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Process pended claims in Australian Immunisation Register (AIR) 011-10110000



This page contains procedures for Service Officers to process pended encounters and episodes in the AIR through Workload Manager (WLM). View PF in Definitions for more information on using these functions.

Pend processing

On this Tab:

Locate pended claim

View and amend immunisation history details

Reassess an episode

Completed Pends not clearing from PaNDA

Locate pended claim

Table 1. when processing pended encounters, Service Officers must check the individual's immunisation history to see which vaccines may be conflicting with the current encounter. Previously recorded immunisation history may need amending to allow the current encounter at a P status to go to an A status.

Step

Action

1

Workload Manager + Read more ...

Locating a pended claim from WLM:

  • Find the claim details. The Summary screen displays
  • Select Copy AIR Search Details to copy the claim details
  • Go to the YICP - Claim Selection Pend Processing screen in Mainframe:
    • Place cursor in State field
    • Paste the claim details
    • Press [Enter]
  • The claim displays

Service Officers should process all pend encounters in the claim for which they are skilled. If there are multiple pended encounters in the claim, go to the Work Item Attributes icon in WLM to view the encounter details.

2

Select claim + Read more ...

Key (/) in the Sel field on the claim line and press [F11] - ENCTR LST.

The YIES - Encounter Selection screen displays.

3

Display pended encounters + Read more ...

  • Key P in the ACTN CODE field and press [Enter]
  • Press [PF13]. The YICP- Claim Selection screen displays

Encounters can also be filtered by Rsn or Ant codes.

4

Check for warning messages + Read more ...

  • Select (/) the encounter and press [Enter]. The YIAE - Encounter Details screen displays
  • Press [Enter] again
  • When the error or warning message displays, go to Step 5 and select the link to display the relevant pend code action table

5

Action all pend code warning messages

Pend code 01 - 24 + Read more ...

Pend code 25 - 49 + Read more ...

Pend code 50 - 74 + Read more ...

Pend code 75 - 99 + Read more ...

Pend code 100 - 124 + Read more ...

6

All pend process completed, select the next claim + Read more ...

When all pends for the claim are processed:

  • Return to WLM - select the back button (top left of screen)
  • Select Ready. New work item shows on Summary screen

View and amend immunisation history details

Table 2: when processing pended encounters, Service Officers must check the individual's immunisation history to see which vaccines may be conflicting with the current encounter. Previously recorded immunisation history may need amending to allow the current encounter at a P status to go to an A status.

Step

Action

1

Access Episode History-Basic screen + Read more ...

  • From the pended claim, navigate to YIAE - Encounter Details screen. See Steps 1 - 5 in Table 1.
  • Press [F14] - HIST

The YIRD - Episode History-Basic screen displays.

2

Evaluate the immunisation history + Read more ...

To allow the current encounter at P status go to A status, determine if:

  • the immunisation history details need to be amended, or
  • the immunisation details currently at P status need to be amended

If necessary, contact the immunising provider to clarify the information received or the immunisations previously recorded.

3

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Verify the identity of recognised vaccination provider for AIR enquiries table.

Contact provider to confirm immunisations.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

PDS search for provider details:

  • Search for the provider number using Program Registration (Medicare provider) or Organisation (Ancillary provider)
  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider)
  • In the *ID Type field, select from drop down:
    • Medicare Stem and Location for Medicare providers, or
    • AIR Provider number for Ancillary provider
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates

Is contact successful?

4

Make an amendment + Read more ...

To amend:

5

Amend a date of service + Read more ...

To amend a date of service:

  • Select (/) the encounter and press [F5] - ENCOUNTER. The YIAE - Encounter Details screen displays
  • Over-key the date of service
  • Press [Enter] and press [F9] to update. The YIAN - Antigens Details screen displays
  • If pend code is removed, press [F9]. The YIAE - Encounter Details screen displays

Go to Step 10.

6

Amend a vaccine and/or dose + Read more ...

To amend vaccine and/or dose details:

Go to Step 10.

7

Amend a vaccine recorded in error + Read more ...

To amend a vaccine recorded in error:

Go to Step 10.

8

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

9

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

10

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Reassess an episode

Table 3

Step

Action

1

Display encounter to be reassessed + Read more ...

From the YIRD - Episode History-Basic screen:

  • Select (/) the encounter to be reassessed and press [F6] - ANTIGEN

The YIAN - Antigens details screen displays.

2

Select the episode + Read more ...

Select the episode to be reassessed:

  • Select (/) the episode (vaccine) to be reassessed and press [F10] - REASSESS. The system applies the status (for example, A)

Reassess more than one episode in the same encounter at the same time by selecting (/) all episodes (vaccines).

3

Apply action code + Read more ...

  • If required, action the episode (vaccine) with the applicable pend action code. See the Action codes used in claims processing table
  • Press [Enter] then press [F9] to update. The YIAE - Encounter Details screen displays

Completed Pends not clearing from PaNDA

Table 4: there has been an ongoing system issue with 2-5% of daily incoming AIR Pends not automatically clearing from PaNDA Worklists once competed. The system issue is unable to be resolved and staff must follow the below process if they identify any idle IT Issue AIR Pends in their PaNDA Worklist. This will filter the work items into one work type category for a system wide clean up.

Step

Action

1

Identify all idle IT Issue AIR Pends + Read more ...

Idle IT Issue AIR Pends are AIR Pend work items not automatically clearing from staff’s Worklist when completed.

  • Access and review PaNDA Worklist for any idle IT Issue AIR Pends
  • Select each identified work item by ticking the corresponding box in the PaNDA Worklist

2

Unassign all identified work items + Read more ...

