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 pended encounter. Previously recorded immunisation history may need amending to allow the pended encounter at a P status to go to an A status.
Expand tableView 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 pended encounter. Previously recorded immunisation history may need amending to allow the pended encounter at a P status to go to an A status.
Expand tableStep | Action |
1 | Access Episode History-Basic screen
- From the pended claim, go to YIAE - Encounter Details screen. See Steps 1 - 5 in Table 1.
- Press [F14] - HIST
The YIRD - Episode History-Basic screen will show. |
2 | Evaluate the immunisation history
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
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm immunisations
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu:
- 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 will show
- Check the Registration End Date column for AIR and Medicare end dates
Is contact successful? |
4 | Make an amendment
To amend: |
5 | Amend a date of service
To amend a date of service: - Select (/) the encounter and press [F5] - ENCOUNTER. The YIAE - Encounter Details screen will show
- Over-key the date of service
- Press [Enter] and press [F9] to update. The YIAN - Antigens Details screen will show
- If pend code is removed, press [F9]. The YIAE - Encounter Details screen will show
Go to Step 10. |
6 | Amend a vaccine and/or dose
To amend vaccine and/or dose details: - Select (/) the encounter and press [F6] - ANTIGEN. The YIAN - Antigens details screen will show
- See Table 8 > Step 4 in Process claims in the Australian Immunisation Register (AIR)
- Add the correct vaccine and/or dose
- Press [Enter]
- Press [F9] to update
Go to Step 10. |
7 | Amend a vaccine recorded in error
To amend a vaccine recorded in error: - Select (/) the encounter and press [F6] - ANTIGEN. The YIAN - Antigens details screen will show
- See Table 8 > Step 4 in Process claims in the Australian Immunisation Register (AIR)
Go to Step 10. |
8 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Record a comment on the customer's Mainframe record, go to Step 9
|
9 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Reassess an episode
Table 3
Expand tableStep | Action |
1 | Display encounter to be reassessed
From the YIRD - Episode History-Basic screen: - Select (/) the encounter to be reassessed and press [F6] - ANTIGEN
The YIAN - Antigens details screen will show. |
2 | Select the episode
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
- If required, action the episode (vaccine) with the applicable pend action code. See Table 6 in Process claims in the Australian Immunisation Register (AIR)
- Press [Enter] then press [F9] to update. The YIAE - Encounter Details screen will show
|
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.
Expand tableStep | Action |
1 | Identify all idle IT Issue AIR Pends
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
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
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 77 Antenatal value may not be valid for this individual
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
Expand tableStep | Action |
1 | Amend the claim encounter
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
- 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? |
3 | Complete the match
To complete the match: - Select (/) the matching person and press [Enter]. The YIAE - Encounter Details screen will show
- Press [Enter] and [F9] to update. The YIAN - Antigens Details screen will show
- Press [F9] to update
Go to Step 5. |
4 | Individual cannot be located
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 will show
- Press [Enter] and [F9] to update. This creates the person on the AIR with a SIN record. The YIAN - Antigens Details screen will show
- Press [F9] to finalise
If the record is a test record sent to the AIR, escalate to an AIR Local Peer Support (LPS). |
5 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounters Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 05/06/11/12 Invalid character in given name or surname
Table 2
Expand tableStep | Action |
1 | Invalid character in name
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/s and select [Enter]
- Possible matches will show
- Search the YXCB screen for Surname, Given Name and date of birth (DOB)
Is a matching record found? |
2 | Search CDMS
- 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 5. - Yes, copy the surname/given name and key into the YXCB screen. Press [Enter]
- No, go to Step 4
|
3 | Complete the match
Complete the match: - Select (/) the matching person and press [Enter]. The YIAE - Encounter Details screen will show
- Press [Enter] and [F9] to update. The YIAN - Antigens Details screen will show
- Press [F9] to update
- Go to Step 6
|
4 | Individual cannot be located
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 will show
- 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 6. |
5 | Error on an existing Medicare customer record
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)
|
6 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounters Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 15/16 Address details invalid or incomplete
Table 3
Expand tableStep | Action |
1 | Check address on the claim encounter
Search Mainframe for the correct address. Is the correct address found? - Yes,
- Press [F11] and press [Enter]
- Address will show 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
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
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, contact provider to confirm the address
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
4 | Locality match found
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 will show, go to Step 5
- Select (/) the record
- Press [F9]. The YIAN - Antigens Details screen will show
- 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
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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounters Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 17/18 Invalid character in address
Table 4
Expand tableStep | Action |
1 | Review and correct address
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 19 Invalid character for second initial
Table 5
Expand tableStep | Action |
1 | Update the claim
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 will show
- Press [F9]. The message UPDATE PROCESSING COMPLETE will show
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 24 Postcode/locality incompatible
Table 6
Expand tableStep | Action |
1 | Correct postcode/locality mismatch
