flag (date given and notifying provider) to enter the Hep B birth dose as an encounter. See Table 3
• not recorded, refer the individual to their vaccination provider to add the vaccine to the AIR. Procedure ends here

For the:

• Australian Immunisation Register immunisation history form (IM013), see Overseas immunisations and processing history forms in the Australian Immunisation Register (AIR)
• Australian Immunisation Register immunisation encounter form (IM018), go to Step 4

The Hep B birth dose can show on the AIR immunisation encounter form (IM018) form in 2 ways, that is, by completing:

• question 7 - notified as documentation sighted and given by another provider in Australia. Follow the process in Overseas immunisations and processing history forms in the Australian Immunisation Register (AIR)
• the vaccination details at question 8, where the vaccine was given by the provider that signed the form. Follow the below process

In AIR mainframe:

• Key YIAM - the Create/Amend Header Register Manual Claim screen displays
• Key the following:
• Information Provider Number
• Claim ID (add 'X9' in front of 5 digit 'P' number) (for example, for P number P22221 the Claim ID will be X922221)
• 1 in the Quoted Number field
• Receipt Date (date form signed)
• Immunisation Date (date noted at question 8)
• Press [Enter] - the message PF9 TO UPDATE displays
• Press [PF9 - UPDATE] - [F9] on keyboard. The YXCB - Individual Selection screen displays
• Key the individual’s details by using the Medicare number or the individual’s details on the form
• Press [Enter] - the YXCB - Individual Selection screen displays
• Key (/) to select the individual, press [Enter] - the YIAE - Encounter Details screen displays
• Press [Enter] - the message PF9 TO UPDATE displays
• Press [PF9 - UPDATE] - [F9] on keyboard. The YIAN - Antigen Details screen displays
• Key the vaccine code in the Vaccine Code field
• Key B in the Dose field if given in first 7 days after birth
• Press [Enter] and [PF9] to update

Display immunisation history.

To display any recorded vaccinations, log on to AIR mainframe then:

• Key YCUI anywhere on a blank screen
• Press [Enter] - the Registration Amendment Search screen displays
• Key Medicare number or individual's details from form
• Press [Enter] - the Amendment Registration screen displays
• Press [PF14] - (shift + [F2] to go to the YIRD - Episode History-Basic screen

Check the immunisation history.

Has the immunisation information already been recorded?

• Yes, and it is for:
• the same claim ID or immunising provider number as the one already recorded, do not process.
  Record a comment in PaNDA notes - 'Duplicate encounter - not processed'. Finalise the document as per Workload Management (WLM) processing guidelines. See Work Optimiser for staff.
  Procedure ends here
• a different claim ID or immunising provider number, see Process pended claims in AIR
• No, go to Step 3

In AIR mainframe:

• Key YIAM, then press [Enter] - the Create/Amend Header Register Manual Claim screen displays
• Key the following:
• Information Provider Number
• Claim ID (add 'X9' in front of 5 digit 'P' number) (for example, for P number P22221 the Claim ID will be X922221)
• 1 in the Quoted Number field
• Receipt Date (date form signed)
• Immunisation Date (date noted at question 8)
• Press [Enter] - the message PF9 TO UPDATE displays
• Press [PF9 - UPDATE] - [F9] on the keyboard. The YXCB - Individual Selection screen displays
• Search for the individual by using the Medicare number or the individual's details on the form
• Press [Enter] - the YXCB - Individual Selection screen displays
• Key (/) to select the individual, press [Enter]. The Encounter Details screen displays
• Press [Enter] - the message PF9 TO UPDATE displays
• Press [PF9 - UPDATE] - [F9] on the keyboard. The YIAN - Antigen Details screen displays
• Key the vaccine code in the vaccine Code field
• Key dose number in the Dose field
• Key the batch number:
• Some vaccines have a lot number instead of a batch number
• Key the lot number
• Press [Enter] and [PF9] to update

If the batch number is not recorded for any National Immunisation Program (NIP), COVID-19, influenza, or Japanese Encephalitis virus (JEV) vaccines:

• Service Officer must attempt 1 outbound call to the provider
• If contact is unsuccessful, send Z2334 standard letter

For multiple encounters, go to Step 4.

Note:

• If error message is returned, see Table 5 on the Resources page
• If amendments to header details are required, see Table 5

Vaccine type and route of administration

If the form has the vaccine type, and/or route of administration, Service Officers must:

• add the vaccine information in mainframe
• escalate the form in PaNDA to a delegate

The skilled group assigned in the delegate role will add the vaccine type and/or route of administration.

To locate individual:

• Press [PF15] - the YXCB - Individual Selection screen will display
• Key Medicare card number (if available), or
• Personal details such as:
• surname
• given name
• gender
• date of birth
• postcode (optional)
• Press [Enter] - the YIAE - Encounter Details screen displays when a unique match or list of possible matches displays on the YXCB - Selection screen
• Select (/) the match from the list to display the YIAE - Encounter Details screen

Is the individual's record located?

