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PBS Safety Net quality checking in QST 111-21031003

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Services Australia website

PBS Safety Net for pharmacists

PBS Safety Net for customers

External websites

Department of Health and Aged Care - The Pharmaceutical Benefits Scheme

Department of Veterans’ Affairs - Reducing medicine costs under the Safety Net Scheme

Privacy and Secrecy

Enterprise Quality Framework

Letters

Pharmaceutical Benefits Scheme (PBS)

Forms

Privacy Incident Portal

Contact details

Health Service Delivery Division - Quality, Performance and Technical Support

Health Service Delivery Division - Program areas - Pharmaceutical Benefits Scheme (PBS)

Pharmaceutical Benefits Scheme (PBS) - Claiming Support

Medicare and Aged Care - Local Peer Support (LPS)

Error codes - error free

Table 1:

Error codes

Error definition

A00

Error free

No errors.

Error codes - B status codes - PBS Safety Net Claims system

Table 2: describes the error codes for the PBS Safety Net Claims system. The processes can be found in Pharmaceutical Benefits Scheme (PBS) Safety Net Processing and enquiries.

Error codes

Error definition

B01S

Critical

SYSTEM Safety Net registration error.

Incorrect Safety Net number, card type or Supplement Card not issued.

B02S

Critical

Applicant or dependant error.

Safety Net registration status for the applicant or a family member is incorrect; not added or removed correctly.

Family member has been omitted from the Safety Net Card.

An incorrect person has been added to the Safety Net Card.

A dependant with concession entitlement was incorrectly recorded as card holder (CH) and the parent/s with no concessional status was recorded as the dependant/s.

Dependant Student (DS) with a safety net age of twenty-five or over has been added to the card.

Incorrectly Voided Card.

B03S

Non-Critical

Relationship code error.

Family dependant (dependent child or student) incorrectly added as card holder (CH) or spouse (SP).

CH or SP incorrectly added as a dependant.

Note: Relationship code errors are only non-critical if there has been no effect on the eligibility of the family. For critical errors refer to error B02S.

It is not an error if the CH and SP are added to the Safety Net Claims System (SNCS) opposite to the information contained on the prescription record form (PRF).

B04S

Non-Critical

Comment error.

Required comments omitted or incorrect.

B05S

Critical

Pharmacy approval number error.

Incorrect pharmacy assigned to Safety Net registration.

Note: includes work items not separated and processed incorrectly.

B14S

Critical

Record not updated.

Safety Net claim, registration or amendment not recorded.

Claim registered but not closed.

Claims that should have been paid, rejected, or deleted.

Patient Surname incorrect on claim registration screen.

B15S

Non-critical

Registration screen error.

Recorded lodgement date incorrectly.

PaNDA Ref# was excluded.

Recorded PaNDA Ref# incorrectly

The claim was registered incorrectly as ‘Reject Whole Claim.’ Each PRF must be entered into the SNCS tool and assessed individually.

Error codes - C status codes - application form

Table 3: describes the error codes for the application form. The processes can be found in:

Error codes

Error definition

C01S

Critical

Form incomplete or not provided.

  • No claim form
  • No prescription record form or prescription evidence
  • Illegible forms or prescription evidence
  • Missing signatures or authorised person’s name
  • Safety Net Claim missing information:
    • pharmacy details
    • date on claim for payment form
    • applicant details
    • applicant card numbers
    • family member details
    • date of supply
    • item code
    • approval number
    • Safety Net value
    • Pharmacist signed as the applicant’s agent or certified the PRF in absence of the applicant/agent signature
  • Safety Net card missing information:
    • Medicare number
    • SN/CN numbers
    • address
    • added family members and relationships
    • reason for replacement
    • contact details
  • No written request from original card holder (not on original PRF)

Error codes - D status codes - letters

Table 4: describes the error codes for letters. The processes can be found in:

Error codes

Error definition

D01S

Critical

Address error.

Letter sent to the correct recipient but used an incorrect address.

D02S

Critical

Attachment error.

An incorrect record or form is included with the letter.

D03S

Critical

Information error.

  • Incorrect standard letter or wording
  • Incorrect information
  • Critical information is missing
  • Did not cover all rejections found within the safety net claim

D04S

Critical

Patient identification error.

The incorrect patient appears on the letter.

Note: if the incorrect patient is also the incorrect recipient, select DO5 error only.

D05S

Critical

Recipient error.

Letter sent to the incorrect recipient.

Note: this error code may also capture patient identification errors and address errors if it is an incorrect recipient.

D06S

Non-critical

Minor message error.

  • Administration reference information is missing or incorrect
  • Spelling errors in free text areas
  • Patient name keyed incorrectly

Error codes - E status codes - assessing errors

Table 5. assessment errors relate to an incorrect eligibility assessment. For example, this might include failure to recognise the correct issue date or to exclude ineligible prescriptions.

Recording errors are listed under B PBS Safety Net Claim system errors.

Processes can be found in Pharmaceutical Benefits Scheme (PBS) Safety Net processing and enquiries.

Error codes

Error definition

E01S

Critical

Entitlement error.

  • Not eligible - did not meet the eligibility criteria or threshold for Safety Net registration type
  • Eligible - rejected in error

E02S

Non-Critical

Date of issue error.

Eligible - but incorrectly determined date of issue from manual review.

Error codes - F status codes - PaNDA

Table 6: processes can be found in Processing and National Demand Allocation (PaNDA) and Work Optimiser for staff.

Error codes

Error definition

F01S

Non-critical

Program or Work Type classification error.

Work is incorrectly classified.

Note: includes work incorrectly named, if also incorrectly classified.

F02S

Non-critical

Naming error.

Classified correctly but naming conventions not applied or incorrect.

F03S

Non-critical

Comment error.

Required comments omitted or incorrect.

F04S

Non-critical

Documentation missing.

Sent letter not uploaded to the Work Item or page/s missing in documentation.

F05S

Non-critical

Work Items not merged and/or associated.

Connected Work Items not merged and/or associated into one.

F06S

Non-critical

Work Items not separated.

Did not separate multiple Work Items from different pharmacies in PaNDA or extract a different Work Type for separate processing (includes work items not separated but processed correctly).

Note: for work items not separated and processed under the incorrect pharmacy, use error code B05S - Critical.