Education guide - Claiming checklist for community pharmacies

PBS claiming checklist for community pharmacies.

Overview of claiming process

The following steps are involved in the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) claiming process:

  1. Check the claim
  2. Complete the Close a Claim transaction
  3. Keep all prescriptions and claim paperwork

Step 1 - Check the claim

  • make sure all the prescriptions or repeat authorisation forms are:
    • signed and dated by the patient
    • signed, dated and addressed by their agent, or
    • correctly certified as supplied by the pharmacist
  • ensure data in the pharmacy dispensing software matches the information on the prescriptions
  • ensure all prescriptions are entered using these categories:

    (G) General patients

    (C) Concession and Safety Net concession cardholders

    (E) Safety Net entitlement cardholders

    (R) RPBS patients

    (D) Emergency drug supplies

  • items that have no documentation, missing prescriptions, rejected prescriptions or items not yet supplied must be removed from the electronic claim data list
  • generate a new serial number and correct any details for prescriptions that need to be reclaimed
  • where required under regulation 25, write Immediate supply necessary on the prescriptions or repeat authorisation forms and include the signature of the dispensing pharmacist

Step 2 - Complete the Close a Claim transaction

  • start the Close a Claim transaction using your dispensing software program
  • acknowledge the certification of supply statement that summarises the claim details
  • the Close a Claim transaction will be sent to us for processing through Online Claiming for PBS
  • claims that are successfully closed using the Close a Claim transaction will get a return message showing the successful closure of the claim - you will be able to continue to make changes to prescriptions up to 90 days from the date of claim closure
  • claims must be prepared separately if there is a change to the pharmacy approval number during the claim period.
  • unless other arrangements have been made with us:
    • only 1 claim can be lodged per month
    • the claim period should cover pharmaceutical benefits supplied over a period of no more than 35 days

Step 3 - Keep all prescriptions and claim paperwork

  • under legislation, prescriptions must be kept in paper or electronic form for a period of 2 years - this is for post payment quality and audit checks
  • for processing and for payment, approved suppliers who claim manually are required to provide the paper prescriptions, as well as a completed and signed claim for payment form to the department - processing by the department will attract a cost which is currently 47 cents per prescription

More information

Contact us for PBS general enquiries.

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Page last updated: 5 July 2016

This information was printed Friday 9 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-claiming-checklist-community-pharmacies It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.