Processing Written Authority requests 012-63020010

To get a Written Authority requests select:

• Worklist on Work Optimiser home page
• Ready
• Work Optimiser assigns a work item which can be:
• a HPOS form upload
• a mailed application, or
• an OPA delayed assessment
• If the request is for a Streamlined Authority item for the listed quantity and repeats, go to Table 2, Step 9

Note: if the documents are hard to read, go to Step 3.

Select PaNDA Search on the Work Optimiser home page.

For Written Authority requests, select:

Program:

• Pharmaceutical Benefits Scheme (PBS), or
• Complex Drugs

Work Type:

• PBS - select based on the State that the prescription has been posted in from:
• Authority Mailed (STATE), for mailed applications, or
• Authority Proforma for HPOS uploads
• Complex Drugs - select based on program:
• Program - WRIT for mailed applications, or
• Program - HPOS for HPOS upload applications
• Search for work item:
• Use Medicare number to search for General
• PBS and Complex Drugs - work items. If the Medicare number is not supplied search on SURNAMEFIRSTNAME or authority number in the Medicare Number field
• For HPOS form Upload authority requests, enter HPOS reference number in the HPOS reference number field or Medicare card number in the Medicare Number field. Select Search > Select the document > Open file - confirm correct prescription

Delayed assessment authority requests

To locate work received in Work Optimiser via OPA for delayed assessments, see Table 4 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System).

Use status filter options to refine search:

• Open for all open work items
• Completed for all work items previously completed
• Pended for work items currently pended

Has the authority application been located?

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

Use alternative search criteria including:

• Authority prescription number, Prescriber number or Surname First name
• Search other work types, for example, different state or escalation folders

If still unable to locate, Service Officers must escalate to Local Peer Support (LPS).

• If the poor quality or incomplete scan is an obvious Service Delivery error, call the prescriber and clarify the missing details
• If the application or prescription details are missing and it is not a Service Delivery error:
• reject the application with the applicable letter, and
• print out a copy of the application form and supporting documents (if applicable)
• post the application, associated documents and rejection letter to the prescriber

Service Officers must refer prescription details displayed in the PDF that do not match the hard copy to:

• LPS, or
• a Team Leader

See Table 5 for more information about Troubleshooting HPOS form uploads.

• For patients with a DVA entitlement, go to Step 2
• If the application is for a Complex Drugs item, go to Step 3
• To escalate to Local Peer Support (LPS) or Pharmaceutical Adviser (PA), go to Step 4
• If the Requests is for a Streamlined Authority item for the listed quantity and repeats, go to Step 9

When a Department of Veterans' Affairs (DVA) file number is recorded on the authority prescription or the Repatriation Pharmaceutical Benefits Scheme (RPBS) tick box has been highlighted, check the Patient Search screen in OPA to confirm PBS eligibility.

For mailed applications if the patient is DVA eligible

• Right click on the prescription/application file and select Save As
• Name the file 'DVA prescription' and save the document in the Customer Information folder
• Open File Explorer and locate the file
• Right click on the file and select Send to > Mail recipient. This will generate a new email with the file attached
• Email Veterans' Affairs Pharmaceutical Advisory Centre (VAPAC):
• see the Resources page for the correct email address
• email Classification must be selected as OFFICIAL: SENSITIVE before selecting Send
• Delete file from the Customer Information folder
• Add a Processing note on the Work Item file indicating action taken and change work status to Completed

For HPOS Form Upload requests, if the patient is DVA eligible

• Respond to the HPOS item by using the 9 digit HPOS reference number to locate the item and send a reply. See the Resources page, Table 1 for the required wording to be included in the email response
• Add a Processing note on the Work Item file indicating action taken and change work status to Completed

Procedure ends here.