Unassign and recategorise the work items by selecting:

  • Actions from the bottom right-hand corner
  • Unassign from the pop-up menu
  • Recategorised as the reason

Note: all recategorised AIR Pends will be quality checked. Only complete this process once the AIR Pend has been resolved.

3

Recategorise all identified work items + Read more ...

Recategorise the work items into:

  • Work Program Type: Australian Immunisation Register
  • Work Type Process Category: Unstructured
  • Work Type: AIR PEND N.O COMPLEX ESCALATION (AIR_PEND_NO)
  • Select Submit

Pend code action

On this Tab:

Pend 01 Medicare number invalid

Pend 05/06/11/12 Invalid character in given name or surname

Pend 15/16 Address details invalid or incomplete

Pend 17/18 Invalid character in address

Pend 19 Invalid character for second initial

Pend 24 Postcode/locality incompatible

Pend 31/40/41/42 Provider number not valid

Pend 32/33 The vaccine and/or dose number administered not supplied

Pend 34/35/36 The immunisation date supplied is either invalid or in the future

Pend 37 The immunisation date is prior to the AIR commencement date 01/01/96

Pend 38 Date missing (if Medicare number is not supplied, date of birth must be supplied)

Pend 43 Immunisation provider not current - provider number not current for the state

Pend 43 Immunisation provider not current - immunisation given prior to provider number start date

Pend 43 Immunisation provider not current - immunisation recorded post the provider number end date

Pend 44 Vaccine not valid for encounter date

Pend 50/51/54 Immunisation date prior to individual's date of birth

Pend 52 Date of receipt prior to immunisation date

Pend 53 The date of immunisation is after the end date recorded on the individual's registration

Pend 80 Individual not identified

Pend 100 Antigen has been administered under the minimum required age

Pend 101 Period between doses of the same antigen is less than the minimum time required

Pend 102 Duplicate antigen dose - same provider

Pend 103 Duplicate antigen dose - different provider

Pend 104 Administered within minimum time required between doses - different provider

Pend 105/112 Dose greater than maximum allowable dose

Pend 106/109 Higher dose already administered - same provider

Pend 107 Dose administered at greater than recommended schedule age

Pend 110 Same provider - Period between doses less than 6 months

Pend 111 Different provider - Period between doses less than 6 months

Pend 113 Dose given at less than (<) schedule age

Pend 115 Antigen has been administered under minimum required age

Pend 01 Medicare number invalid

Table 1

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F11] and then [Enter] to display the YXCB - Individual Selection screen
  • Remove Medicare card number
  • Search the YXCB screen for the Surname, Given Name and date of birth (DOB)

Is a matching record found?

2

Search CDMS + Read more ...

  • Log in to CDMS. See CDMS for Medicare for assistance
  • Select Inquire on Consumer Details
  • Select the Detailed Search tab and key the:
    • Family Name
    • First Name (also search without First Name)
    • Gender
    • DOB
    • Select the Group button, Medicare number is under Group ID

Is a match is found?

  • Yes:
    • Copy the Medicare number and key into the YXCB screen
    • Press [Enter]
    • Go to Step 4
  • No, search Customer First - FOH, go to Step 3

3

Search Customer First - Front of House (FoH) + Read more ...

  • Key:
    • Family Name
    • First Name
    • DOB
    • Select the Centrelink radio button
    • Select Search Account
  • Check any results for 'also known as' (AKA) names
  • If an AKA match is found, copy the customer details and re-check CDMS

Is a correct match found?

4

Complete the match + Read more ...

To complete the match:

  • Select (/) the matching person and press [Enter]. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. The YIAN - Antigens Details screen displays
  • Press [F9] to update

Go to Step 6.

5

Individual cannot be located + Read more ...

If the individual cannot be located, create a Supplementary Identification Number (SIN) record:

  • On the YXCB screen for the claim press [F10] - NEW INDV. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. This creates the person on the AIR with a SIN record. The YIAN - Antigens Details screen displays
  • Press [F9] to finalise

If the record is a test record sent to the AIR, escalate to an AIR Local Peer Support (LPS).

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounters Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 05/06/11/12 Invalid character in given name or surname

Table 2

Step

Action

1

Invalid character in name + Read more ...

Amend the claim encounter:

On the YIAE - Encounter Details screen:

  • Press [F11] and [Enter] to display the YXCB - Individual Selection screen
  • Remove the invalid character
  • Search the YXCB screen for Surname, Given Name and date of birth (DOB)

Is a matching record found?

2

Search CDMS + Read more ...

  • Log in to CDMS. See CDMS for Medicare for assistance
  • Select Inquire on Consumer Details
  • Select the Detailed Search tab and key the:
    • Family Name
    • First Name (also search without First Name)
    • Gender
    • DOB

Is a match is found?

For an invalid character on the Medicare record, go to Step 6.

  • Yes, copy the surname/given name and key into the YXCB screen. Press [Enter]
  • No, search Customer First - FOH, go to Step 3

3

Search Customer First + Read more ...

  • Key:
    • Family Name
    • First Name
    • DOB
    • Select the Centrelink radio button
    • Select Search Account
  • Check any results for 'also known as' (AKA) names
  • If an AKA match is found, copy the customer details and re-check CDMS

Is a correct match found?

4

Complete the match + Read more ...

Complete the match:

  • Select (/) the matching person and press [Enter]. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. The YIAN - Antigens Details screen displays
  • Press [F9] to update
  • Go to Step 7

5

Individual cannot be located + Read more ...

If the individual cannot be located, create a Supplementary Identification Number (SIN) record:

  • On the YXCB screen for the claim press [F10] - NEW INDV. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. This creates the person on the AIR with a SIN record. The YIAN - Antigens Details screen appears
  • Press [F9] to finalise

Go to Step 7.

6

Error on an existing Medicare customer record + Read more ...

