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

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Troubleshooting

Table 1

Scenario

Action

Medicare number on the pend of a newborn child

Confirm the newborn is not on any Medicare card:

  • On the YXCB - Individual Selection screen, remove the Medicare card number
  • Press [F10] to create individual

Gender missing from pend

On the YXCB - Individual Selection screen:

  • Key F/M/X based on first name (if unsure try all 3 options)
  • Press [Enter] a list of possible matches will display (on occasions an auto-match may display)

Note: if a match cannot be found, an individual'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.

Validation error: after creating a new individual and updating, a blank screen with validation error message will show

This has updated correctly:

  • press [F5]
  • press [F4]

Claim will have disappeared from the YICP - Claim Selection screen. Search for next pend.

Validation error 24: after creating a new individual and updating, a screen with validation error message and RSN 24 will show

The postcode does not match the suburb:

  • Search CDMS for the locality that is recorded against the person
    • Select Inquire on Consumer Details
    • Select the Address Search button
    • Key the location (the address will match Australia Post)
  • Or do a Google search for the location/postcode

More than 3 Polio immunisations given under 3.5 years of age

Whenever a child receives more than 3 doses of Polio under 3.5 years of age:

  • Change the additional dose numbers to duplicate dose 3 and C and Y
  • If unsuccessful, escalate to an AIR Local Peer Support (LPS)

Polio administered overseas and dose given at birth

When a polio vaccine was administered overseas and a dose was given at birth, action the pend as follows:

  • Record the dose given at Birth (up to 7 days after birth) as dose 1 and C and Y
  • Record the next dose (under 1.5-2 months old) as dose 1 and C and Y

If unsure, escalate to AIR Local Peer Support (LPS).

Assessing Rabies vaccines

Rabies vaccine doses are administered close to each other, usually 7 days between doses.

There are usually 3 doses of Rabies, however, can be more, depending on the individual's situation.

For more information on rabies, see Vaccines, dosage and administration | Rabies and other lyssaviruses | The Australian Immunisation Handbook

Doses can be given at days 0, 3, 7, 14 and 28.

Processing for deceased customers

When processing information for a deceased customer and they have a record on:

Mainframe prompts an entry in the Antenatal field

Do not use this process for resolving Pend 77. See Process page > Table 19 for that process.

The antenatal value must be entered for females aged 10 - 65 years of age (inclusive).

If the vaccine needs R and Z:

  • key N (no) as the antenatal value
  • procedure ends here

If the vaccine needs C and Y, and the antenatal indicator was not confirmed with the provider, continue with this process.

Vaccine type AEN:

If the individual is female aged 10 - 65 years inclusive, and was administered a:

  • NIP vaccine, key:
    • Y (yes) in the Antenatal field
    • NIP in the vaccine type field
  • non-NIP vaccine, key:
    • Y (yes) in the Antenatal field
    • OTH in the vaccine type field

Vaccine type NIP, STP, PRV, or OTH:

Key:

  • N (no) in the Antenatal field
  • If required, change the vaccine type field to NIP or OTH

State codes when processing pends

Table 2

State

State abbreviation

Code

Australian Capital Territory

ACT

A

New South Wales

NSW

N

Northern Territory

NT

Z

Other

U

Tasmania

TAS

T

South Australia

SA

S

Queensland

QLD

Q

Victoria

VIC

V

Western Australia

WA

W


System reason codes and explanations returned during claim processing

Table 3: search the list using [Ctrl + F].

