Education guide - Dispensing and claiming for participating public hospitals

Information to help you dispense and claim Pharmaceutical Benefits Scheme (PBS) medicines in participating public hospitals.

Dispensing

When you dispense PBS medicines in a public hospital make sure you have the following information.

Patient details

When you dispense a prescription, check the patient's:

  • full name and address - make sure you spell their name exactly as it appears on their Medicare card
  • valid Medicare card number - you must record all 11 digits and the expiry date
  • valid entitlement number if applicable - for example, their Health Care Card and PBS Safety Net card

Item details

When you dispense a prescription, make sure you record in your dispensing software:

  • the item name as specified by the prescriber
  • the item form as specified by the prescriber - for example tablets, capsules, ointment, suppository
  • the strength as specified by the prescriber
  • the quantity and number of repeats as specified by the prescriber
  • the authority prescription number for each authority required item, and
  • the streamlined authority code in the case of authority required (streamlined) items

Prescriber details

When you dispense a prescription make sure the prescription is signed and dated by the prescriber:

  • the prescriber name
  • the prescriber number, and
  • the prescription date as written on the prescription

Other requirements

You also need to:

  • stick the dispensing labels in sequence on the Department of Human Services' copy of the prescription
  • ensure the stickers don’t obscure any details written by the prescriber - you can place labels on the back of the form if extra space is needed
  • ensure the prescription is signed and dated by the patient or patient's agent or correctly certified as supplied by the pharmacist
  • ensure the patient's name is handwritten by the prescriber if you are using computer generated patient labels for your patient's details
  • ensure you dispense prescriptions written by dentists as a dental prescription and mark the prescription form 'for dental treatment only'

Claiming

The following steps will help you to submit your claim correctly.

Step 1: Check claim thoroughly

When claiming PBS medicines in a participating public hospital make sure you:

  • check 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
  • write 'Immediate supply necessary' on the prescriptions or repeat authorisation forms, where required under regulation 25, and include the signature of the dispensing pharmacist
  • make sure data in the pharmacy dispensing software matches information on the prescriptions
  • make sure 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

  • remove items from the electronic claim data list that:
    • have no documentation
    • are missing prescriptions
    • are rejected prescriptions, or
    • are not yet supplied
  • ensure you generate a new serial number and correct any details for prescriptions that need to be reclaimed

Step 2: Complete the Close a claim transaction

  • start the Close a claim transaction using your dispensing software program
  • acknowledge the certification supply statement that summarises the claim details
  • the Close a claim transaction will be sent to us for processing
  • claims closed using the Close a claim transaction will get a return message showing the claim was closed successfully - 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
  • approved suppliers who claim manually need to provide us with the paper prescriptions, as well as a completed and signed claim for payment form for processing and payment - processing 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 Saturday 10 December 2016 from humanservices.gov.au/health-professionals/enablers/education-guide-dispensing-and-claiming-participating-public-hospitals 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.