Escalate to an AIR Local Peer Support (LPS) when:

  • CDMS contains an invalid character which has come across to Mainframe (Mainframe sources name detail from CDMS)
  • CDMS has the accurate spelling of the name but Mainframe contains an invalid character (CDMS data has not been transferred to Mainframe)

7

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounters Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 15/16 Address details invalid or incomplete

Table 3

Step

Action

1

Amend the claim encounter + Read more ...

Search Mainframe for the correct address.

Is the correct address found?

  • Yes,
    • Press [F11] and press [Enter]
    • Address displays in the Recent Addr field, with the message THIS ENCOUNTER REQUIRES UPDATING
    • Press [Enter]
    • Press [F9] to update
    • Go to Step 6
  • No, go to Step 2

2

Search CDMS + Read more ...

Search CDMS for the individual's address details

  • Log in to CDMS. See CDMS for Medicare for help
  • Select Inquire on Consumer Details
  • Select the Detailed Search tab and key the:
    • Family Name
    • First Name (also search without First Name)
    • Gender
    • DOB
  • Select Group button, or/and
  • Select the Address Search button (only if an address is listed) and key the:
    • suburb or postcode
    • address
  • Select Groups button
  • address not found through search, contact the provider to confirm address

Is an address found through CDMS?

3

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact provider to confirm the address.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

4

Locality match found + Read more ...

The correct address details found in CDMS:

  • Key correct address details on YIAE - Encounter Details screen and press [Enter]
  • If message NO RECORDS MATCH SEARCH CRITERIA displays, go to Step 5
  • Select (/) the record
  • Press [F9]. The YIAN - Antigens Details screen displays
  • Press [F9] to update, the YIAE - Encounter Details screen appears, with message UPDATE PROCESSING COMPLETE

Go to Step 6.

5

Locality not found - message NO RECORDS MATCH SEARCH CRITERIA + Read more ...

Check for the following:

  • Press [F11] and press [Enter]. A message appears: THIS ENCOUNTER REQUIRES UPDATING
  • Press [F9] to update record

Go to Step 6.

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounters Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 17/18 Invalid character in address

Table 4

Step

Action

1

Review and correct address + Read more ...

On the YIAE - Encounter Details screen:

  • Check the address for:
    • an invalid character
    • an incorrect space or double space
    • a hyphen (-) or forward slash (/) missing or spaced incorrectly
  • Confirm the address though CDMS, use the Address Search or Google
  • Correct the address on the YIAE - Encounter Details screen and press [Enter]
  • Press [F9] to update

Error on an existing Medicare customer record

If CDMS has the address recorded correctly, but Mainframe contains an invalid character, escalate to an AIR Local Peer Support (LPS).

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 19 Invalid character for second initial

Table 5

Step

Action

1

Update the claim + Read more ...

To process the claim:

  • On the YCUA - Amendment Registration screen, remove the invalid character
  • Press [Enter], and press [F9] to update. The YIAN - Antigens Details screen displays
  • Press [F9]. The message UPDATE PROCESSING COMPLETE displays

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 24 Postcode/locality incompatible

Table 6

Step

Action

1

Correct postcode/locality mismatch + Read more ...

To check the postcode/locality:

  • Search CDMS for the locality that is recorded on the record. See CDMS for Medicare for assistance
  • Select Inquire on Consumer Details
  • Select the Address Search button
  • Key the location (the address will match Australia Post)
  • Update the YIAE - Encounter Details screen, with the accurate locality/postcode details
  • Press [Enter] and then press [F9] to update

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 31/40/41/42 Provider number not valid

Table 7

Step

Action

1

Check provider number in Provider Directory System (PDS) + Read more ...

Note: for outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Is contact successful?

  • Yes:
    • Over-key the provider number on the YIAE - Encounter Details screen
    • Press [Enter], press [F9] to update
    • Go to Step 2
  • No, go to Step 2

2

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include who was contacted and what information was confirmed
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

3

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 32/33 The vaccine and/or dose number administered not supplied

Table 8

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen, press [F14] to display the customer immunisation history.

If the dose number or vaccine is missing, check the record to determine correct dose number or vaccine. Call the provider, if necessary.

2

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact provider to confirm the correct vaccine and/or dose number.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

3

Amend the claim encounter + Read more ...

  • Select (/) the pended episode and press [F6]
  • Update the episode with the correct dose number or vaccine code
  • Press [Enter] and then press [F9] to update
  • This may create a new pended episode. Press [F14] to check and correct any further generated pends

4

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update
    • Add comment, go to Step 5

5

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • If unable to contact after 3 attempts write ‘unable to contact provider after 3 attempts R+Z to resolve pend’
  • Press [Enter]
  • Press [F9] to update

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 34/35/36 The immunisation date supplied is either invalid or in the future

Table 9

Step

Action

1

Confirm date of service + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact provider to confirm the vaccination date of service.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

  • Search for the provider number using Program Registration (Medicare provider) or Organisation (Ancillary provider)
  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider)
  • In the *ID Type field, select from drop down:
    • Medicare Stem and Location for Medicare providers, or
    • AIR Provider number for Ancillary provider
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates

Is contact successful?

2

Amend the claim encounter + Read more ...

Provider confirms vaccination date of service.

On the YIAE - Encounter Details screen:

  • Over-key to correct immunisation date
  • Press [Enter] and [F9] to update. Note: this may create a new pended episode

Go to Step 4.

3

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

4

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

5

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 37 The immunisation date is prior to the AIR commencement date 01/01/96

Table 10

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F17] to delete the encounter
  • Press [F23] to delete the encounter. The DELETE SUCCESSFUL message displays

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 38 Date missing (if Medicare number is not supplied, date of birth must be supplied)

Table 11

Step

Action

1

Amend the claim encounter + Read more ...

