Process pended claims in Australian Immunisation Register (AIR) 011-10110000

Troubleshooting

Table 1

Scenario

Action

Medicare number on the pend of a newborn child

Confirm the newborn is not on any Medicare card:

On the YXCB - Individual Selection screen, remove the Medicare card number
Press [F10] to create individual

Gender missing from pend

On the YXCB - Individual Selection screen:

Key F/M/X based on first name (if unsure try all 3 options)
Press [Enter] a list of possible matches will display (on occasions an auto-match may display)

Note: if a match cannot be found, an individual’s gender is not required to process an encounter. Service officers can view a record where there is no gender recorded by going to YCEI - Individual enquiry screen in Mainframe.

Validation error: after creating a new individual and updating, a blank screen with validation error message displays

This has updated correctly:

press [F5]
press [F4]

Claim will have disappeared from the YICP - Claim Selection screen. Search for next pend.

Validation error 24: after creating a new individual and updating, a screen with validation error message and RSN 24 displays

The postcode does not match the suburb:

Search CDMS for the locality that is recorded against the person

Select Inquire on Consumer Details
Select the Address Search button
Key the location (the address will match Australia Post)

Or, do a Google search for the location/postcode

More than 3 Polio immunisations given under 3.5 years of age

Whenever a child receives more than 3 doses of Polio under 3.5 years of age:

Change the additional dose numbers to duplicate dose 3 and C and Y
When the C and Y will not work, try to X off on the YIAN - Antigens Details from the Enc St field
If unsuccessful, escalate to an AIR Local Peer Support (LPS)

Processing for deceased customers

When processing information for a deceased customer and they have a record on:

CDMS but not Mainframe:

escalate to a LPS using the LPS referral form
multiple can be listed on the LPS referral form. Include claim number, date of birth and customer name

Mainframe:

follow the relevant pend procedure

State codes when processing pends

Table 2

State	State abbreviation	Code
Australian Capital Territory	ACT	A
New South Wales	NSW	N
Northern Territory	NT	Z
Other		U
Tasmania	TAS	T
South Australia	SA	S
Queensland	QLD	Q
Victoria	VIC	V
Western Australia	WA	W

System reason codes and explanations returned during claim processing

Table 3: search the list using [Ctrl + F]

Reason code	Explanation
001	Medicare number invalid
002	Medicare sub-numerate invalid
003	Medicare sub-numerate only, Medicare number also required
004	Given name required when no Medicare sub-numerate supplied
005	First character in given name is invalid
006	Invalid character in given name
010	Individual’s Medicare number or full name and date or birth not supplied
011	First character in surname is invalid
012	Invalid character in surname
013	Date of birth format not acceptable - must be DDMMYY
014	Date of birth in the future
015	Address details invalid or incomplete
016	Invalid postcode
017 018	Invalid character in address
019	Invalid character for second initial
020	Aboriginality indicator not valid
023	Gender must be F/M or X
024	Postcode/locality incompatible
025	Ethnicity indicator not valid
026	HepB birth dose indicator invalid - must be Y or blank
030	Provider number missing
031	Provider number not valid
032 033	The vaccine and/or dose number administered not supplied
034 035 036	The immunisation date supplied is either invalid or in the future
037	The immunisation date is prior to the AIR commencement date 01/01/96
038	Date of birth not valid
039	Provider practice not found
040	Provider check digit not valid
041 042	Provider number not valid
043	Immunisation provider not current
044	Vaccine not valid for encounter date
050	Immunisation date prior to individual's date of birth
051	Date of receipt prior to individual's date of birth
052	Date of receipt prior to immunisation date
053	The date of immunisation after the end date recorded on the individual's registration
054	Date of HEPB birth dose prior to individual's date of birth
055	Child over 12 months of age at date of service
056	Date of HepB birth dose must be in accepted format (DDMMYY), with correct days in month, correct months in year and not a future date
060 061 062 075	The vaccine and/or dose number administered not supplied
080	Individual not identified
100	Antigen has been administered under the minimum required age
101	Period between doses of the same antigen is less than the minimum time required
102	Duplicate antigen dose - same provider
103	Duplicate antigen dose - different provider
104	Administered within minimum time required between doses - different provider
105 112	Dose greater than maximum allowable dose
106	Higher dose already administered - same provider
107	Dose administered at greater than recommended schedule age - PF18 to ack warning
108	Dose administered under the recommended schedule age - PF18 to ack warning Note: no longer applicable for assessment as of 26 March 2017
109	Higher dose already administered - different provider
110	Same provider: Period between doses less than 6 months
111	Different provider: Period between doses less than 6 months
113	Dose given < schedule age 42 months PF18 to ack Warning
114	DTP dose 4 given > 42 months
115	Antigen has been administered under the minimum required age
116	DTP dose 4 already given < 42 months - check history - convert to dose 5
300	Duplicate - this service has already been reported
301	Duplicate - service previously reported by different provider
303	Duplicate History Form episode
305	Encounter split: greater than 5 episodes
334	Dose given at < schedule age 15 weeks
400	Individual has > 149 episodes - reduce episodes to continue processing

Workload Manager escalation for pend processing

Table 4

Scenario	Action
Deceased customer - needs escalation due to record on CDMS but not on Mainframe	Complete a LPS referral form In PaNDA, select: Unassign reason ‘Service Support Referral’ Submit
Pend - Customer contact required out of hours	Add comment in Mainframe for customer: ‘Unable to contact provider AH on DD/MM/YY to resolve pend’ In PaNDA, select: Unassign reason ‘Proficiency Raised’ Submit
Pend - LPS referral	Add comment in Mainframe for customer: ‘Referred to LPS DD/MM/YY Pend (Type e.g. 100)’ In PaNDA, select: Hold to User 7 for ‘amount of days to hold’ Confirm
Pend - Web form filled (Aspen, Sonic and Victoria Health) for more information	Add comment in Mainframe for customer: ‘(organisation e.g. Aspen) form submitted on DD/MM/YY re Pend (Type e.g. 100)’ In PaNDA, select: Hold to User 7 for ‘amount of days to hold’ Confirm

Contacts