Reason code

Explanation

001

Medicare number invalid

002

Medicare sub-numerate invalid

003

Medicare sub-numerate only, Medicare number also required

004

Given name required when no Medicare sub-numerate supplied

005

First character in given name is invalid

006

Invalid character in given name

010

Individual's Medicare number or full name and date or birth not supplied

011

First character in surname is invalid

012

Invalid character in surname

013

Date of birth format not acceptable - must be DDMMYY

014

Date of birth in the future

015

Address details invalid or incomplete

016

Invalid postcode

017

018

Invalid character in address

019

Invalid character for second initial

020

Aboriginality indicator not valid

023

Gender must be F/M or X

024

Postcode/locality incompatible

025

Ethnicity indicator not valid

026

HepB birth dose indicator invalid - must be Y or blank

030

Provider number missing

031

Provider number not valid

032

033

The vaccine and/or dose number administered not supplied

034

035

036

The immunisation date supplied is either invalid or in the future

037

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

038

Date of birth not valid

039

Provider practice not found

040

Provider check digit not valid

041

042

Provider number not valid

043

Immunisation provider not current

044

Vaccine not valid for encounter date

050

Immunisation date prior to individual's date of birth

051

Date of receipt prior to individual's date of birth

052

Date of receipt prior to immunisation date

053

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

054

Date of HEPB birth dose prior to individual's date of birth

055

Child over 12 months of age at date of service

056

Date of HepB birth dose must be in accepted format (DDMMYY), with correct days in month, correct months in year and not a future date

060

061

062

075

The vaccine and/or dose number administered not supplied

77

Antenatal value may not be valid for this individual

080

Individual not identified

100

Antigen has been administered under the minimum required age

101

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

102

Duplicate antigen dose - same provider

103

Duplicate antigen dose - different provider

104

Administered within minimum time required between doses - different provider

105

112

Dose greater than maximum allowable dose

106

Higher dose already administered - same provider

107

Dose administered at greater than recommended schedule age - PF18 to ack warning

108

Dose administered under the recommended schedule age - PF18 to ack warning

Note: no longer applicable for assessment as of 26 March 2017

109

Higher dose already administered - different provider

110

Same provider: Period between doses less than 6 months

111

Different provider: Period between doses less than 6 months

113

Dose given < schedule age 42 months PF18 to ack Warning

114

DTP dose 4 given > 42 months

115

Antigen given under minimum required age

116

DTP dose 4 already given < 42 months - check history - convert to dose 5

300

Duplicate - this service has already been reported.

This is triggered by the system. Note: no action needed

301

Duplicate - service previously reported by different provider

303

Duplicate History Form episode

305

Encounter split: greater than 5 episodes

334

Dose given at < schedule age 15 weeks.

The system automatically resolves to Z status. Note: no action needed

400

Individual has > 149 episodes - reduce episodes to continue processing


Influenza vaccines

Table 4

Vaxigrip

VG

VAXGRP

Flucelvax

FX

FLCLVX

Fluzone

FZ

FLUZNE

Influvac

FC

INFLUV

Fluad

FL

FLUAD

Fluzone High-Dose

FH

FLUHID

FluMist

FM

FLUMIS

All ages from 6 months onwards

All ages from 6 months onwards

All ages from 6 months onwards

All ages from 6 months onwards

From 50 years and over

From 60 years and over

From 2 to 17 years


Workload Manager escalation for pend processing

Table 5

Scenario

Action

Deceased customer - needs escalation due to record on CDMS but not on Mainframe

Pend - Customer contact required out of hours

  • Add comment in Mainframe for customer:
    • 'Unable to contact provider AH on DD/MM/YY to resolve pend'
  • In PaNDA, select:
    • Unassign
    • reason 'Proficiency Raised'
    • Submit

Pend - LPS referral

  • Add comment in Mainframe for customer:
    • 'Referred to LPS DD/MM/YY Pend (Type e.g. 100)'
  • In PaNDA, select:
    • Hold to User
    • 7 for 'amount of days to hold'
    • Confirm

Pend - Web form filled (Aspen, Sonic and Victoria Health) for more information

  • Add comment in Mainframe for customer:
    • '(organisation e.g. Aspen) form submitted on DD/MM/YY re Pend (Type e.g. 100)'
  • In PaNDA, select:
    • Hold to User
    • 7 for 'amount of days to hold'
    • Confirm

Contacts

Australian Immunisation Register (AIR) - AIR Local Peer Support (LPS)