[Revised June 2015]
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Closing of a claim
The Department of Human Services introduced a process to close a claim starting from the 1st of April 2015.
For detailed information about ‘Close a Claim’ and what to do with your paper scripts please refer to the Changes to PBS and RPBS claiming arrangements from 1 April 2015 on the PBS website.
The ‘Close a Claim’ mechanism involves two steps: Close Claim and Finalise Claim
Step 1: Close Claim
1. Close the PBS Online module
2. From RxOne Start Menu click ‘Claims’ then ‘PBS Online Claims’
3. You will see two tabs ‘Claim Status, Close, Finalise’ and ‘Claim Reports / Statements’. From the ‘Claim Reports / Statements’ tab, run the reports as usual to check if there are any unclaimed scripts before closing the claim.
Note that you should always check the ‘Unclaimed, Rejected, Missing Serials, Original Req.’ report to check if you have any unclaimed scripts in that claim period before you close the claim. You should also run the reports under the section ‘Reports to run Before Closing Claim Period’ before closing the claim.
4. When you are ready to close the claim go to the ‘Claim Status, Close, Finalise’ tab and highlight the Claim Reference that needs to be closed then click ‘CLOSE CLAIM’ button.
5. Click ‘Yes’ to the message ‘Please exit out Dispense Program on all machines while closing the Claim Period.’ (Make sure the PBS online module is closed before clicking ‘Yes’).
6. Click ‘Ok’ to the message ‘About to check if there are any unclaimed scripts, before closing the claim’.
7. Choose the Claim Reference from the drop down box to perform a check for unclaimed scripts.
If you had any unclaimed scripts in that period you will get a box saying ‘There are scripts in the chosen period that have not yet been claimed…’ , Click ‘YES’ to open Dispense Program and PBS Online to claim the unclaimed scripts OR click ‘No’ to close the claim anyway
If you haven't got any unclaimed scripts then click ‘Ok’ to the ‘No unclaimed script found’ message.
When closing a claim period, RxOne will check against the 'Unclaimed, Rejected, Missing Serials, Original Required Script' Report to see if there are any unclaimed scripts. This will prevent any unclaimed scripts being included in the wrong claim period when the PBS is down. e.g. when the connection to Medicare is temporarily unavailable
8. Choose the Claim Reference again to close the claim and click ‘Ok’. The ‘Closed’ column of your claim reference should now say ‘YES’.
Step 2: Finalise the claim
1. Once the claim has been closed you will need to highlight the closed claim and click ‘Finalise Claim’. (Please note: the option to finalise the claim is only available for claims opened after 1st of April. For claims opened prior to 1st of April you are required to close the claim and send in your paper work and scripts to the department as before).
2. When you click ‘Finalise Claim’ you will be asked to fill in the ‘Certification of Supply Acknowledgement’ electronically before submitting to PBS.
3. Choose your name from the drop down box as an authorised person. Enter ‘0’ (zero) on all three fields if you haven't got any scripts in a particular category. i.e. if you haven't got any scripts under Doctor Bag category then enter D 0 to D 0 with total of 0.
Additional Notes
[July 2015]
Ninety Days Rule
Please note: approved Suppliers will be able to continue to make adjustments to prescriptions for up to 90 days from the date of claim closure. After 90 days the pharmacy will not be able to adjust the script
Emergency Authority Number
From 1 April 2015, the department has introduced a generic Authority Approval Number P9999RX. This means under Emergency provisions your doctor may write P9999RX on the prescription in the event an authority approval cannot be obtained, due to the department not being contactable.
Please note: increases in quantity and / or repeats is not permissible under the emergency provisions. Please visit the Changes to PBS and RPBS claiming arrangements from 1 April 2015 for more information about Emergency Authority Number.