Claiming (Smart Claim)

To prepare a SmartClaim

• Click the Reports tab, and then click on Exception Report to prepare the report for a new claim. You will be prompted to do this when going to make up a claim.

• You will be prompted to enter the date for the end of the current Claim Period. Enter the date then click OK and wait while the report is prepared. This will usually take a few minutes.

• Check each item on the Exception report.

This displays scripts which are exceptional in some way that will cause them to be excluded from the SmartClaim.

Some reasons for exclusion could be if it is a Phoned Script still waiting to be received, or a script which has an invalid Pharmacode or is corrupted.

If you see any exceptions that need correcting, edit the script to do so (see below). If you wish to verify that the exceptions have been correctly fixed, prepare the Exception report again. You can do it as many times as you wish until you are satisfied. Suppressing Under snet and NSS scripts saves clutter, so long as you realise they are not missing scripts.

Note

In the "SmartClaim Contents" Report, under Disk Contents-Script Listing" tab there is an extra column showing the Claim ID Suffix.

If you are phoning MoH Sector Services for help with a script error and you need to supply a suffix ID number, this is the suffix ID number to use.

 To show the details of comments in the Exception Report hover the mouse over the line to see the full comments.

• Once any exceptions have been fixed, click the New Claim button on the SmartClaim tab.

• You will be prompted to enter the date for the end of the current Claim Period. Enter the date then click OK and wait while the SmartClaim is prepared.

• When you claim by online claiming the claim will automatically go to HPAC when you click OK.

At the end of the SmartClaim, a claim report will be displayed. This tells you all scripts which were included in the claim, and also highlights which scripts were excluded. This can be printed and checked for correctness if you wish.

The claim ‘Disk Contents’ and ‘Failed Items’ report will come up to give you a chance to check these reports before sending the claim. Make sure youve checked the Failed Items before proceeding to send the claim. Select Exit to exit of the reports. The computer will then ask if you would like to send the claim now.

Editing, Fixing exceptions, manual over-rides.

In the Exception report you can double-click on any line to go back to the Dispensary section to edit any faulty scripts before making up the New claim.

To edit after a claim has been made, see Redo Claim.

 Redo Claim

Apart from fixing any exceptions, such as invalid pharmacode, invalid quantity etc, it is possible to force an item to be claimed even though the machine does not think it should be.

On the edit screen, there is a Claim panel, one of the panels on the RHS including status price etc. This shows the claim status of the script, e.g.

• Script has not yet been claimed or,

• Claim attempt made 15-May-00, if this was considered for a claim. Normally the attempt will be successful, but if not, the reason will be stated, and the item will have appeared on the exception report to give you the chance to correct it.

Reconciliation

A reconciliation report will be sent by HealthPAC, in the form of an error and report.

Reclaiming options.

After receiving your reconciliation report a script may need to be resent and/or repriced by HealthPAC, there are several repricing options as follows.

• Dont Claim which prevents it being claimed, even if the computer thinks it is legal and payable. E.g., when you have dispensed a script for a foreign tourist but forgotten to mark it as NSS at the time of dispensing and wish to intercept it now.

• Cancel HealthPAC Payment and Price Again {F9}. If a script has been paid by HealthPAC and you want to change details (quantity or repeat number) select this option.

•  Re-submit Script Not Yet Paid. If a script has ERRORED at HealthPAC, select this

•   Credit script in next claim enables script to be reversed. E.g. where a script has been unintentionally claimed for payment.

These flags are acted on the next time that New claim is selected, which can be immediately but can also not be until the end of the next batch period.

Phoned/Owing scripts

These are excluded from the claim until the computer is advised that the phoned script form has arrived or the owings have been supplied, at which point it is automatically marked to claim on the next batch. There is no need to go into the claim pane. Unitck the phoned script or drugs owing tick box to automatically claim it at the next opportunity.

Manual over-rides.

After getting the Exception Report go back to the Dispensary section and edit any faulty scripts before making up the New claim. To edit after a claim has been made up, see Redo Claim

It is possible to force an item to be claimed even though the machine does not think it should be.

On the edit screen, there is a Claim panel, one of the panels on the RHS including status price etc. This shows the claim status of the script, eg,

• Script has not yet been claimed, or

• Claim attempt made 15-May-04, if this was considered for a claim. Normally the attempt will be successful, but if not, the reason will be stated, and the item will have appeared on the exception report to give you the chance to correct it. 

Split period

A claim batch period can be split into several claims if necessary, typically on change of ownership part way through a period.

Override options.

Normally leave the computer to claim appropriately, but you can over-ride the computers intentions on an individual script at any time by ticking the box;

Claim Regardless which forces the item to be claimed even if the computer does not think it is legitimate. E.g. when you know that the quantity is correct, even though it is so unusual that the computer will not let it pass.

NSS Claim Regardless - Forcing an NSS item on claim: In the scenario where the original script is NSS because there is no special authority number, but on dispensing the repeat an SA number is available and the repeat now becomes SS. You can now force the original NSS script through on to the next claim for HeathPac to record in their system by ticking the NSS claim regardless button on the claim panel. And then submit the SS repeat into the next claim. (Note: HealthPAC has advised that the subsidised repeat has to be submitted into the next claim, it can not be on the same claim as the NSS item)

Dont Claim which prevents it being claimed, even if the computer thinks it is legal and payable. E.g., when you have dispensed a script for a foreign tourist but forgotten to mark it as NSS at the time of dispensing and wish to intercept it now.

Resubmit script in next claim forces it to be considered again. E.g. a script has been claimed and rejected by payment agency, you have had the problem fixed and wish to have it claimed again.

Credit script in next claim withdraws (reverses) claim for an item already claimed.

Claim for Wastage flags chargeable wastage. E.g. 100mls of a mixture is prepared and claimed for, but only 75mls dispensed. Setting this flag will cause the whole 100mls to be claimed. Normally this is set by the computer, but can be over-ridden if required.

These flags are acted on the next time that New Claim is selected, which can be immediately but can also not be until the end of the next batch period.

Foils packs dispensed ahead of time.

Leave them marked as phoned scripts until they are supplied. This is usually the case automatically, as most foil scripts are phoned.

Redo will recreate the claim from scratch, to be used after you have fixed a fault or want to add more scripts to an existing claim.

Background;

The SmartClaim background and how it works are described separately.

Speed

SmartClaim usually takes less than five minutes to make up.

Response file (Answerback)

If the HealthPAC response file is obtained it can be reported and checked by the Claim response utility.