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 31/40/41/42 Provider number not valid
Table 7
Expand tableStep | Action |
1 | Check provider number in Provider Directory System (PDS)
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, contact the vaccination provider to get the correct provider number for the date the immunisation was given
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 32/33 The vaccine and/or dose number administered not supplied
Table 8
Expand tableStep | Action |
1 | Amend the claim encounter
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
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm the correct vaccine and/or dose number
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
3 | Amend the claim encounter
- 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
If unable to contact the provider or the Auth to Rel = N, action the pend as follows: - Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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, key the relevant comment:
- Unable to contact provider on DD/MM/YY to resolve pend
- Unable to contact provider after 3 attempts, R+Z to resolve pend
- Unable to contact provider as Auth to Rel = N
- Press [Enter]
- Press [F9] to update
|
6 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- 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
Expand tableStep | Action |
1 | Contact the provider to confirm date of service
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y:
- make 3 genuine attempts to contact the provider to confirm the vaccination date of service
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu:
- 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 will show
- Check the Registration End Date column for AIR and Medicare end dates
Is contact successful? |
2 | Amend the claim encounter
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
If unable to contact the provider or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Add a comment, go to Step 4
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
4 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- 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
Expand tableStep | Action |
1 | Amend the claim encounter
On the YIAE - Encounter Details screen: - Press [F17] to delete the encounter
- Press [F23] to delete the encounter. The DELETE SUCCESSFUL message will show
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- 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
Expand tableStep | Action |
1 | Amend the claim encounter
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 will show
- Press [Enter] and the press [F9] to update
- The YIAN - Antigen Details screen will show
- 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: |
Pend 43 Immunisation provider not current - provider number not current for the state
Table 12
Expand tableStep | Action |
1 | Amend the claim encounter
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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
2 | Contact the practice/organisation
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the practice/organisation to confirm the correct provider number
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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) - Select Program Registration
- Select View. The Program Registration screen will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- 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
- 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. Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
4 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the end as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 43 Immunisation provider not current - immunisation given prior to provider number start date
Table 13
Expand tableStep | Action |
1 | Check provider number details in the Provider Directory System (PDS)
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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
|
2 | Contact the practice/organisation
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the practice/organisation to confirm the provider number
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Is the correct provider number for the immunisation confirmed? |
3 | Correct provider number is confirmed
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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
4 | Correct provider number cannot be confirmed
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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Record a comment on the customer's Mainframe record, go to Step 6
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
6 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 43 Immunisation provider not current - immunisation recorded post the provider number end date
Table 14
Expand tableStep | Action |
1 | Check provider number details in the Provider Directory System (PDS)
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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- 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
Contact the provider to check the provider number entered is correct. Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to check the provider number
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Is the practice/organisation still active? - Yes, call to confirm provider number. If:
- No, practice is no longer active. Go to Step 5
|
3 | Provider number is end dated with AIR but not with Medicare
- 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 pend can be resolved. Go to Step 8. |
4 | Correct provider number confirmed
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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Provider number cannot be confirmed
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 will show
- Reprocess the R and Z vaccine details as history (YIAF) using details from the screenshot
Go to Step 8. Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
6 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Record a comment, go to Step 7
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
7 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 44 Vaccine not valid for encounter date
Table 15
Expand tableStep | Action |
1 | Check vaccine
Is the vaccination for Synflorix? (SYNFLX) |
2 | Check provider location
Is the vaccine showing the overseas provider number A92009H? |
3 | Check encounter date
Is the encounter date on or after 1 April 2025? - Yes:
- Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- Over-key the P with C
- Press [Enter]
- Over-key the C with Y
- Press [Enter]
- Press [F9] to update
- Complete next pend or select next claim.