Service Officers skilled in the work type presented:

• see Processing Complex Authority Required Listings to action the work, or
• with a Complex Authority request that is a Delayed Assessment item, see Table 5 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System)

Service Officers not skilled in the work type presented:

• HPOS (Form Upload) or mail received applications:
• add a Processing note on file, ‘Re-categorised from PBS/Authority Proforma’
• unassign with reason Re-categorised
• select the relevant HPOS or WRIT folder - if unsure, escalate to a Complex drugs LPS
• select Submit
• Delayed Assessment items:
• if not skilled in OPA Delayed Assessment items, unassign to return the item to the national allocation pool and refer to a Team Leader to review skill tags

If the Written Authority requires help from LPS or a PA:

• Request help from LPS and follow advice provided
• If there is no LPS available, complete the Tier 1 - Request for LPS Assistance - Health online form
• If LPS is unable to resolve the query, escalate the work item to a PA via the applicable escalation folder
• Service Officers must add Processing notes to the Work Item that outlines the action required before recategorising
• Leave the Status as Open. Do not change the Status to ‘Pended’
• For PA escalation, re-categorise the application:
• For general authorities - to the Pharmaceutical Benefits Scheme/Authority Mailed Escalation folder
• For complex authorities - to the Complex Drugs/Written Authority Escalation folder
• For delayed assessments accessed via Work Optimiser Worklist to the Delayed assessment escalation folder

Note:

• processing notes cannot be added to delayed assessment work items in Work Optimiser/ Worklist
• Service Officers must add an authority comment in the Authority Comments in OPA to explain the reason for escalation and outline the action required
• the comment must be saved to be visible to PA’s
• delete the comment once the escalation is resolved

For detailed information about entering an authority into OPA, see Table 2 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System).

If the request is:

• Approved, go to Step 8
• Approved with changes, go to Step 7
  Note: prescriptions where the quantity and repeats guidelines are not met may need more consideration, see Changes to quantity and repeats for authority required (written) approvals
• Rejected, go to Step 6
• Authority not required, go to Step 9
• Too soon and rejected by OPA - a manual assessment may be required, see Table 2, Step 12 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System)
• Opioid authority prescriptions with incorrect criteria (for example, missing 1 June 2020 information, missing initial/continuing), go to Table 1, Step 2 in Opioids - prescriptions and approvals

Saving an application

If a Service Officer needs to stop processing, an authority application can be saved:

• To save an application:
• select Save on any screen after the item has been selected, or
• use the keyboard shortcut, press [Ctrl]+[Shift]+[S]
• To continue assessing an application that has been saved, find the saved authority application using Search Authorities from the homepage in OPA
• Select Resume against the authority which is saved. This opens the authority at the point that it was saved
• Amend any previously entered information by selecting the Back button
• Complete authority as usual

Note: staff must know how to tell the difference between HPOS and mailed authority requests in Work Optimiser. This helps to determine the correct letter and process to follow.

If the request does not have a HPOS reference number, search for the number in the History tab. If there was never a HPOS reference number even in the History, then it was not a HPOS upload.

If the authority request has been rejected:

• generate a rejection letter, use the:
• General letter tool for processing general authorities, or
• Complex letter tool for processing complex authorities
  Note: see the Resources page for links to the tools
• if the reason is not available, escalate to Health Service Delivery Division > Pharmaceutical Benefit Scheme (PBS) for a letter
• save a copy of the letter as a PDF in the Customer Information folder
• for mailed applications, print a copy of the letter, application form and supporting documents (if applicable) via secure print. The Resources page has more details about setting up secure print. Service Officers must delete the documents from the printer queue
• upload the rejection letter into the Open work item in Work Optimiser, go to Step 10 for details

To post a rejection letter for a mailed Authority request, go to Step 11.

If replying to a HPOS Form upload Authority request, see Table 3, Step 4.

See Table 5 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System) for details about rejecting an authority received in Work Optimiser via OPA for a delayed assessment.

Note: use the Primary Reference details for the letter’s reference field. For PBS Authorities this is the Medicare number field.

• Generate an approved with changes letter, use the:
• General letter tool for processing general authorities, or
• Complex letter tool for processing complex authorities
  Note: see the Resources page for links to the tools
• Save a copy of the letter as a PDF in the Customer Information folder
• For mailed applications, print a copy of the letter, application form and supporting documents (if applicable) via secure print. The Resources page has more details about setting up secure print. Service Officers must delete the documents from the printer queue
• Upload the rejection letter into the Open work item in Work Optimiser, go to Step 10 for details

To post a rejection letter for a mailed Authority request, go to Step 11.