Check the YIAE - Encounter Details screen.

If Medicare number or name and date of birth is present:

  • Press [F11] and then press [Enter] to perform individual search
  • Select (/) the correct record and then press [Enter]
    • The YIAE - Encounter Details screen displays
  • Press [Enter] and the press [F9] to update
    • The YIAN - Antigen Details screen displays
  • Press [F9] to update. This may create a new pended episode
  • Press [F14] to check and correct any further generated pends

If both Medicare number, and name and date of birth are missing:

  • Escalate to LPS

Pend 43 Immunisation provider not current - provider number not current for the state

Table 12

Step

Action

1

Amend the claim encounter + Read more ...

Is the episode paid? Check the Info Asm + Payment fields, the Run and Amt fields.

  • Yes,
    • Screenshot the YIAE - Encounter Details screen
    • In the Enc St field, over-key the P with R and press [Enter]
    • In the Enc St field, over-key the R with Z and press [Enter]
    • Press [F9] to update
    • On a new screen, key YIEM - Immunisation Encounters Menu
    • Key 5 and press [Enter]. The YIAF - Register History Form Claim screen displays
    • reprocess the R and Z vaccine details as history (YIAF) screen, using details from the screenshot
    • Go to Step 6
  • No, go to Step 2

2

Contact the practice/organisation + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact practice/organisation to confirm correct provider number.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

  • Yes, if the:
    • practice/organisation confirms the provider number, go to Step 3
    • provider number cannot be confirmed, reprocess the R and Z vaccine details as history (YIAF) using details from the screenshot. Go to Step 5
  • No, go to Step 4

3

Amend the claim encounter - not paid + Read more ...

  • Screenshot the YIAE - Encounter Details screen
  • Press [Enter] then press [F9] to update encounter
  • In the Enc St field, over-key the P with R and press [Enter]
  • In the Enc St field, over-key R with Z and press [Enter]
  • With the correct provider number, reprocess the unpaid encounter as a Manual Claim (YIAM) using details from the screenshot. For assistance processing manual claim, see Step 3 in the Register and process an immunisation encounter table

Go to Step 5.

4

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

5

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include who was contacted and what information was confirmed
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 43 Immunisation provider not current - immunisation given prior to provider number start date

Table 13

Step

Action

1

Check provider number details in the Provider Directory System (PDS) + Read more ...

Log on to PDS.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

2

Contact the practice/organisation + Read more ...

Contact the practice/organisation to confirm the provider number.

Is the correct provider number for the immunisation confirmed?

3

Correct provider number is confirmed + Read more ...

Practice/organisation has confirmed correct provider number. Update the record.

Is the episode paid? Check the Info Asm + Payment fields, the Run and Amt fields.

  • Yes,
    • Screenshot the YIAE - Encounter Details screen
    • In the Enc St field, over-key the P with R and press [Enter]
    • In the Enc St field, over-key R with Z and press [Enter]
    • Press [F9] to update
    • On a new screen, key YIEM - Immunisation Encounters Menu
    • Key 5 and press [Enter]. The YIAF - Register History Form Claim screen displays
    • reprocess the R and Z vaccine details as history (YIAF) screen, using details from the screenshot
    • Go to Step 7
  • No,
    • Screenshot the YIAE - Encounter Details screen
    • Press [Enter] then press [F9] to update encounter
    • In the Enc St field, over-key the P with R and press [Enter]
    • In the Enc St field, over-key R with Z and press [Enter]
    • With the correct provider number, reprocess the unpaid encounter as a Manual Claim (YIAM) using details from the screenshot. For assistance processing manual claim, see Step 3 in the Register and process an immunisation encounter table of Process claims in the Australian Immunisation Register (AIR)
    • Go to Step 7

4

Correct provider number cannot be confirmed + Read more ...

Practice/organisation cannot confirm the correct provider number:

  • Screenshot the YIAE - Encounter Details screen
  • In the Enc St field, over-key 'R', press [Enter]
  • In the Enc St field, over-key 'Z', press [Enter] and [F9] to update
  • On a new screen, key YIEM - Immunisation Encounters Menu
  • Key (5) and press [Enter]. The YIAF - Register History Form Claim screen displays
  • Reprocess the R and Z vaccine details as history (YIAF) using details from the screenshot. For help, see Step 2 in the Process notification of a hepatitis B birth dose based on form type table

5

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

6

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include details from the conversation with the provider
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

7

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 43 Immunisation provider not current - immunisation recorded post the provider number end date

Table 14

Step

Action

1

Check provider number details in the Provider Directory System (PDS) + Read more ...

Log on to PDS.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is the provider number end dated on both AIR and Medicare?

2

Provider number is end dated with Medicare + Read more ...

Is the practice/organisation still active?

3

Provider number is end dated with AIR but not with Medicare + Read more ...

  • Contact an AIR Local Peer Support (LPS) with the claim and provider details
  • LPS to advise AIR Program Support to refresh the provider number as end date incorrectly recorded on the AIR

Once refreshed, AIR Program Support advises the LPS so the claim can be processed.

Go to Step 8.

4

Correct provider number confirmed + Read more ...

Practice/organisation has confirmed correct provider number. Update the record.

Is the episode paid? Check the Info Asm + Payment fields, the Run and Amt fields.

