Provider eligibility for R-type diagnostic imaging services for Medicare 012-42050000

• email: from Royal Australian College of General Practitioners (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM). Go Step 2
• application from medical practitioner: application for Remote Area Exemption for R Type Diagnostic Imaging Services for a Medical Practitioner. Go to Step 4

Check to ensure the document includes:

• an email notification from the RACGP or ACRRM with the medical practitioner’s personal details (may contain attachments). The email will come through with prefilled information in a table
• send application for delegation approval using the ‘Send for Delegation’ function in PaNDA

Once the delegate has assessed the request and actions in PaNDA go to Step 3.

Open PDS:

• Select Provider
• Select View
• Select Detailed Search
• In the Family name field enter the first 3 letters of the last name followed by a %
• In the Given name field enter the first 3 letters of the first name followed by a %
• Select profession in from the dropdown list in profession field
• Select Search
• A list of health professionals with matching details will show
• Select View against the medical practitioner that matches the application

Check the providers stem for a 147 specialty code.

If there is an open 147 on the stem, no further processing is required:

• add a note to the work item in PaNDA stating 147 code already open on provider stem
• save changes, close the file and mark as processed in line with current workflow procedures
• procedure ends here

If there is no 147 on stem:

• select Edit > Specialty Code Tab > Add button
• key Specialty code 147
• start date: date of receipt of email notification
• end date: not required
• select Add New > Close Dialog box > Save button

Note: if a completed Application for remote area exemption for R-type diagnostic imaging services for a medical practitioner form (HW065) has also been received and requires processing go to Step 4.

Check the providers stem for a current existing 145 specialty code. If there is no current 145 speciality code on the provider stem:

• complete a RAE - Confirmation of Enrolment letter confirming the 147 specialty registration confirming the 147 specialty registration
• save letter as PDF and upload letter to PaNDA
• the delegate will issue the letter to the provider via:
• post, and
• HPOS (if the provider has an active HPOS account)
• the delegate will complete the work item in line with current workflow procedures

If there is an open 145 speciality code on the medical practitioner’s stem, go to Step 7.

Ensure the application form is complete and signed by the medical practitioner.

Question 8 - 30km or less:

• ensure all proceeding questions have been answered

If Question 8 has been completed and contains a response of 30kms or less, recategorize the application to National Office Escalations in PaNDA. Include a note advising the Programme Officers will escalate via email to National Office.

Question 8 - Greater than 30km:

If Question 8 has been completed and contains a response of greater than 30kms, open PDS:

• Select Provider
• Select View
• Select Detailed Search
• In the Family name field enter the first 3 letters of the last name followed by a %
• In the Given name field enter the first 3 letters of the first name followed by a %
• Select profession in from the dropdown list in profession field
• Select Search
• A list of health professionals with matching details will show
• Select View against the medical practitioner that matches the application
• Select the provider’s stem number (orange hyperlink), a list of all issued provider number locations will appear
• check existing locations against the application form on Question 5 and 6
• ensure the medical practitioner's provider number and address on the application match PDS

If the details match, go to Step 5.

If locations do not match, or if the locations requested have not been issued:

• return the application to the medical practitioner using Z2306
• add a note to the work item in PaNDA advising the reason for rejecting
• save letter as a PDF and upload reject letter to the work item in PaNDA
• ensure the following are complete:
• Surname,
• First Name,
• Provider Number and,
• Case ID fields
• print the letter and send to the Medical Practitioner via:
• post, and
• HPOS (if the Provider has an active HPOS account)
• procedure ends here, complete the work item

Check the provider file for access to Medicare rebates. The medical practitioner must:

• be recognised as a General Practitioner (GP) for Medicare purposes, and
• have access to a Medicare Benefit as a GP at the requested location. Contact Local Peer Support (LPS) if unsure

Does the provider have access to Medicare billing as a GP and is not a specialist and/or Consultant Physician in a speciality other than General Practice?