- No, go to Step 4
|
4 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm the immunisation date and vaccine brand name
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
5 | Confirm details and amend the claim encounter
- Confirm:
- vaccine brand
- dose
- date vaccine/s given
- If provider confirms details are correct:
- Tell them they need to contact their public health unit (PHU) in their state or territory to discuss reporting incorrect vaccine administration
- Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- Remove dose number, over-key the P with R and press [Enter]
- Over-key the R with Z and press [Enter]
- On the line below add key generic vaccine brand associated with confirmed vaccine brand ie: Generic Influenza code
- Press [Enter] and [F9] to update
- Add comment, include the vaccine name, immunisation date, who provided the details and that the provider was advised to contact their PHU in their state or territory. Go to Step 7
- If provider cannot confirm details:
- Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- 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 7
- If providers confirm different vaccine brand:
- Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- Over-key using the correct vaccine brand name (operator code) provider has given
- Press [Enter] and [F9] to update
- Add comment, go to Step 7
- 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 7
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
6 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Over-key (R and Z) the second:
- Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- 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 7
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
7 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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, key the relevant comment:
- Unable to contact provider on dd/mm/yy, to resolve pend
- Unable to contact provider after 3 attempts, - R&Z <name of vaccine> dated <ddmmyy> to resolve pend
- Unable to contact provider as Auth to Rel = N – R & Z <name of vaccine> dated <ddmmyy> to resolve pend
- Press [Enter]
- Press [F9] to update
- Complete next pend or select next claim
|
Pend 50/51/54 Immunisation date prior to individual's date of birth
Table 16
Expand tableStep | Action |
1 | Confirm the claim encounter details
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm the encounter details
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
2 | Confirm error reason
If the error relates to the: |
3 | Date of birth incorrect
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 will show
- 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 will show
- Key Y in the Continue Processing field and press [F3]. The YCUA - Amendment Registration screen will show with corrected date
- Press [F14]. The YIRD - Episode History-Basic screen will show
- 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
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. Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Add a comment in mainframe, go to Step 6
|
6 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 52 Date of receipt prior to immunisation date
Table 17
Expand tableStep | Action |
1 | Contact the provider to confirm immunisation date
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm the correct immunisation date
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
2 | Amend the claim encounter
On the YIAE - Encounter Details screen: - Press [F6]. The YIAN - Antigens Details screen will show
- 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. Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
3 | Unable to contact provider
If unable to contact the provider after 3 attempts or Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Add a comment, go to Step 4
|
4 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- 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.
Expand tableStep | Action |
1 | Display Individual Selection screen
- Press [Enter]
- Press [F9] to update
Does this resolve the pend? |
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- do not contact the provider
- escalate to AIR Local Peer Support (LPS)
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the vaccination provider who reported the vaccine
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Confirm the following encounter details: - Individuals name
- Vaccination date
- Vaccine brand
Was the contact successful? - Yes, go to Step 3
- No, add a comment to the AIR record for each attempt and escalate to AIR Local Peer Support (LPS)
|
3 | Contact successful
Did the provider confirm the encounter details are correct? - Yes, escalate to AIR Local Peer Support (LPS)
- No, amend the AIR record as confirmed by the provider. Add a comment to the AIR record with details of the updated information. If this:
- does resolve the pend, go to Step 4
- does not resolve the pend, escalate to AIR Local Peer Support (LPS)
|
4 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 77 Antenatal value may not be valid for this individual
Table 19: This error will appear if antenatal has been recorded for individuals other than females aged 10 - 65 years inclusive.
