Call enquiries for pharmacy online claiming and payments in Pharmaceutical Benefits Scheme (PBS) 012-60130000

Tell the pharmacist the correct number to call. For contact details, see PBS - General enquires line.

Is the Service Officer trained in PBS general enquiry line calls?

• Yes, see Table 2
• No, go to Step 2

Transfer the call to the correct number. For contact details, see PBS - General enquires line.

If the call is received on the IME line, follow the authentication process in Table 1 of the Improved Monitoring of Entitlements (IME) service.

• Ask the caller to confirm their identity with:
• the pharmacy approval number, and
• their full name
• If the caller cannot provide:
• the pharmacy approval number - tell them to phone back when they can provide the number
• their full name - tell them this is required for security purposes and if not provided, details will not be released

Has the caller confirmed their identity?

• Yes, go to Step 3
• No, procedure ends here

• Key the pharmacy approval number in the RPBC screen
• Ask the caller:
• the name of the pharmacy, and
• the location address of the pharmacy
• Check the details provided match Mainframe/Customer First records

Note:

• The name of the pharmacy may differ if there has been a change to the trading name. If so, ensure the address provided matches mainframe records before proceeding with the call
• If there has been a change in a pharmacy’s details, they must update this with the Department of Health and Aged Care - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers

If the approval number is:

• current, go to Step 5.
• revoked or suspended, ask for the date of supply that the enquiry relates to

Is the date of supply prior to the date the approval was revoked or suspended?

• Yes, go to Step 5
• No, if the approval number is:
• revoked, ask the caller for the new approval number, and verify the below details before proceeding with the call:
  - Go to the RPBC screen and key the new pharmacy approval number
  - Check Date approved
  If the new approval number is unknown, ask the caller to call back when they can provide the approval number
• suspended, tell the caller they must contact the Department of Health and Aged Care - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers

If the call relates to a:

• claim period payment enquiry, go to Step 6
• prescription claim enquiry, security check procedure ends here, proceed with the enquiry
• a pharmacy requesting to update details. Tell them they must contact the Department of Health and Aged Care - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers to update details
• all other enquiries, escalate to the appropriate business area

Service Officers must ensure the caller is an approved or authorised person before releasing information about a claim period or payment enquiry:

• Press [PF9] from the RPBC screen to display approved persons
• Confirm the caller’s full name

Is the caller listed as an approved person?

• Yes, escalate to LPS
• No, go to Step 7 to display the Approved Persons screen

From the Approved Persons screen, press [PF9] to display authorised persons.

Is the caller listed as an authorised person?

• Yes, escalate to LPS
• No, tell the caller information can only be released to an approved or authorised person. Procedure ends here

Note: if approved or authorised persons are not displayed or require updating, refer the pharmacist to the Department of Health and Aged Care - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers. Service Officers cannot release payment or claim period information to a new approved/authorised person until updates are completed and the person can successfully complete the security check.

• Launch Internet browser, access intranet home page
• Select My Tools
• Select Medicare Portal from the menu displayed
• Select the Source Office code relevant to work area
• Select PBS Claims Processing System from the eBusiness System dropdown box
• Select Submit

From the PBS Online Claim Processing home screen:

• Select Query Claim Period
• On the Query Claim Period screen:
• Key Approved Supplier Number (ASN)
• Key Claim Period Number (if known)
• Select Online in the Channel drop down menu
• Select Search or press [Enter]
• Select the radio button next to the relevant claim period
• Select Open Claim Period tab

From the PBS Online Claim Processing home screen, select Query Prescription.

On the Query Prescription screen, Service Officers can perform searches in various ways using the fields displayed.

The most efficient search is with:

• Approved Supplier Number (ASN)
• Claim Period Number (CPN), and
• The prescription serial ID located on the pharmacy dispensing sticker

Other search options include ASN with:

• payment category
• date of supply
• Medicare or Concession number

Note: to search for Under-Co claims, change the prescription type from Claim to Under-Co claim.

Select the relevant prescription from the search results, select Open Prescription.

Check the correct prescription has displayed by asking the caller to confirm the patient and item details on this screen.

• Scroll to the lower section of the screen to view any rejection/warning reason codes displayed
• See the Service Officer Fix instructions in the Reason Code Management System and Pharmaceutical Benefits Scheme (PBS) reason codes for online claiming for PBS pharmacies

To navigate the system to view other prescriptions, Service Officers can use any of these methods:

• Previous prescription tab - will go to the previous serial number in the sequence
• Next prescription tab - will go to the next serial number in the sequence
• Query prescription tab - will go to a new query prescription search screen
• PBS online home tab -will go back to the PBS claim processing home screen

• Launch Internet browser, access intranet home page
• Select My Tools
• Select Medicare Portal from the menu displayed
• Select the Source Office code relevant to work area
• Select PBS Claims Processing System from the eBusiness System dropdown box
• Select Submit

Select Query Payment Status.

Key the approved supplier number in the Approved Supplier Number field.

Key at least 1 of the following search criteria:

• payment status
• claim period number
• PBS payment ID
• Payment request date (date range including From and To dates)

Select Search.

The search results displays showing a list of payments matching the search criteria.

Select the radio button of the payment required.

Select Open Payment Summary.

To provide payment details, from the Payment Summary screen, select:

• Payment Line Details to view all prescriptions that make up the payment
• Disbursement Details to view bank account details of the approved supplier and the date the payment request was made. Note: Service Officers can confirm bank account details but not release them, or
• Claim Period Details to view all details on the selected claim period, whether part of this payment or not

If an approved supplier requests an increase to their daily payment cap, Service Officers must:

• Complete the pharmacy security check to ensure the caller is an approved/authorised person. If the caller is not an approved/authorised person, see Table 2
• Request the following details:
• pharmacy name
• approval number
• approved/authorised person’s name
• contact telephone number

Email the above details to Pharmaceutical Benefits Scheme (PBS) - PBS Claiming Support team who will assess and action the request.

Note: include in the email:

• subject - 'Request for daily cap increase'
• if offered by the approved supplier, the amount the cap should increase to
• reason the approved supplier requests the increase