  • Yes,
    • Screenshot the YIAE - Encounter Details screen
    • In the Enc St field, over-key the P with R and press [Enter]
    • In the Enc St field, over-key R with Z and press [Enter]
    • Press [F9] to update
    • On a new screen, key YIEM - Immunisation Encounters Menu
    • Key 5 and press [Enter]. The YIAF - Register History Form Claim screen displays
    • Reprocess the R and Z vaccine details as history (YIAF) screen, using details from the screenshot
    • Go to Step 8
  • No,
    • Screenshot the YIAE - Encounter Details screen
    • Press [Enter] then press [F9] to update encounter
    • In the Enc St field, over-key the P with R and press [Enter]
    • In the Enc St field, over-key R with Z and press [Enter]
    • With the correct provider number, reprocess the unpaid encounter as a Manual Claim (YIAM) using details from the screenshot
      For help processing manual claim, see Step 3 in the Register and process an immunisation encounter table

5

Provider number cannot be confirmed + Read more ...

Practice/organisation not active or provider number cannot be confirmed:

  • Screenshot the YIAE - Encounter Details screen
  • In the Enc St field, over-key 'R'
  • In the Enc St field, over-key 'Z'
  • On a new screen, key YIEM - Immunisation Encounters Menu
  • Key (5) and press [Enter]. The YIAF - Register History Form Claim screen displays
  • Reprocess the R and Z vaccine details as history (YIAF) using details from the screenshot

Go to Step 8.

6

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

7

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include details from the conversation with the provider
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

8

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 44 Vaccine not valid for encounter date

Table 15

Step

Action

1

Confirm immunisation date and vaccine brand name + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact the provider to confirm the correct immunisation date and vaccine brand name.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

2

Confirm details and amend the claim encounter + Read more ...

  • Confirm:
    • vaccine brand
    • dose
    • date vaccine/s given
  • If provider confirms details are correct:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Remove dose number, over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • On line below add key generic vaccine brand associated with confirmed vaccine brand ie: Generic Influenza code
    • Press [Enter] and [F9] to update
    • Add comment, go to Step 4
  • If provider cannot confirm details:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Remove dose number, over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [Enter] and [F9] to update
    • Add comment, go to Step 4
  • If providers confirm different vaccine brand:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Over-key using the correct vaccine brand name (operator code) provider has given
    • Press [Enter] and [F9] to update
    • Add comment, go to Step 4
  • If providers confirm different vaccine date:
    • On the YIAE - Encounter Details screen, press [Enter] then press [F9]
    • In the ST field over key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update
    • Ask the provider to re-submit the encounter with the correct immunisation date
    • Add comment, go to Step 4

3

Unable to contact provider + Read more ...

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
  • Over-key (R and Z) the second:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Remove dose number, over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update
    • Add comment, go to Step 4

4

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include details from the conversation with the provider
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • If unable to contact Provider after 3 attempts comment on record Three attempts to contact provider unsuccessful. Pend actioned with R&Z
  • Press [Enter]
  • Press [F9] to update

Pend 50/51/54 Immunisation date prior to individual's date of birth

Table 16

Step

Action

1

Confirm the claim encounter details + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact the provider.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

2

Confirm error reason + Read more ...

If the error relates to the:

3

Date of birth incorrect + Read more ...

Supplementary Identification Number (SIN):

  • Copy the PIN number from the YIAE - Encounter Details screen
  • Go to the YCUI - Registration Amendment Search screen
  • Key/paste the PIN number into the PIN field and press [Enter]. The YCUA - Amendment Registration screen displays
  • Over-key the DOB on the SIN record, press [Enter]
  • Press [F9] to update. The message UPDATE SUCCESSFUL will display, or the YXCL - Possible Duplicate Registration screen displays
  • Key Y in the Continue Processing field and press [F3]. The YCUA - Amendment Registration screen displays with corrected date
  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the pended vaccine/s have auto-corrected, or continue to correct pends
  • Go to Step 7

Medicare record:

  • A Medicare record cannot be updated with the date of birth (DOB) on the provider’s advice
  • Tell the provider that the customers DOB is incorrect and the customer needs to contact a Medicare office, or phone Medicare to correct the DOB
    Note: in some circumstances, updating DOB over the phone may not be possible
  • Go to Step 6

4

Immunisation date incorrect or incorrect record + Read more ...

If the immunisation date, or record used is incorrect:

  • On the YIAE - Encounter Details screen, in the Enc St field:
    • over-key the P with R and press [Enter]
    • over-key the R with Z, press [Enter]
  • Press [F9] to update
  • Ask the provider to re-submit the encounter with the correct immunisation date/customer record

Go to Step 7.

5

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

6

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include details from the conversation with the provider
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

7

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 52 Date of receipt prior to immunisation date

Table 17

Step

Action

1

Confirm immunisation date + Read more ...

For outbound calls, Service Officers must use the script in Step 5 of Authentication of recognised vaccination providers for AIR enquiries table.

Contact the provider to confirm the correct immunisation date.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

2

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F6]. The YIAN - Antigens Details screen displays
  • Remove the dose number
  • In the ST field, over-key the P with R and press [Enter]
  • In the ST field, over-key the R with Z and press [Enter]
  • Press [F9] to update
  • Tell the provider to re-submit the correct details of the immunisation

Go to Step 4.

3

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

4

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment, include details from the conversation with the provider
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

5

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 53 The date of immunisation is after the end date recorded on the individual's registration

Table 18: Encounters pended with a reason code (RSN) 053 display the message INDIVIDUAL'S END DATE PRIOR TO IMMUNISATION DATE. This indicates that the individual is not on the selected Medicare registration as at the immunisation date of service.

Step

Action

1

Display Individual Selection screen + Read more ...

  • Press [Enter]
  • Press [F9] to update

Does this resolve the pend?

  • Yes, go to Step 2
  • No, escalate to AIR Local Peer Support (LPS), who will escalate to the AIR Helpdesk for resolution

2

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 80 Individual not identified

Table 19

Step

Action

1

Search for possible matches + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F11] and [Enter]. The YXCB - Individual Selection screen displays
  • Check the list for a match using
    • Name
    • Address
    • Date of birth (DOB)

Is an exact and unique match found?