If replying to a HPOS Form upload Authority request, see Table 3, Step 5

Note:

• use the Primary Reference details for the letter’s reference field. For PBS Authorities this is the Medicare number field
• there are 2 options for assessing Delayed Assessment items, Approved and Rejected. If the prescriber has over-prescribed an item, staff must reject the application as there is no option to amend the quantities and repeats as 'approved with change'

• Generate an approved with changes letter, use the:
• General letter tool for processing general authorities, or
• Complex letter tool for processing complex authorities
  Note: see the Resources page for links to the tools
• Save a copy of the letter as a PDF in the Customer Information folder
• For mailed applications, print a copy of the letter via secure print. The Resources page has more details about setting up secure print. Service Officers must delete the documents from the printer queue
• For mailed authority requests, upload the letter into the correct Open work item in Work Optimiser, go to Step 10 for details

Posting an approval assessment letter for a mailed Authority request, go to Step 11.

If replying to a HPOS Form upload Authority request, see Table 3, Step 3.

Note:

• assessment letters must be returned to the prescriber. A copy of the written authority request is not required to be returned to the prescriber
• assessment outcomes for Delayed Assessments automatically generate and sends to the prescriber once an assessment decision has been made in the Authorities System (OPA System)
• see Table 5 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System) for details about approving an authority received in Work Optimiser via OPA delayed assessment

For written authority requests for Streamlined items where there is no increase to the listed quantity and repeats:

• Enter the authority request in OPA, OPA will assess as Authority not required
• Use the General Letter Tool to generate a Streamline Authority letter
• Save a copy of the letter as a PDF the Customer Information folder
• For mailed applications, print a copy of the letter via secure print. The Resources page has more details about setting up secure print. Service Officers must delete the document from the printer queue
• Upload the letter into the correct Open work item, go to Step 10

Posting a Streamlined Authority letter for a mailed Authority request, go to Step 11.

If replying to a HPOS Form upload Authority request, see Table 3, Step 6.

Open the attached file(s) from the original email to make sure the response is for the correct patient and sent to the correct prescriber.

To upload the letter Service Officers must:

• make sure the correct work item is selected (if not, select Work list and select the item)
• select Upload Document
• use the Browse button to select (highlight) the applicable PDF file from the saved location
• select Open > Upload
• delete the file from the Customer Information folder

• Use window envelopes if available, folded with the prescriber address visible through the window. Include the return application form (if applicable) and rejection letter to the approved prescriber, or generate an envelope
• Confirm the prescriber’s name and address on the envelope or letter matches the authority request. If the prescriber address is missing, contact the clinic (if known) to confirm the address
• Place the envelope in the correct mailroom tray

• Before completing the work item in Work Optimiser, check that the application is named correctly with the patient's:
• Medicare number
• program reference number, if applicable
• Attach rejection letters and approved with changes letter
• On completion of the work item in OPA:
• select Complete in the Status field
• select Save
• A message will show at the bottom of the screen advising that the work item has been successfully saved
• Delayed Assessment applications are automatically closed in Work Optimiser once an assessment decision has been made in OPA

Note: it may take up to 2 minutes for the work item to disappear from the Worklist.

Procedure ends here.

• Go to Work Item
• Select the Open in HPOS link located top right hand corner
• Open the attached file from the prescriber to double check the response is for the correct patient:
• if incorrect, escalate to Local Peer Support (LPS)
• if the link does not work, find the HPOS file by keying the 9 digit HPOS reference number into the Quick Search field on the top right hand corner of HPOS Support

Note:

• the HPOS reference number can be found in the HPOS Reference Number field in the Work Item. It is also available in the History tab. Only key the first 9 digits of the reference number when searching in HPOS Support
• if error messages show when sending a HPOS response, go to Step 7

For an authority request with the assessment result of:

• Approved, go to Step 3
• Rejected, go to Step 4
• Too soon and rejected by OPA - a manual assessment may be required, see Table 2, Step 12 in Online Pharmaceutical Benefits Scheme (PBS) Authorities System (OPA System)
• Approved with changes, go to Step 5
• Authority not required, go to Step 6

For written authority requests submitted via HPOS that have been Approved:

• Select the Open in HPOS link in top-right corner. If an error message is received and the Service Officer is unable to reply, go to Step 7
• Reply to the authority request by using the:
• Suggested text for email and HPOS responses to a prescriber or delegate, or
• applicable letter to generate a reply - General letter tool, for processing general authorities or Complex letter tool, for processing complex authorities
• Open the attached file(s) from the original HPOS authority request to make sure the response is for the correct patient and sent to the correct prescriber
• Send the response
• Go to Step 8