Expand tableStep | Action |
1 | Amend the claim encounter
On the YIAE - Encounter Details screen, press [F14] to show the customer immunisation history. Contact provider to confirm: - they correctly recorded it as antenatal, and
- the vaccine type (NIP or OTH)
Note: do not discuss gender or age of the individual with the provider. If the provider advises that the vaccine type is state program (STP) or privately (PRV) funded, enter this as OTH (other) in the vaccine type field. |
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Search for provider contact details in the Provider Directory System (PDS). See Table 2 in Amend Medicare providers for Australian Immunisation Register (AIR) in Provider Directory System (PDS) for help. Program Registration (Medicare provider) Search for the provider number using Program Registration: - Select View. The Program Registration screen will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) Search for the provider number using Organisation: - Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Service Officers must make 3 attempts to contact the provider by phone. If unable to contact the provider, after each attempt: - leave the record in a P status
- add comment to the individual's record in mainframe (after each attempt):
- 'Unable to contact provider on DD/MM/YY to resolve pend 77 for encounter on DD/MM/YY'
Is contact successful? |
3 | Amend the claim encounter
- Select (/) the pended episode
- Press [F6]
Did the provider intend to record the vaccine as antenatal? - Yes, on the YIAN - Antigen Details screen:
- Press [Enter]
- Press [F9]
- Key Y in the Antenatal field
- In the vaccine type field, over-key AEN with NIP or OTH (as confirmed with provider)
- Only if required, key the route of administration code, as confirmed with provider, (PO, SC, ID, or IM)
- In the ST field over-key the P with C
- Press [Enter]
- Over-key the C with Y
- Press [Enter]
- Press [F9] to update
- Add comment
- Go to Step 5
- No, on the YIAN - Antigen Details screen:
- Press [Enter]
- Press [F9]
- Key N in the Antenatal field
- In the vaccine type field, over-key AEN with NIP or OTH (as confirmed with the provider)
- Only if required, key the route of administration code, as confirmed with the provider, (PO, SC, ID, or IM)
- Press [Enter]
- Press [F9] to update. Note: this may create a new pended episode. Press [F14] to check and correct any further generated pends
- Add comment
- Go to Step 5
|
4 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N action the pend as follows: - Select (/) the pended vaccine line
- Press [F6]. The YIAN - Antigens Details screen will show
- Over-key the P with C
- Press [Enter]
- Over-key the C with Y
- Press [Enter]
- Press [F9] to update
- Add comment:
- Third attempt to contact provider on DD/MM/YY for confirmation of antenatal indicator for encounter on DD/MM/YY have C and Y pend 77 as per process, or
- Unable to contact provider for confirmation of antenatal indicator for encounter on DD/MM/YY due to authority to release (Auth to Rel)= N. Have C and Y pend 77 as per process
- Go to Step 5
|
5 | Record a comment
Record a comment on the customer's mainframe record: - Key the Medicare number on the YCUI - Registration Amendment Search screen
- Press [Enter]. The YCUA - Amendment Registration screen will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- Add a comment including:
- provider contacted
- correct date of immunisation
- immunisation given
- antenatal indicator
- name of the person confirming/providing information
- If unable to contact, add comment 'unable to contact provider on DD/MM/YY to resolve pend'
- If unable to contact after 3 attempts, add comment 'unable to contact provider after 3 attempts C+Y to resolve pend'
- Press [Enter]
- Press [F9] to update
|
6 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 80 Individual not identified
Table 20
Expand tableStep | Action |
1 | Search for possible matches
On the YIAE - Encounter Details screen: - Press [F11] and [Enter]. The YXCB - Individual Selection screen will show
- Check the list for a match using
- Name
- Address
- Date of birth (DOB)
Is an exact and unique match found? |
2 | Select matched person
To complete the match: - Select (/) matching person and press [Enter]. The YIAE - Encounter Details screen will show
- Press [Enter] and [F9] to update. The YIAN - Antigens Details screen will show
- Press [F9] to update
Go to Step 6. |
3 | System does not identify a match
Search for person in CDMS under both name and address: - Log on to CDMS. See CDMS for Medicare for assistance
- Select Inquire on Consumer Details. The Inquiry Search screen will show
- Select Address search button
- Key in the address from the pended encounter
- Select consumers - List of consumers at that address will show
- If not found - continue searching by name
- Select the Detailed Search tab and enter:
- Program field -Select All Programs from the dropdown menu. 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
