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External Breast Prostheses Reimbursement Program (EBPRP) quality checking in QST 111-22050000

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External Breast Prostheses Reimbursement Program (EBPRP)

Quality and Skill Tags

Error-free status code for EBPRP quality checking

Table 1

Error-free status code	Definition	Processing Tip
EB01	Error-free	Quality check did not detect errors

Document (claim form) error status codes for EBPRP quality checking

Table 2

Error status codes	Definition	Processing tip
EB04 Critical	Prosthesis/Prostheses Information incomplete or omitted on the form	It is an error when the Prosthesis/Prostheses information is omitted or incomplete and there is no evidence to support action taken
EB05 Critical	Bank Account details incomplete or omitted on form when appropriate	It is an error when the BSB number account number account name is omitted or incomplete from the claim form, bank account details have not previously been provided, and there is no evidence to support action taken
EB06 Critical	Claim form not signed	It is an error when the application form is not signed and the form has been actioned
EB07 Critical	Supporting documentation not attached or insufficient	It is an error when the receipt does not include the: description of item amount paid supplier details date of purchase and there is no evidence to support action taken
EB30 Critical	Verification of details not recorded on file note	It is an error when the details have been verified on the phone and they have not been notated on the file note
EB31 Critical	Program Policy’s approval email not attached for overrides	It is an error when the Program Policy’s approval mail is not printed and attached to front of claim
EB32 Critical	Claimant cannot be uniquely identified from details supplied	It is an error when the claimant details section does not have sufficient information to uniquely identify the claimant, and there is no evidence that contact was made by the Service Officer

Processing error status codes for EBPRP quality checking

Table 3

Error status codes	Definition	Processing tip
EB09 Non-Critical	Address details incorrect	It is an error when the address details do not match the application on Personal and Group and there is no evidence contact was made by the Service Officer
EB10 Non-critical	Contact details not updated or incorrect	It is an error when the contact details do not match the application form
EB11 Critical	Bank account details incorrect	It is an error when the bank account details do not match the application form and there is no evidence to support action taken
EB12 Non-critical	Comments omitted incomplete or incorrect	It is an error when the comments have not been updated, or updated incorrectly, upon the receipt of the claim
EB13 Critical	Claim processed against incorrect claimant	It is an error when the claim has been processed against the incorrect person
EB14 Non-critical	Date of Lodgement incorrect	It is an error when the date of lodgement has been keyed incorrect in the General Payment Parameter System (GPPS)
EB15 Critical	Prosthesis/Prostheses type (left/right) keyed incorrectly	It is an error when the Prosthesis/Prostheses type is keyed incorrectly in EBPRP within GPPS
EB16 Critical	Date of purchase keyed incorrectly	It is an error when the date of purchase is keyed incorrectly in EBPRP within GPPS
EB17 Critical	Amount Claimant has paid keyed incorrectly	It is an error when the total amount the claimant has paid for their prosthesis/prostheses, including any Private Health Care reimbursement amounts, has been keyed incorrectly
EB18 Critical	Overrides keyed incorrectly	It is an error when the override is: performed when not authorised not performed when authorised in EBPRP within GPPS as per supporting documentation
EB19 Critical	Authorisation number or reason for rejection incorrectly keyed in GPPS comments or not keyed	It is an error when the comments in the ECPRP claim screen for Authorisation number Reason for rejection are not keyed in EBPRP within GPPS as per supporting documentation
EB20 Critical	Non-external Prosthesis/Prostheses processed in error	It is an error when a non-external Prosthesis/Prostheses item has been processed (for example a bra, swimwear, internal prostheses)
EB22 Critical	Claim rejected in error	It is an error when the claim is deemed payable but has been rejected in error by the Service Officer
EB23 Critical	Claimant indicated a private health fund rebate, but amount omitted or incomplete	It is an error when a claimant has indicated that they received a private health fund rebate/other financial assistance, however the amount was omitted or incomplete and there is no evidence that contact was made by the Service Officer
EB33 Non-critical	PaNDA naming convention not complete or incorrect	It is an error when the PaNDA naming convention is not complete or incorrect
EB34 Critical	Work items closed in PaNDA but item not processed	It is an error when the work item is closed prior to the item being processed

Intranet links

See Service Delivery Quality and Evaluation for a link to the Enterprise Quality Framework.