For written authority requests submitted via HPOS that have been Rejected:

• Complete a Reject letter. See the Resources page for details on which letter to use
• Select the Open in HPOS link in top-right corner. If an error message is received and the Service Officer is unable to reply, go to Step 7
• Reply by using the:
• Suggested text for email and HPOS responses to a prescriber or delegate, or
• applicable letter to generate a reply - General letter tool, for processing general authorities or Complex letter tool, for processing complex authorities
• Attach the completed letter to original HPOS authority request. To attach a letter:
• Select Choose File to find the letter > Open > Add file
• Open the attached file(s) from the original authority request to make sure the response is for the correct patient and sent to the correct prescriber
• Send the response
• Go to Step 8

Note: always return rejection letters to the approved prescriber by responding to the original request in the HPOS system.

For written authority requests submitted via HPOS that have been Approved with changes:

• Select the Open in HPOS link in top-right corner. If an error message is received and the Service Officer is unable to reply, go to Step 7
• Reply by using the:
• Suggested text for email and HPOS responses to a prescriber or delegate, or
• applicable letter to generate a reply - General letter tool, for processing general authorities or Complex letter tool, for processing complex authorities
• Upload the completed Approved with changes letter to the HPOS response. To attach a letter:
• Select Choose File to find the letter > Open > Add file
• Send the response
  Note: always return the approved with changes letter to the approved prescriber by responding to the original request in the HPOS system
• Open the attached file(s) from the original email to make sure the response is for the correct patient and sent to the correct prescriber
• Go to Step 8

For written authority requests for Streamlined items if there is no increase to the listed quantity and repeats:

• select the Open in HPOS link located in top-right corner. If an error message is received and the Service Officer is unable to reply, go to Step 7
• respond to the original request in HPOS with ‘Please read the attached letter for the outcome of your recent PBS authority approval application.’
• attach the completed Authority not required letter to the HPOS response
• To attach a letter:
• Select Choose File to find the letter > Open > Add file
• Open the attached file(s) from the original upload message to make sure the response is for the correct patient and sent to the correct prescriber
• Send the response
• Go to Step 8

Note: always return Streamlined authority requests to the approved prescriber by responding to the original request in HPOS.

Has a duplicate application has been received (check HPOS/OPA)?

• Yes, make a note in the Work Item as ‘Duplicate application’
• No,
• if the authority has been approved, phone the prescriber and tell them the approval number
• if rejected, provide the rejection reason
• if the prescriber is not available, release the following information to the prescriber’s nursing or administrative staff. See Release of Authority information in Pharmaceutical Benefits Scheme(PBS) for more details. Status of authority (approved or rejected), The date that Services Australia approved the prescription, Medicine description form and strength, PBS item code, Quantity and number of repeats, Make a note in Work Item, with the date and time of the call
• if the authority is not required, tell the prescriber that - Authority required (STREAMLINED) items for the listed quantity and/or repeats do not require approval from Services Australia. Streamlined authority codes are available in the Schedule of Pharmaceutical Benefits via the PBS website

Go to Step 8

Update the Work Item:

• with the correct primary reference number (Medicare number) and if applicable, Program Reference Number
• attach rejection letters and approved with changes letter
• change status to Complete
• select Save

Note: approval letters are not required to be uploaded to Work Optimiser for applications received via HPOS Form Upload.

For returned:

• assessment letters, go to Step 2
• original prescriptions, go to Step 4
• Streamlined approved Authority prescription inadvertently received, see Process for Authority required (STREAMLINED) item

Check the prescriber's address on the assessment letter matches original authority request in Work Optimiser, see Table 1, Step 2.

If the address:

• does not match, create a new envelope
• matches, contact the prescriber for the correct address details to forward the assessment letter. If:
• needed provide the approval number if the authority has been approved
• rejected, provide the rejection reason
• matches and the doctor's contact details on the authority request are outdated, go to Step 3

• Log into the Medicare Portal - eBusiness Gateway
• From the dropdown menu select the PDS, then Submit
• From the Provider Directories open Provider > View > Basic search
• From the ID Type dropdown menu select Prescriber Number
• Type in prescriber number in the Search ID field and Search
• If the prescriber is:
• not found, enter an Authority comment ‘RTS, unable to find prescriber contact details’
• found and contact details are recorded, call the prescriber and clarify address details
• found but no contact details recorded, enter an Authority comment ‘RTS, unable to find prescriber contact details’

Procedure ends here.