2

Select matched person + Read more ...

To complete the match:

  • Select (/) matching person and press [Enter]. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. The YIAN - Antigens Details screen displays
  • Press [F9] to update

Go to Step 6.

3

System does not identify a match + Read more ...

Search for person in CDMS:

  • Log on to CDMS. See CDMS for Medicare for assistance
  • Select Inquire on Consumer Details. The Inquiry Search screen displays
  • Select the Detailed Search tab and enter:
    • Program field -Select All Programs from the drop down box. Medicare is the default
    • Family Name (mandatory)
    • First Name (also search without First Name if no options return)
    • Gender (mandatory) - select All
    • Date of Birth or Age range (mandatory)
    • Postcode Range (0001 to 9999)

Note:

  • Try variations of the surname. For example, a different spelling or if it is hyphenated, try with and without the hyphen or each of the hyphenated surnames separately
  • If there are too many results, refine the search by adding the first initial of the customer’s first name
  • Search for an age by entering a number in the first field only. For example, search for ‘45’ in the first field and leave the second field blank, results will be from 45 years through to 45 years 11 and months old
  • Search for an age range by entering a number in the first and second fields. For example, ‘45’ and ‘50’ will return customers between 45 to 50 years old

If not found in CDMS, search in Mainframe:

  • Key YCUI - Registration Amendment Search screen, anywhere on Mainframe
  • Key:
    • Given Name
    • Date of Birth
    • Postcode (0001 to 7999)
  • Check the list to search for a match. To scroll multiple pages use [F8] - Forward or [F7] Backward

Is a match found?

4

Medicare / Supplementary Identification Number (SIN) is found + Read more ...

To complete the match:

  • Key the Medicare/SIN number on the YXCB - Individual Selection screen in the PIN field
  • Delete personal details and press [Enter]. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update

Go to Step 6.

5

Medicare / Supplementary Identification Number (SIN) is not found + Read more ...

To complete the non-match:

  • On the YXCB - Individual Selection screen press [F10] - NEW INDV. The YIAE - Encounter Details screen displays
  • Press [Enter] and [F9] to update. This creates the person on the AIR with a SIN record). The YIAN - Antigens Details screen displays
  • Press [F9] to finalise
  • Go to Step 6

A person's gender is not required to process an encounter. Service Officers can view a record where there is no gender recorded by going to YCEI - Individual enquiry screen in Mainframe.

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 100 Antigen has been administered under the minimum required age

Table 20

Step

Action

1

Confirm date of immunisation + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact provider to confirm the correct date of immunisation.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

2

Amend the claim encounter + Read more ...

Is the immunisation date recorded, correct?

  • Yes,
    • On the YIAN - Antigen Details screen, press [Enter] then press [F9]
    • In the ST field over-key the P with C and press [Enter]
    • Over-key the C with Y and press [Enter]
    • Press [F9] to update
    • Go to Step 4
  • No, provider advises the wrong immunisation date is recorded:
    • On the YIAN - Antigen Details screen, press [Enter] then press [F9]
    • In the ST field over key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update
    • Ask the provider to re-submit the encounter with the correct immunisation date
    • Go to Step 4

3

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

4

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

5

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 101 Period between doses of the same antigen is less than the minimum time required

Table 21

Step

Action

1

Check for other antigens + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the record for any other vaccines that may be causing the pend

Vaccines different, dates given are the same:

  • Select (/) the pend and press [F6]. The YIAN - Antigens Details screen displays
  • Select (/) the pend and press [F10] to reassess
  • If pend does not change, contact the provider to confirm vaccine brand given
  • R and Z the incorrect vaccine

Vaccines different, dates given are different:

Vaccines the same, dates given are different:

  • Contact the provider to confirm the correct date given
  • R and Z the incorrect date

Vaccines the same, dose number and date given are different:

  • Contact the provider to confirm vaccine given, date given and correct dose number
  • R and Z the incorrect dose and date

Rabies vaccine:

  • C and Y the dose

2

Contact the provider + Read more ...

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

3

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

4

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

5

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 102 Duplicate antigen dose - same provider

Table 22

Step

Action

1

Check same or equivalent dose that is pended + Read more ...

Check the same or equivalent dose:

  • On the YIAE - Encounter Details screen press [F6]. The YIAN - Antigens Details screen displays
  • Check the same or equivalent dose
  • Press [F14]. The YIRD - Episode History-Basic screen displays

One component only of a vaccine can be pended. For example, third dose Infanrix Hexa, dose 3 of the Polio has a pend status; all other components of dose 3 are correct.

2

Check immunisation history + Read more ...

Can the duplicate dose on the immunisation history be corrected?

  • Yes:
    • Over-key incorrect dose number with correct dose and press [Enter]
    • Press [F9] to update. UPDATE PROCESSING COMPLETE message appears
      Note: see Troubleshooting on Resources for more than 3 doses of Polio given under 3.5 years of age.
    • Go to Step 6
  • No, go to Step 3

3

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact provider to confirm immunisation and brand if necessary

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

4

Amend the claim encounter + Read more ...

  • Incorrect episode, remove the dose number, over key the P status with R and press [Enter]
  • Over key the R status with Z and press [Enter]
  • Press [F9] to update

Go to Step 6.

5

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second
  • For help recording a comment on Mainframe, go to Step 7

6

Re-check immunisation history + Read more ...

Re-check the individual's record.

  • Press [F14]

The YIRD - Episode History-Basic screen displays.

7

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

8

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 103 Duplicate antigen dose - different provider

Table 23

Step

Action

1

Check immunisation history + Read more ...

Check the immunisation history:

  • On the YIAE - Encounter Details screen press [F14]. The YIRD - Episode History-Basic screen displays
  • Assess the whole record

Is there the same or equivalent antigen dose recorded?