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 will show
- Press [Enter] and [F9] to update
Go to Step 6. |
5 | Medicare / Supplementary Identification Number (SIN) is not found
To complete the non-match: - On the YXCB - Individual Selection screen press [F10] - NEW INDV. The YIAE - Encounter Details screen will show
- Press [Enter] and [F9] to update. This creates the person on the AIR with a SIN record). The YIAN - Antigens Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 100 Antigen has been given under minimum required age
Table 21
Expand tableStep | Action |
1 | Confirm date of immunisation
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm the correct date of immunisation
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? Note: if Polio was administered overseas and the individual was given a dose at birth, see Troubleshooting on the Resources page. |
2 | Amend the claim encounter
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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
3 | Unable to contact provider
If unable to contact the provider after 3 attempts or Auth to Rel = N, action the pend as follows: - Go to 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
- Add comment in mainframe, go to Step 4
|
4 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- 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 22
Expand tableStep | Action |
1 | Check for other antigens
On the YIAE - Encounter Details screen: - Press [F14]. The YIRD - Episode History-Basic screen will show
- 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 will show
- 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: - Contact the provider to confirm vaccine given and correct date given
- R and Z the incorrect record in P status
- Reject the other incorrect episode, see Table 8 > Steps 2 to 5 in Process claims in the Australian Immunisation Register (AIR)
- Update correct details as history
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: |
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
|
3 | Unable to contact provider
If unable to contact the provider after 3 attempts or Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Add a comment, go to Step 4
|
4 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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, key the relevant comment:
- Unable to contact provider on DD/MM/YY to resolve pend
- Unable to contact provider after 3 attempts - R&Z <name of vaccine> dated <ddmmyy> to resolve pend on DD/MM/YY to resolve pend
- Unable to contact provider as Auth to Rel = N – R & Z <name of vaccine> dated <ddmmyy> to resolve pend
- Press [Enter]
- Press [F9] to update
|
5 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 102 Duplicate antigen dose - same provider
Table 23
Expand tableStep | Action |
1 | Check same or equivalent dose that is pended
Check the immunisation history for same or equivalent dose: - From the YIAE - Encounter Details screen press [F6]. The YIAN - Antigens Details screen will show
- Press [F14]. The YIRD - Episode History-Basic screen will show. Check the immunisation history to confirm the recorded dose numbers are correct
Note: 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. Can the duplicate dose be corrected? - Yes, on the encounter with the incorrect dose number:
- No, go to Step 2
|
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
3 | Amend the claim encounter
Confirm the immunisation date and brand with the provider. - Select ( / ) the incorrect episode and press [Enter]
- remove the dose number, over key the P or A status with R and press [Enter]
- Over key the R status with Z and press [Enter]
- Press [F9] to update
Go to Step 5. |
4 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, Service Officers must action the pend as follows: - Duplicate influenza (Flu) vaccines only - Keep the flu vaccine dose in P status by removing (R and Z) the flu vaccine dose in A status (must have the same immunisation date):
- Select ( / ) the flu encounter line with the A status (same immunisation date as pend) and press [F6]
- Remove the dose number and press [Enter]
- Over key the A status with R and press [Enter]
- Over key the R status with Z and press [Enter]
- Press [F9] to update - the encounter in P status should automatically resolve to A status
- Add comment in Mainframe 'Unable to contact provider <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>'
Note: if the pended vaccine (P status) is the generic flu (GNFLU) or is not approved for the individual's age group, R and Z the pended vaccine (P status). See the Resources page for a list of Influenza Vaccines eligible for registered age groups. - All other duplicate vaccines - Keep the vaccine dose in A status by removing (R and Z) the vaccine dose in P status (must have the same immunisation date):
- Select ( / ) the encounter line with the P status (must have the same immunisation date as the one in A status). Press [F6]
