Claiming

To prepare a Claim

From the RxOne Start Menu.
Click the 'Claims'
Click the Reports tab, and then click on Exception Report to prepare the report for a new claim.
Check each item on the exception report

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

Some reasons for exception could be:

if it is a Script Owing still waiting to be received, or
a script which has an invalid PDE code or is corrupted.

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

Once any exceptions have been fixed, click the 'New Claim' button on the 'Claims' tab.

When the computer has finished making up the Claim, it will ask for a floppy disk (or ask to transmit if electronic). For disk claiming, insert a blank, formatted 3 ½ floppy disk into the disk drive and select the appropriate a: drive from the list. When you click OK, Claims will copy the claim to disk and print a label for it.

At the end of the Claims, 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 out and checked for correctness if you wish.

Editing, Fixing exceptions, Manual over-rides.

To edit a script from within the Report, before the claim has been made, double click on the offending items. To edit after a claim has been made, see 'Redo Claim'.

Apart from fixing any exceptions, such as 'invalid NHS code', '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 30-Jun-05', 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.

Override options.

Normally leave the computer to claim appropriately, but you can over-ride the computer's 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.
'Don't 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 Private 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.

Reclaiming options.

After receiving your reconciliation report a script may need to be resent and/or repriced by 'Medicare Australia', 'RxOne' provides several repricing options as follows.

· 'Don't 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 Private at the time of dispensing, and wish to intercept it now.
· Re-submit Script Not Yet Paid. If a script has ERRORED at 'Medicare Australia', select this

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.

ReClaim Selected Scripts

On the main Dispense Screen go to Utilities and 'Reclaim Selected Scripts'. You can highlight selected scripts from the PBS Online/Claim Information and use the 'ReClaim Selected Scripts' function.

Script Owing / Drug Owing

These are excluded from the claim until the computer is advised that the Script Owing form has arrived or the Drug 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 panel… just unticking the Script Owing or Drug Owing tick box automatically claims it at the next opportunity.

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

'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 Claims background and how it works are described separately.

Speed

Claims usually takes less than five minutes to make up. If it consistently takes longer compact the Database before making up the claim.

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