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

Table 1: lists the main general enquiry types and usual callers from which those enquiries are received.

Enquiry type	Approved Supplier	Members of the public	Doctor	Medicare Service Centres	If unable to be resolved by Service Officer, refer call to
Release of Entitlement number	Yes				Local Peer Support (LPS)
Authority detail clarification	Yes				LPS
PBS payments	Yes - escalate to LPS				LPS
Claim period status	Yes - approved or authorised person only				LPS
Pricing - not related to a submitted claim / prescription	Yes	Yes			PA
Script claim warnings or rejections	Yes				LPS
PBS Safety Net	Yes	Yes		Yes	LPS
Stationery	Yes		Yes		LPS
Claiming advice	Yes				PA
RHCA	Yes	Yes	Yes		LPS
PBS patient refunds		Yes		Yes	LPS
PBS status of medication	Yes	Yes	Yes		PA
Schedule listings	Yes	Yes	Yes		LPS or PA
Statements	Yes				LPS
Prescription writing procedures and legislative requirements	Yes		Yes		LPS
Prescription shoppers	Yes	Yes	Yes		LPS who may refer warm transfer to Prescription Shopping Information Service

Table 2: describes the current status of the claim shown in the Claim Period Status field of the PBS Online Claiming System.

Claim period status	Description
In progress	Approved supplier sending prescription claim transactions for that claim period.
Abandoned	When all of the prescriptions in a claim package have been cancelled.
Generate statement	Indicates payment request and the statement generation process can start.
Statement generated	Statement details have been generated for that claim period.
Complete	All processing has been completed and record is ready for auto-culling.
Ready for Culling	Indicates data is ready to be auto-culled.
Culled	Indicates data has been culled from the tables.
Culling exempt	Indicates data cannot be auto-culled.
Auto Abandoned	Indicates this claim encountered an error during processing and has not been assessed.

Table 3: describes the payment status fields in the PBS Online Claims Processing System.

Payment status	Description
Ready	Claim period is ready to be compiled into a payment request.
Payment requested	A request has been sent to the Payment Utility (PU) system for payment and the External Payment ID is populated in the PBS Online Claims Processing System.
Withhold	Claim period is not to be paid.

Table 4: details typical enquiries and appropriate responses Service Officers may provide to death related enquiries in PBS.

Example	Questions and answers
1	There are other warning reason codes with the same details, why is this a reject? Release of entitlement details for the patient is restricted under the secrecy provisions. I can only confirm that the claim was assessed against Services Australia's records and the rejection was based on the patient's ineligibility at the date of supply provided.
2	Is there any other details you can provide? I can confirm that the patient does not hold valid entitlements to PBS subsidised medications.
3	Why cannot you provide further details? Due to the secrecy provisions outlined in the National Health Act 1953 and the Health Insurance Act 1973, there is no authority to release further details.
4	I have the patient in my pharmacy with me right now, what should I say to them? Advise the patient to visit a service centre or contact Services Australia to confirm their Medicare eligibility and current details.

Contact details

Pharmaceutical Benefits Scheme (PBS) - general enquiries

Pharmaceutical Benefits Scheme (PBS) - Authority approvals