  • Yes,
    • Over-key incorrect dose number with correct dose number and press [Enter]
    • Press [F9] to update: UPDATE PROCESSING COMPLETE message appears
  • No, go to Step 2

2

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact both providers to confirm the vaccine given on the date recorded and by their practice.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

3

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second
  • For help recording a comment on Mainframe, go to Step 7

4

Confirm vaccine/s + Read more ...

Is the provider who gave the vaccine and the date the vaccine given confirmed?

  • Yes, select (/) the incorrect vaccine line:
    • Press [F6]. The YIAN - Antigens Details screen displays
    • If dose number needs correcting, over-key with correct dose number [Enter], press [PF9] to update. Otherwise remove dose number [Enter], over-key the P status with R and press [Enter]
    • Over-key the R status with Z and press [Enter]
    • Press [F9] to update
    • If over-keying dose number is not accepted, go to Step 5
  • No: select (/) the latest receipt date vaccine line:
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Remove dose number [Enter], over-key the P status with R and press [Enter]
    • Over-key the R status with Z and press [Enter]
    • Press [F9] to update
    • If over-keying dose number is not accepted, go to Step 5

Go to Step 6.

5

Episode cannot be deleted - a payment has been made + Read more ...

Cannot amend the pend due to payment already having been paid:

  • Select (/) the pend line to be actioned
  • Remove the dose number and press [Enter]
  • Over-key the P status with R and press [Enter]
  • Over-key the R status with Z and press [Enter]
  • Press [F9] to update

Go to Step 6.

6

Re-check immunisation history + Read more ...

Re-check the individuals record:

Press [F14]. The YIRD - Episode History-Basic screen appears.

7

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

8

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 104 Administered within minimum time required between doses - different provider

Table 24

Step

Action

1

Check for other providers + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the record for any other vaccines that may be causing the pend

2

Contact the provider + Read more ...

Note: for outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact both providers to confirm if they gave the vaccine or were just reporting it.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

3

Confirm details and amend the claim encounter + Read more ...

  • Confirm:
    • vaccine brand
    • dose
    • date vaccines given
  • If providers confirm details are correct:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Over-key the P with 'C', press [Enter], press [F9] to update
    • over-key the C with 'Y', press [Enter], press [F9] to update
  • If providers cannot confirm details:
    • Select (/) the pended vaccine line
    • Press [F6]. The YIAN - Antigens Details screen displays
    • Remove dose number, over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update

Go to Step 5.

4

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

5

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

6

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 105/112 Dose greater than maximum allowable dose

Table 25

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the record for dose numbers of all vaccines
  • Dose number requires changing:
    • Select (/) episode and press [F6] The YIAN - Antigens Details screen displays
    • Over-key the dose number with the correct dose, e.g. BCG (V) with (1)
    • Press [Enter] and press [F9] to update
  • Dose is greater than maximum allowable dose
    • Press [Enter] and press [F9]. The YIAN - Antigens Details screen displays
    • In the ST field over-key the P with C and press [Enter]
    • Over-key the C with Y and press [Enter]
    • Press [F9] to update

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 106/109 Higher dose already administered - same provider

Table 26

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [Enter] and press [F9]. The YIAN - Antigens Details screen displays
  • Check immunisation history to confirm the previously recorded dose numbers are correct
  • Press [F14]

Are the previous dose numbers correct?

  • Yes:
    • Select (/) the pended immunisation and press [F6]
    • Over-key the current incorrect dose number with the correct dose number
  • No:
    • Select (/) the incorrectly recorded encounter and press [F6] to enter the YIAN - Antigens Details screen
    • Over-key the incorrect dose number with the correct dose number
    • Press [Enter] and press [F9] to update

When adjusting dose numbers, check the system does not pend other immunisations. If this occurs, correct the pends.

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 107 Dose administered at greater than recommended schedule age

Table 27

Step

Action

1

Amend the claim encounter + Read more ...

On the YIAE - Encounter Details screen:

  • Press [F9]. The YIAN - Antigens Details screen displays
  • Press [F18] to acknowledge warning and [F9] to update

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 110 Same provider - Period between doses less than 6 months

Table 28

Step

Action

1

Episode reported by same provider - period between doses less than 6 months + Read more ...

Check the record to confirm pend reason:

  • On the YIAE - Encounter Details screen, press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the immunisation history to determine why the encounter has pended:
    • Vaccine given by the same provider less than 6 months and more than 27 days apart
    • Vaccine given by the same provider less than 6 months and less than 27 days apart
    • Vaccines with similar antigens and unclear which vaccine was given. For example, Infanrix and Infanrix Hexa

2

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact the provider to confirm the immunisation and date given.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

3

Reported encounter is correct + Read more ...

The provider confirms the vaccination reported was given:

  • Select (/) episode, press [F6]. The YIAN - Antigens Details screen displays
  • On the ST field, over-key the P with C and press [Enter]
  • Over-key the C with Y and press [Enter]
  • Press [F9] to update

Go to Step 6.

4

Reported encounter is incorrect + Read more ...

The provider confirms the reported encounter is incorrect. The vaccination was not given:

  • Select (/) episode, press [F6]. The YIAN - Antigens Details screen displays
  • On the ST field over-key the P with R and press [Enter]
  • Over-key the R with Z and press [Enter]
  • Press [F9] to update

Go to Step 6.

5

Unable to contact provider + Read more ...

If unable to contact the provider:

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer must action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second
  • For help recording a comment on Mainframe, go to Step 6

6

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

7

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 111 Different provider - Period between doses less than 6 months

Table 29

Step

Action

1

Episode reported by different provider - period between doses less than 6 months + Read more ...

