Process claims in the Australian Immunisation Register (AIR) 011-10100000

Category title

Description

An exact match for the individual is not found and more than one record is listed

Select (/) the record and press [Enter] to view the details.

Individual personal details missing

Use Medicare card number and reference number to identify individual.

Medicare card and reference number missing or unable to be identified

• Check keying and amend if necessary
• If still invalid:
• remove Medicare number and reference number
• key surname, given name, gender, date of birth and postcode (optional)
• press [Enter]
• select (/) record from list
• press [Enter] to view the details

Personal details and Medicare card number missing or unable to be identified

• Contact provider by phone to confirm identity of the individual, or
• If unable to contact provider, return form to provider with standard letter

Newborn baby is unnamed, quoted on form as:

• baby
• B/O - baby of
• NBF - new born female
• NBM - new born male
• Blank (given name not supplied)

• Present:
• key Medicare number without reference number and press [Enter]
• if match is returned, select (/) correct record and press [Enter]
• Not present:
• key surname, given name as (baby of), gender, date of birth, postcode (optional), and
• press [Enter]
• If match is returned, select (/) correct record, and press [Enter]

Aboriginal or Torres Strait Islander status indicator not completed

No action required. (This section is not mandatory and requires parental/individual consent to report).

Hepatitis B birth dose not completed

No action required. (This section is not mandatory and may have already been reported).

Immunisation service date missing or unable to be identified

Use date of service shown on encounter. If not shown on encounter, contact provider by phone and either obtain immunisation date or return form with a standard letter if provider is unable to assist.

Claim ID has 1 alpha and less than 6 numerics

Key '0' between alpha and numerics shown to provide a total of 6 numerics (for example, change B1234 to B001234).

Claim ID cannot be identified

Service Officers key 'X9' and full Service Officer logon, for example, X922221.

Vaccination details section no boxes marked or vaccines or doses unclear

Contact the provider by phone to obtain vaccination details or return form to provider with standard letter.

Provider number missing

• Perform name search on the Provider Directory Service (PDS) to obtain provider number
• Use NHSI - Medicare Patient History screen in AIR Mainframe to obtain provider number based on date immunisation given. See Table 6
• Provider number possibly obtained by searching previous history on YIRD screen and phone provider
• Use provider address to conduct an internet search for the possible immunisation provider and phone provider

Note: any provider number found using the searches above must call the provider and verbally confirm before updating the information. Record notes in WLM including provider number and details from the call.

Multiple provider numbers supplied

Contact practice by phone to confirm correct immunising provider or information provider number.

Provider name missing

No action required. (This section is not mandatory).

Unable to confirm provider

Make note on AIR Mainframe and PaNDA. See Work Optimiser for staff.

Signature missing

Form not signed, contact the vaccination provider by phone to advise. Confirm the vaccinations were given by vaccination provider. Record note on AIR Mainframe each time vaccination provider is called.

Note: if unable to contact vaccination provider, then after 3 attempts, send letter Z2334 noting on AIR Mainframe and PaNDA. See Work Optimiser for staff.

Signature does not match provider name

Contact vaccination provider by phone to advise that someone else signed the form. Confirm the vaccinations were given by the vaccination provider. Record note on AIR Mainframe each time vaccination provider is called.

Note: if unable to contact vaccination provider, then after 3 attempts, send letter Z2334 noting on AIR Mainframe and PaNDA. See Work Optimiser for staff.

Signature date

Use the date the form was signed. If the signature date is missing, use the date the form was received.

Message 'End date prior to immunisation date' is displayed

See Resolve pend reason codes in AIR.

Medicare number is end-dated (and no other registration exists)

See Individual registrations in AIR.

Channel information received

Action

Verbal update

See: Table 6 on the Process page

Provider statement of payment or letter

If not supplied, contact provider by phone to confirm immunising provider number. Include confirmation in a comment in notes as per processing guidelines.

If unable to contact provider, process as a history claim and use the provider number on statement of payment or letter as the information provider number.

