[Revised Jan 01]
During dispensing RxOne notes its estimate of the value of the claim, based on schedule price plus the schedule markup and pharmaceutical service fee to arrive at the subsidy value. These figures are accumulated when the claim is made up and presented as an approximate estimate of the payment to be received.
The computer will work off the current figure if this is defined by the user on the 'major options' menu.
SmartClaim claims for the scripts by PDE, quantity, patient category etc, and the actual price is worked out by the pricing office computer. The claim is not by dollar value.
Please note that the estimated price produced during claiming is only that, an estimate and is not the claim. No matter how high or low it is the estimated price never influences claim itself, which is the pde-quantity-category data. Variances in the estimated price can never affect the pay out.
Variance report
The payment may come with a 'Variance report' listing all scripts for which the payment varies by more than 10c from the estimate.
This is provided so the pharmacists can reassure themselves that the variances are all legitimate.
Resubmitted items If an item is resubmitted, it's withdrawl will appear as a negative amount on the variance report, since RxOne will not estimate negative values so the reversal is bound to be more than 10c different from a zero estimate. The balancing +ve payment for the item will only appear if it varies by more than 10c from RxOne new estimate. The existence of a -ve item and no +ve item is expected and does not indicate a loss of overall payment.
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