- 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
- Add comment in Mainframe 'Unable to contact provider <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>'
|
5 | Re-check immunisation history
Re-check the individual's record. - Press [F14]- Episode History-Basic screen will show
Are there any pends on the record? - No, record a comment in Mainframe. Go to Step 6
- Yes, continue to resolve pends until no more appear
|
6 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- Add a comment. To confirm details, include:
- provider number contacted
- date of immunisation
- immunisation given
- name of the person/provider confirming/providing information
- if unable to contact, write unable to contact provider <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>
- Press [Enter]
- Press [F9] to update
- Go to Step 7
|
7 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 103 Duplicate antigen dose - different provider
Table 24
Expand tableStep | Action |
1 | Check immunisation history
Check the immunisation history for the same or equivalent dose. From the YIAE - Encounter Details screen: - Press [F6], the YIAN Antigens details screen will show
- Press [F14]. The YIRD - Episode History-Basic screen will show
- Assess the whole record to confirm the recorded dose numbers are correct
Can the duplicate dose be corrected? - Yes, on the encounter with the incorrect dose number:
- Over-key the dose number with correct dose number and press [Enter]
- Press [F9] to update: UPDATE PROCESSING COMPLETE message appears
- No, go to Step 2
Note: for how to action single dose MMR, see Measles, mumps, and rubella (MMR) in Process claims in the Australian Immunisation Register (AIR). |
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider to confirm immunisation and brand if needed
- add a comment in Mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
3 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, Service Officers must action the pend as follows: - Duplicate influenza (Flu) vaccines only - Keep the flu vaccine dose in P status by removing (R and Z) the flu vaccine dose in A status (must have the same immunisation date):
- Select ( / ) the flu encounter line with the A status (same immunisation date as pend) and press [F6]
- Remove the dose number and press [Enter]
- Over key the A status with R and press [Enter]
- Over key the R status with Z and press [Enter]
- Press [F9] to update - the encounter in P status should automatically resolve to A status
- Add comment in Mainframe 'Unable to contact provider <number> and <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>'
Note: if the pended vaccine (P status) is the generic flu (GNFLU) or is not approved for the individual's age group, R and Z the pended vaccine (P status). See the Resources page for a list of Influenza Vaccines eligible for registered age groups. - All other duplicate vaccines - Keep the vaccine dose in A status by removing (R and Z) the vaccine dose in P status (must have the same immunisation date):
- Select ( / ) the encounter line with the P status (must have the same immunisation date as the one in A status). Press [F6]
- 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
- Add comment in Mainframe 'Unable to contact provider <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>'
Note: if the: - Service Officer can only contact one provider and not the other, they can accept the information provided by that provider
- antenatal value is required, follow the instructions on Resources page > Troubleshooting
|
4 | Confirm vaccine/s
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 will show
- 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, escalate to AIR LPS
- No: select (/) the latest receipt date vaccine line:
- Press [F6]. The YIAN - Antigens Details screen will show
- 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, escalate to AIR LPS
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting Go to Step 6. |
5 | Re-check immunisation history
Recheck the individual's record to ensure no further encounters are in Pend status: - Press [F14]
- YIRD - Episode History-Basic screen will show
Are there any other pends on the record? - No, record a comment on the individual's record in Mainframe. Go to Step 6
- Yes, continue to resolve pends until no more appear
|
6 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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 <number> and <number> on DD/MM/YY to resolve pend. R & Z'd <vaccine name/brand> given on <DD/MM/YY>'
- Press [Enter]
- Press [F9] to update
- Go to Step 7
|
7 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 104 Administered within minimum time required between doses - different provider
Table 25
Expand tableStep | Action |
1 | Check for other providers
On the YIAE - Encounter Details screen: - Press [F14]. The YIRD - Episode History-Basic screen will show
- Check the record for any other vaccines that may be causing the pend