For inadvertently received approved prescriptions, check the paper prescription details.

If the approved prescriber has endorsed an approval number (for example, M9999RX) on the prescription, but has sent the prescription to Services Australia, and the prescription does not require further approval:

• access Authorities System (OPA), and
• confirm that all the prescription details match the entry in OPA

Search for and view an Authority - Access Online PBS Authorities - Search Authorities

In the Medicare - eBusiness Gateway:

• Log on to PBS Authority Application System from the eBusiness System dropdown menu
• Submit and select Search Authorities
• Enter the search criteria

There are 4 Search types, each with mandatory or minimum fields. Mandatory fields are marked with an *. Explanatory text will display to indicate minimum fields

• The search types include:
• Medicare Number
• Patient (name, DOB)
• Authority, and
• Prescriber
• The default Search type is Medicare Number. Enter the patient’s Medicare number if this is the Search type being used
• If another Search type is to be used, select from the Search type dropdown menu
• To search, select [Enter] or Search
• Select from the search result
• Authorities matching the search criteria will display
• To view an authority, select View
• If all the details are correct, generate letter Z2303 Your patient’s authority prescription is already approved, and
• Go to Step 5

Key the following details into the authority Comments:

• Add ‘RTS - what action has been taken’, for example:
• Rx now forwarded to prescriber
• Incorrect address on envelope, resent to prescriber
• Add Service Officer P-number or log-on
• Select Save

If some details are incorrect or a discrepancy is identified, escalate to Local Peer Support (LPS).

Is the file:

• unclear or cannot be read, go to Step 2
• a form other than a prescription request, go to Step 3
• a prescription that has previously been actioned, go to Step 4
• the prescriber has sent multiple requests through HPOS, go to Step 5

Search for the HPOS Form Upload:

• Select the Open in HPOS link located in top right hand corner
• Open the attached file from the prescriber and check the response is for the correct patient
• If incorrect patient, escalate to a Pharmaceutical Adviser (PA)
• Press Reply
• Copy and paste the information below into the Text field
• The image uploaded was not clear. Please re-scan or take a new photo of the documentation and make sure the image is clear. Once completed please resubmit all documentation
• Press Send

Escalate to Local Peer Support (LPS)Table or a team leader for instruction on how to action if:

• the form is not a prescription request, e.g. stationery or a pathology form or
• the form has been categorised incorrectly

The prescription has already been actioned and the prescriber has sent in multiple requests:

• select the ‘Open in HPOS’ link located in top right hand corner
• open the attached file from the prescriber and check the response is for the correct patient
• if incorrect patient, escalate to a Pharmaceutical Adviser (PA)
• press Reply
• copy and paste the information below into the Text field:
• Please note, this prescription has already been assessed and your response can be found in HPOS reference number XXXXXXXX

If there are multiple patient prescriptions in one file:

• Save the file:
• Right click the file and select Save As
• Save the file in the Customer Information folder
• Extract the additional prescriptions from the PDF file and save the new files to the computer:
• In Acrobat DC, select Tools > Organize Pages > Extract
• Highlight the pages to be extracted
• If the pages are to be extracted as separate documents, tick the Extract Pages As Separate Files box before selecting Extract
• Save the item(s). These item(s) can be found in the saved folder which has the same name and numerics to differentiate, for example 2 or as pages from <original title>
• Locate the saved file (the file will have the same title and a numeric, e.g. 2)
• In Work Optimiser create separate files for each person. To create new work items:
• Select PaNDA Document Upload under the Health Services menu
• Select Create New Work Item from Upload Type field
• Select Browse and select a file from the pop up window
• Change the Date of Lodgement (defaults to today’s date)
• Select Program from the dropdown menu
• Select Work Type from the dropdown menu
• Add Primary Reference Number (Medicare number)
• Add HPOS reference number, from original file. The Work item must have a HPOS reference number for sending an email response to a prescriber or delegate
• Add a processing note, if applicable
• Select Upload to submit the new work item into the allocation pool
• Repeat process as needed until all files are uploaded
• Delete files from the in the Customer Information folder
• On the original file, include a processing note to indicate the other documents in the file have been extracted into new files