• Yes, go to Step 7
• No, go to Step 6
• The message Amend search details or PF10 to add child displays, or
• List of possible matches found. Scroll list to check for a match
• Search Medicare CDMS for the individual. If the individual cannot be found, add the individual to the AIR by creating a SIN (Supplementary Identification Number) record

To add the individual:

• go to the YXCB - Selection screen, remove Medicare number if present
• press [PF10] - new child or individual to the AIR as a SIN record

When adding an individual, key:

• a Medicare address, or
• an address supplied by the provider, and
• the individuals gender

To record vaccination details:

• Key the date the immunisation was given in the Imm Date field
• Press [PF9] to update
• Key vaccine code and dose in applicable fields on the YIAN - Antigen Details screen
• Press [Enter]
• Check that there are no pends by looking for an A in the ST field and 00 in the Pend Count field. If there are pends, action pended antigen with appropriate action code
• If all vaccines have an A status, press [PF9 - UPDATE] - the YIAE - Encounter Details screen displays
• Finalise the document as per processing guidelines

Note: if recording a hepatitis B birth dose from the immunisation encounter form, enter B in the Dose field if given to a child up to 7 days of age.

See AIR system for a list of vaccine code names or place cursor on VACC field and select [PF1-HELP] to display a list of vaccine codes.

Check the Medicare CDMS personal tab

Are the details listed on Medicare CDMS?

• Yes, do not update the record
• No:
• Key YCUI anywhere on a blank screen - the YCUI - Registration Amendment Search screen displays
• Key Medicare number or individual's details
• Press [Enter] - the YCUA - Amendment Registration screen displays
• Key Y in the Indigenous field
• Press [Enter] - the message PF9 TO UPDATE displays
• Press [PF9 - UPDATE] - the message update successful will display
• Procedure ends here

Is the Service Officer still in the encounter claim, having previously added vaccine details?

• Yes:
• Select [PF15 - NEW ENC] to add next encounter
• Key vaccines, press [Enter] and action any pends
• Select [PF9 - UPDATE] to finalise
• No, go to Step 2

To access the Immunisation Encounters screen:

• Key YIEM
• Press [Enter] - the YIEM - Immunisation Encounters Menu screen displays
• Key option 2 - Claim Selection (Encounter Processing) (YICE)
• Press [Enter] - the YICE - Claim Selection (Encounter Processing) screen displays

To search for claim details:

• Key provider number
• Key Claim ID
• Press [Enter]. Claims entered previously with these search criteria will display

Amending the Rcpt Date From and To fields narrows the search.

To select claim details

• Key (/) in the Cursor field to select correct claim
• Select [PF15 - ADD ENCTR] - the YXCB - Selection screen will display

To record encounter:

• See Table 3, Steps 4 to 7
• Finalise the document as per processing guidelines

Complete Table 3, Steps 1 to 3

A list of claims matching details keyed will display.

To select claim:

• Select (/) claim to be amended
• Press [PF17 - Update Header Encounter]
• Press [PF4 - Claim]
• select (/) claim to be amended
• Press [PF17 - Upd Header] - the Create/Amend Header Update Header Details screen and message Key/amend header details displays

The claim type selected for amendment will determine last alpha in screen name returned.

To amend the selected claim:

• Amend applicable unprotected fields (immunising provider number and immunisation date).
• Press [Enter] - the message PF9 to update displays
• Press [PF9] to update - the YICE - Claim Selection Encounter Processing screen is displayed and details are updated

Check individual's Medicare history in AIR mainframe to see if a date of service that corresponds to the vaccination date can be found:

Key anywhere on blank AIR mainframe screen type.

• NHSI
• (,) comma
• Medicare number
• (,) comma
• Medicare individual reference number
• Press [Enter] - the Medicare - Patient History screen appears

Is a corresponding date found?

• Yes, go to Step 3
• No, go to Step 6

Using the provider number shown against the relevant date of service:

• search for provider's contact number, and
• attempt to contact them by phone. See Action a vaccination provider's enquiry on the AIR for more information

For outbound calls, Service Officers must use the script in Table 2, Step 4 in the Authentication and release of information for Australian Immunisation Register (AIR).

Can the provider be contacted?

• Yes, go to Step 4
• No, go to Step 5

Tell the provider more information is needed to process the immunisation data.

Did they provide the immunisations in question?

• Yes:
• Ask for their provider number
• Key into header as immunising and information provider
• Include confirmation in a comment in notes as per processing guidelines
• Procedure ends here
• No, go to Step 5

• Record encounter information as history form claim recording the provider number as the information provider. See Overseas immunisations and processing history forms in the Australian Immunisation Register (AIR)
• Record note in AIR mainframe
• Record comment in notes as per processing guidelines

Record note in AIR mainframe.

Record comment in notes as per Workload Management (WLM) processing guidelines.