|
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Services Officers must:
- make 3 genuine attempts to contact both providers to confirm if they gave the vaccine or were just reporting it
- add a comment after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Locate provider contact details in the Provider Directory System (PDS). See Table 2 in Amend Medicare providers for Australian Immunisation Register (AIR) in Provider Directory System (PDS) 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
3 | Confirm details and amend the claim encounter
- 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 will show
- 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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. Go to Step 5. |
4 | Unable to contact provider
If unable to contact the provider after 3 attempts or Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
For Rabies vaccine only: Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
5 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 105/112 Dose greater than maximum allowable dose
Table 26
Expand tableStep | Action |
1 | Amend the claim encounter
On the YIAE - Encounter Details screen: - Press [F14]. The YIRD - Episode History-Basic screen will show
- Check the record for dose numbers of all vaccines
- Dose number requires changing:
- Select (/) episode and press [F6] The YIAN - Antigens Details screen will show
- 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 will show
- 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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
Pend 106/109 Higher dose already administered - same provider
Table 27
Expand tableStep | Action |
1 | Amend the claim encounter
On the YIAE - Encounter Details screen: - Press [Enter] and press [F9]. The YIAN - Antigens Details screen will show
- 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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 107 Dose administered at greater than recommended schedule age
Table 28
Expand tableStep | Action |
1 | Amend the claim encounter
On the YIAE - Encounter Details screen: - Press [F9]. The YIAN - Antigens Details screen will show
- 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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 110 Same provider - Period between doses less than 6 months
Table 29
Expand tableStep | Action |
1 | Episode reported by same provider - period between doses less than 6 months
Check the record to confirm pend reason. On the YIAE - Encounter Details screen, press [F14]. The YIRD - Episode History-Basic screen will show: - 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
- Check comments for any previous interactions
|
2 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact the provider
- add a comment in mainframe after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Confirm: - the immunisation given
- the date given
- if required, the appropriate antenatal indicator (Y/N)
Note: if the information provider is at a different location to the immunising provider, staff may need to contact both providers to confirm. 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- 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 will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? - Yes, the information reported in the encounter is:
- No, go to Step 5
|
3 | Reported encounter is correct
The provider confirms the vaccination reported was given: - Select (/) episode, press [F6]. The YIAN - Antigens Details screen will show
- On the ST field, over-key the P with C and press [Enter]
- Over-key the C with Y and press [Enter]
- If prompted, key antenatal value (Y/N), as confirmed with provider
- Press [F9] to update
- Add a comment
Note: if antenatal value is required and was not confirmed, follow the instructions on Resources page > Troubleshooting. Go to Step 6. |
4 | Reported encounter is incorrect
The provider confirms the reported encounter is incorrect. The vaccination was not given: - Select (/) episode, press [F6]. The YIAN - Antigens Details screen will show
- On the ST field over-key the P with R and press [Enter]
- Over-key the R with Z and press [Enter]
- If prompted to enter a value in the antenatal field, key N
- Press [F9] to update
- Record a comment
Go to Step 6. |
5 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- If prompted to enter a value in the antenatal field, key N
- Record a comment, go to Step 6
|
6 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- Add a comment. To confirm details, include:
- provider contacted
- correct date of immunisation
- immunisation given
- correct antenatal indicator, if applicable
- name of the person confirming/providing information
- If unable to contact, key 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
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 111 Different provider - Period between doses less than 6 months
Table 30
Expand tableStep | Action |