Check the record:

  • On the YIAE - Encounter Details screen, press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the immunisation history to determine why the encounter has pended:
    • Vaccine given by a different provider less than 6 months and more than 27 days apart
    • Vaccine given by a different provider less than 6 months and less than 27 days apart

2

Catch up schedule + Read more ...

Does the vaccine appear to be a catch-up?

3

Vaccination assists with catch-up schedule + Read more ...

The vaccination assists in completing the persons schedule as a catch-up

  • Select (/) episode, press [F6]. The YIAN - Antigens Details screen displays
  • On the ST field over-key the P with C and press [Enter]
  • Over-key the C with Y and press [Enter] to update

Go to Step 7.

4

Contact the provider + Read more ...

For outbound calls, Service Officers must use the script in Step 5 in Authentication of recognised vaccination providers for AIR enquiries table.

Contact both providers to confirm the immunisations were given.

Locate provider contact details in the Provider Directory System (PDS). See the Log on to PDS table for help.

Search for provider details in PDS:

Program Registration (Medicare provider)

Search for the provider number using Program Registration

  • Select View. The Program Registration screen displays
  • In the *Search ID field, key provider number stem and location (first 7 digits Medicare provider or 6 digits Ancillary provider number)
  • In the *ID Type field, select Medicare Stem and Location from the drop down
  • Select the radio button Program Registrations for this Provider/Practice/Organisation
  • Select Search. The Program Registration View screen displays
  • Check the Registration End Date column for AIR and Medicare end dates
  • Select View from the AIR Program line. The Program Registration View screen displays. This screen contains contact phone number

Organisation (Ancillary provider)

  • Search for the provider number using Organisation
  • Select View. The Organisation Registration View screen displays
  • In the *Search ID field, key provider number stem and location (first 6 digits of Ancillary provider number)
  • In the *ID Type field, select AIR Provider number from the drop down
  • Select Search. The Organisation Registration Summary screen displays
  • Check the End Date. This screen contains contact phone number

Is contact successful?

5

Amend the claim encounter + Read more ...

  • Both providers confirm the immunisations were given:
    • Select (/) episode, press [F6]. The YIAN - Antigens Details screen displays
    • On the ST field over-key the P with C and press [Enter]
    • Over-key the C with Y and press [Enter] to update
    • Press [F9] to update
    • Go to Step 7
  • Provider confirms immunisation was not given
    • Select (/) episode, press [F6]. The YIAN - Antigens Details screen displays
    • On the ST field over-key the P with R and press [Enter]
    • Over-key the R with Z and press [Enter]
    • Press [F9] to update
    • Go to Step 7

6

Unable to contact provider + Read more ...

  • Leave pend in a P status and write the comment unable to contact provider on DD/MM/YY to resolve pend on the individual’s Mainframe record
  • Make a maximum of 3 attempts to contact the provider by phone
  • If contact cannot be made, the Service Officer should action the pend:
    • accept the first dose that has come in
    • over-key (R and Z) the second

7

Record a comment + Read more ...

Record a comment on the customer's Mainframe record:

  • Key the Medicare number on the YCUI - Registration Amendment Search screen and press [Enter]. The YCUA - Amendment Registration screen displays
  • Press [F3]. The YCCO - Comments List screen displays
  • Press [F3]. The YCCV - Comment Details screen displays
  • Add a comment. To confirm details, include:
    • provider contacted
    • correct date of immunisation
    • immunisation given
    • name of the person confirming/providing information
  • If unable to contact, write unable to contact provider on DD/MM/YY to resolve pend
  • Press [Enter]
  • Press [F9] to update

8

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 113 Dose given at less than (<) schedule age

Table 30

Step

Action

1

Dose given at less than schedule age 17 months + Read more ...

Check the immunisation and dose history:

  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the immunisation history
  • Select (/) the pend and press [F6]. DOSE GIVEN AT < SCHEDULE AGE 17 MONTHS - PF18 TO ACK WARNING message displays
  • Press [F18] then [F9] to update
  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Re-check history to confirm no outstanding immunisations are showing

Go to Step 3.

2

Dose given at less than schedule age 42 months + Read more ...

Check the immunisation and dose history:

  • Press [F14]. The YIRD - Episode History-Basic screen displays
  • Check the immunisation history
  • Select (/) the pend and press [F6]. DOSE GIVEN AT < SCHEDULE AGE 42 MONTHS PF18 TO ACK WARNING message displays
  • The encounter displays dose 4 of DTP or DTP-Polio given
  • Over-key the dose number to 3
  • Over-key the ST field P to C and press [Enter]
  • Over-key the C to Y and press [Enter]
  • Press [F9] to update
  • Press [F14]. The YIRD - Episode History-Basic screen displays. Re-check history to confirm no outstanding immunisations are showing
  • Go to Step 3

3

Complete next pend or select next claim + Read more ...

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim

Pend 115 Antigen has been administered under minimum required age

Table 31

Step

Action

1

Check immunisation history + Read more ...

Check the immunisation history:

  • Non HIB vaccine
    • On the YIAE - Encounter Details screen press [F14]. The YIRD - Episode History-Basic screen displays
    • Check the record for dose numbers of all vaccines
    • Select (/) episode and press [F6]. The YIAN - Antigens Details screen displays
    • Press [F18] to acknowledge the warning
    • Press [F9] to update
  • HIB is the pended vaccine
    • In the ST field, over-key the P with C and press [Enter]
    • Over-key the C with Y and press [Enter]
    • Press [F9] to update

If there are multiple episodes in the claim, the next pend will display automatically. Use the relevant pend code table to process the warning message displayed.

Once the last pend for the claim is processed:

  • Press [F5]. The YIAE - Encounter Details screen displays
  • Press [F4]. The YICP - Claim Selection screen displays
  • Key search parameters to select the next claim