• Yes:
• determine the from and to dates which will be entered into the processing notes in PanDA, check for any existing RAE entitlement
• log into Medicare Mainframe/CICS
• key ‘FPRX’ into control line and press Enter
• key provider number from application minus the last alpha
• key ‘R’ in the exemption type and press Enter

This will show if there is any current/previous RAE entitlement on the provider number. If the date range on screen is current, the:

• from date to be entered on the file note is the day after the current end date on screen, and
• end date is entered in line with the provider number eligibility up to a maximum of 3 years in total

If there are no current dates on screen, the from date will be date of receipt of application or date that Medicare billing starts, whichever is later.

To date to be entered should be in line with Medicare billing entitlement end date, with a maximum of 3 years.

Add in PaNDA the dates the medical practitioner has access to Medicare Benefits. Send the application for delegation approval using the ‘Send for Delegation’ function in PaNDA.

Note: delegation approval must be obtained before processing at Step 6.

• No:
• add a note to the work item in PaNDA, include the reason for rejecting
• return application to the medical practitioner using Z2305 if the provider numbers do not have access to Medicare billing as a GP
• save letter as a PDF and upload reject letter to the work item in PaNDA
• ensure the Surname, First Name, Provider Number and Case ID fields are complete
• print the letter and send to the medical practitioner via post and HPOS (if the provider has an active HPOS account)
• procedure ends here, complete the work item

• check for a note in PaNDA with delegate approval and dates, if not present return to Step 5
• if delegate approval is present, return to PDS
• check for an existing 145 Specialty Code

If there is no existing 145 on Stem:

• select Edit > Specialty tab> Add Specialty Code button
• key code 145
• in Start Date and End Date, key the dates determined earlier that are recorded in the notes section of the application
• select Update button
• close the dialog box

If Specialty Code 145 already exists on stem:

• select Edit > Specialty tab> Amend the specialty code 145
• extend End Date to match the determined earlier which are recorded in the notes section of the application
• select Update button
• close the dialog box

Add a note to PDS:

• select Notes tab and select New Note button
• in Notes Subject, type – 145 Approval
• in Notes Description, type – 145 approved for (enter street address) from (start date DDMMYYYY) to (end date DDMMYYYY)
• select Add New button
• select Save button

Is there a 147 specialty code on the stem?

• Yes:
• pend the application in PaNDA for 1 day to allow overnight updates to occur
• go to Step 7

• No:
• as only the 145 specialty has been added, the medical practitioner will not have access to a Medicare Benefit until advice from the GP College has been received
• create RAE - Approval with no Benefits letter
• save letter as a PDF and upload confirmation letter to the work item in PaNDA
• ensure the Surname, First Name, Provider Number and Case ID fields are complete
• add any comments to the PaNDA file
• print the letter and send to the Medical Practitioner via post and HPOS (if the provider has an active HPOS account)
• select Complete
• select Request Approved
• select either Save or Save and Next
• procedure ends here

Log into Medicare Mainframe/CICS:

• key FPRX in control line and press Enter
• type the relevant provider number minus the last alpha
• key ‘R’ in the exemption type

If the date range is an extension on the existing line displayed and there is no gap:

• over key the end date (not item end date) with the approved to date on the application. Go to Step 8

If the screen shows there is a gap between eligibility dates, or is no existing dates present:

• key a new line with start date and end date to match approved dates

Go to Step 8

Under Item Range key the following:

• 55054 – 55851
• 57712 – 59974
• 60100 – 60509
• do not key an End date in item End date fields
• press F5 to save changes

If the dates on PDS for the 145 match the FPRX dates:

• create an RAE Approval letter

If the dates on PDS do not match the FPRX dates due to the 147 specialty code effective after the 145 specialty code:

• create an RAE Approved dependent on QA and CPD letter
• save letter as a PDF and upload confirmation letter to work item in PaNDA
• ensure the Surname, First Name, Provider Number and Case ID fields are complete
• add any comments to the PaNDA file
• send application for delegation approval using the ‘Send for Delegation’ function in PaNDA

After approval, the delegate will issue the confirmation letter to the medical practitioner via:

• post, and HPOS (if the provider has an active HPOS account), and
• complete the work item in line with current workflow procedures