This document outlines details about different types of online claiming and payment enquiries received regarding PBS or Repatriation Schedule of Pharmaceutical Benefits (RPBS) telephony.
On this page:
Pharmacist enquiries on the PBS authority line
Perform a pharmacy security check
Locate a claim period or prescription claim in PBS Online
Locate a payment in the PBS Online Claims Processing System
Manual claim enquiry
Payment capping - request an increase to a payment cap
Pharmacist enquiries on the PBS authority line
Pharmacists enquiring about an authority approval should contact the PBS - General Enquiries Line. This section contains the process service officers follow when a pharmacist incorrectly enquires about an authority approval on the Pharmaceutical Benefits Scheme (PBS) Authorities line.
Table 1: describes how to respond to a call from a pharmacist on the PBS Authorities Line.
Expand tableStep | Action |
1 | Advise correct number to call
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? |
2 | Transfer the call
Transfer the call to the correct number. For contact details, see PBS - General enquires line. |
Perform a pharmacy security check
Table 2: describes how service officers perform a security check to establish or confirm the identity of the caller.
Expand tableStep | Action |
1 | Check incoming call destination
If the call is received on the IME line, follow the authentication process in Table 1 of the Improved Monitoring of Entitlements (IME) service. |
2 | Confirm identity
- Ask the caller to confirm their identity with:
- the pharmacy approval number, and
- their name
- If the caller cannot provide:
- the pharmacy approval number - tell them to phone back when they can provide the number
- their name - tell them this is required for security purposes and if not provided, details will not be released
Has the caller confirmed their identity? |
3 | Check pharmacy approval number
- Key the pharmacy approval number in the Approved Pharmacy Display (RPBC) screen
- Ask the caller the:
- name of the pharmacy, and
- location address of the pharmacy
- Check the details given match Mainframe/Customer First records
Note: |
4 | Check the status of the approval number
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 before the date the approval was revoked or suspended? |
5 | Ask caller the reason for enquiry
If the call relates to a: |
6 | Identify the caller for a claim period or payment enquiry
Service officers must make sure the caller is an approved or authorised person before releasing details about a claim period or payment enquiry: - Press [PF9] from the RPBC screen to show approved persons
- Confirm the caller's full name
Is the caller listed as an approved person? |
7 | Caller not listed on Approved Persons screen
From the Approved Persons screen, press [PF9] to show Authorised Persons. - If the caller is not listed as an approved or authorised person, ask if:
- there is an approved or authorised person to manage the enquiry, and
- the approved or authorised person for the pharmacy requires updating
- If so refer the pharmacist to the Department of Health, Disability and Ageing - Pharmaceutical Benefits Scheme (PBS) Approved Suppliers
- Service officers cannot release payment or claim period details until updates to approved/authorised persons listing are completed and the person can successfully complete the security check.
Is the caller listed as an authorised person? - Yes, escalate the call to LPS, LPS officers:
- must take over the call, and if unable to resolve the enquiry
- escalate to a Service Support Officers, see LPS in Medicare and Aged Care > Step 12 in Tier 1 technical support - Local Peer Support (LPS)
- No, tell the caller details can only be released to an approved or authorised person. Procedure ends here
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Locate a claim period or prescription claim in PBS Online
Table 3
Expand tableStep | Action |
1 | Access PBS Online Claims Processing System
- Launch internet browser, access intranet home page
- Select:
- My Tools
- Medicare Portal from the menu shown
- the Source Office key relevant to work area
- PBS Claims Processing System from the eBusiness System dropdown menu
- Submit
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2 | Locating a claim period
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 dropdown menu
- Select Search or press [Enter]
- Select the radio button next to the relevant claim period
- Select Open Claim Period tab
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3 | Locating a specific prescription
From the PBS Online Claim Processing home screen, select Query Prescription. On the Query Prescription screen, service officers can search in many ways using the fields shown. 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 shown by asking the caller to confirm the patient and item details on this screen. |
4 | Determine the reason code and relevant fix instructions, if required
To navigate the system to view other prescriptions, service officers can use any of these methods: - Previous prescription tab - goes to the previous serial number in the sequence
- Next prescription tab - goes to the next serial number in the sequence
- Query prescription tab - goes to a new query prescription search screen
- PBS online home tab - goes back to the PBS claim processing home screen
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LPS instructions to locate a payment in the PBS Online Claims Processing System
LPS Process only
Table 4: describes how to search for a payment for an approved supplier after completing the security check.
Expand tableStep | Action |
1 | Access PBS Online Claims Processing System
- Launch internet browser, access intranet home page
- Select:
- My Tools
- Medicare Portal from the menu
- the Source Office code relevant to work area
- PBS Claims Processing System from the eBusiness System dropdown menu
- Submit
|
2 | Access the Query Payment screen
Select Query Payment Status. |
3 | Key approved supplier number
Key the approved supplier number in the Approved Supplier Number field. |
4 | Search for payments
Key at least one of the following search criteria: - payment status
- claim period number
- PBS payment ID
- Payment date (date range including From and To dates)
Select Search. The search results show a list of payments matching the search criteria. |
5 | Select payment for the approved supplier
Select: - the radio button of the payment required
- Open Payment Summary
|
6 | Provide payment details to the caller
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
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Manual claim enquiry
Table 5: describes how to help an approved supplier with a manual claim enquiry after a security check.
Expand tableStep | Action |
1 | Ask caller the reason for the enquiry
If the call relates to: |
2 | The Approved Supplier must submit a manual or manual under co-payment (UCP) claim
Tell the approved supplier the following details must be completed and sent: - A completed Approved Supplier manual payment reconciliation form (PB242)
- A completed Manual prescription processing fee for pharmaceutical benefits - Bureau service deduction authority form (PB259)
- Original paper prescriptions requiring manual payment, which include the pharmacy dispensing sticker
All forms must be completed by an authorised/approved person. |
3 | Where to look for a manual or manual UCP claim received
When a Manual claim is received, a PaNDA work item is created: - Search work type PBS_PBS_MAN
- External Reference ID is the pharmacy approval number
Was a record found? - Yes, check the relevant forms are sent and advise customer documents received
- No, advise customer no documents have been received:
- Verify the documents were sent to the correct address
- Confirm the expected delivery date
- Request documents to be resent if necessary
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Payment capping - request an increase to a payment cap
Table 6: describes the procedure that a service officer must complete when an approved supplier requests to increase the daily payment cap.
Expand tableStep | Action |
1 | Request pharmacy details
If an approved supplier requests an increase to their daily payment cap, service officers must: - complete the pharmacy security check to make sure 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
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2 | Email pharmacy details to PBS Claiming Support
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
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