1 | Episode reported by different provider - period between doses less than 6 months
Check the record: - On the YIAE - Encounter Details screen, press [F14]. The YIRD - Episode History-Basic screen will show
- 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
Does the vaccine appear to be a catch-up? |
3 | Vaccination assists with catch-up schedule
The vaccination assists in completing the persons schedule as a catch-up - Select (/) episode, press [F6]. The YIAN - Antigens Details screen will show
- On the ST field over-key the P with C and press [Enter]
- Over-key the C with Y and press [Enter] to update
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. Go to Step 7. |
4 | Contact the provider
Staff must check the authority to release (Auth to Rel) indictor on the individual's registration record before calling a provider. - If Auth to Rel = N:
- If Auth to Rel = Y, Service Officers must:
- make 3 genuine attempts to contact both providers to confirm the immunisations were given
- add a comment after each attempt
For outbound calls, Service Officers must use the script in Table 2 > Step 4 in Authentication and release of information for Australian Immunisation Register (AIR). Locate provider contact details in the Provider Directory System (PDS). See Table 2 in Amend Medicare providers for Australian Immunisation Register (AIR) in Provider Directory System (PDS) 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 will show
- 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 dropdown menu
- Select the radio button Program Registrations for this Provider/Practice/Organisation
- Select Search. The Program Registration View screen will show
- Check the Registration End Date column for AIR and Medicare end dates
- Select View from the AIR Program line. The Program Registration View screen will show. This screen contains contact phone number
Organisation (Ancillary provider) - Search for the provider number using Organisation
- Select View. The Organisation Registration View screen will show
- 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 dropdown menu
- Select Search. The Organisation Registration Summary screen will show
- Check the End Date. This screen contains contact phone number
Is contact successful? |
5 | Amend the claim encounter
- Both providers confirm the immunisations were given:
- Select (/) episode, press [F6]. The YIAN - Antigens Details screen will show
- 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 will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
6 | Unable to contact provider
If unable to contact the provider after 3 attempts or the Auth to Rel = N, action the pend as follows: - Accept the first dose that has come in
- Over-key (R and Z) the second
- Add a comment, go to Step 7
|
7 | Record a comment
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 will show
- Press [F3]. The YCCO - Comments List screen will show
- Press [F3]. The YCCV - Comment Details screen will show
- 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
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
8 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 113 Dose given at less than (<) schedule age
Table 31
Expand tableStep | Action |
1 | Dose given at less than schedule age 17 months
Check the immunisation and dose history: - Press [F14]. The YIRD - Episode History-Basic screen will show
- Check the immunisation history
- Select (/) the pend and press [F6]. DOSE GIVEN AT < SCHEDULE AGE 17 MONTHS - PF18 TO ACK WARNING message will show
- Press [F18] then [F9] to update
- Press [F14]. The YIRD - Episode History-Basic screen will show
- Re-check history to confirm no outstanding immunisations are showing
Go to Step 3. |
2 | Dose given at less than schedule age 42 months
Check the immunisation and dose history: - Press [F14]. The YIRD - Episode History-Basic screen will show
- Check the immunisation history
- Select (/) the pend and press [F6]. DOSE GIVEN AT < SCHEDULE AGE 42 MONTHS PF18 TO ACK WARNING message will show
- The encounter will show 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 will show. Re-check history to confirm no outstanding immunisations are showing
- Go to Step 3
Note: if antenatal value is required, follow the instructions on Resources page > Troubleshooting. |
3 | Complete next pend or select next claim
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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|
Pend 115 Antigen given under minimum required age
Table 32: Pend 115 is specific to HIB vaccines only.
Expand tableStep | Action |
1 | Check immunisation history
HIB vaccines only. Check the immunisation history. If it is a: - non HIB vaccine, go to Table 21
- HIB 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 shown. Once the last pend for the claim is processed: - Press [F5]. The YIAE - Encounter Details screen will show
- Press [F4]. The YICP - Claim Selection screen will show
- Key search parameters to select the next claim
|