See also: Overseas immunisations and processing history forms in the AIR

Header type

Information provider number keyed

Overseas

A92009H

Australia

Provider number as indicated on form

Method of data transmission

Unprotected field

IDI

Immunising provider number

API

No fields are to be amended. Contact an AIR Local Peer Support (LPS) if an API header requires amendment. Refer to AIR Program Support for further action

WEB

No fields can be amended

MAN

Immunising provider number and immunisation date

FRM

Quoted number

Error message

Description

Provider not current

Follow Pend 43 process

See: Process pended claims in AIR

Practice not found

Check that keying is accurate.

Check provider registration on Medicare using PDS. If provider is registered and current, send the request with the details to an AIR Local Peer Support (LPS) to be actioned by AIR Program Support

Check digit incorrect

Check provider registration on Provider Directory System (PDS) to obtain correct check digit

Claim ID invalid

Ensure claim ID has 1 alpha and 6 numerics (for example, X999999) and staff member's P number is included

Date invalid

Ensure a valid date is keyed

Date of receipt prior to immunisation date

Amend receipt date or immunisation date so that receipt date is after immunisation date. This may involve clarifying immunisation date with the provider

Action code

When to use

Impact of action code

A (system generated only)

Data is good (for example, vaccine, dose, and date of service present).

Data is within guidelines.

Recorded on the Immunisation History Statement.

Information payment may be generated if all antigens required to complete schedule are present and at A status.

Used to assess AIR and family assistance status.

Appears on AIR Statement of Payment once.

C

Data is good (for example, vaccine, dose, and date of service present).

Data is within guidelines.

Data requires clarification from provider.

Recorded on the Immunisation History Statement.

No payment generated from this antigen record.

Used to assess AIR and family assistance status.

Appears on AIR Statement of Payment until clarified.

R

Data is not complete (for example, missing dose number).

Extra information is required from provider.

Note: single doses of measles, mumps or rubella are not to have dose numbers removed. Do not use R and Z action codes until a full dose of MMR is recorded for the required dose.

Not recorded on the Immunisation History Statement.

No payments generated from this antigen record.

Not used to assess AIR and family assistance status.

Appears on AIR Statement of Payment until resolved.

Does not appear on AIR reports.

X

Data not to be included on AIR (for example, duplicate data).

Not recorded on the Immunisation History Statement.

No payment generated from this antigen record.

Not used to assess AIR and family assistance status.

Appears on AIR Statement of Payment once.

Does not appear on AIR reports.

Y

Data is good (for example, vaccine, dose, and date of service present).

Data is outside guidelines.

Provider has clarified data.

Recorded on the Immunisation History Statement.

No payment generated from this antigen record.

Used to assess AIR and family assistance status.

May appear on AIR Statement of Payment.

Z

Data not to be included on AIR (for example, incorrect information).

Note: single doses of measles, mumps or rubella are not to have dose numbers removed. Do not use R and Z action codes until a full dose of MMR is recorded for the required dose.

Not recorded on the Immunisation History Statement.

No payment generated from this antigen record.

Not used to assess AIR and family assistance status.

Does not appear on AIR Statement of Payment.

Does not appear on AIR reports.

Step

Action

1

Determine claim lodgement method

In AIR Mainframe:

• Key YICE
• Key the provider number in the Prov Number field, and press [Enter]
• Key [F19] to return the registration details
• Key [F14] to get to Provider Episode Details (YPES) screen

2

Assess Claim ID

The Provider Episode Details screen (YPES) lists data lodged (claims) to AIR by this provider. The Claim ID column provides information regarding the lodgement channel used (and therefore available) for each episode by assessing the last character of the Claim ID:

• Claim ID with a ! or % means provider has lodged data using the AIR site
• Claim ID with a + or @ means provider has lodged data using Practice Management Software
• Claim ID with a $ means provider has lodged data using Practice Management Software that supports web services
• Claim ID with a * or no symbol mean a claim that has been keyed by an AIR Service Officer (manual)
• Claim ID with a & means a claim that has come through via an automatic upload