PBS Claims

This PBS Claims section is used for PBS Claim maintenance including viewing and submitting PBS Claims. For quick access to PBS Claims, click on PBS Online in the top right corner of Dispense Works.

On the PBS Claims screen, 2 months worth of claims is displayed by default. You can view older claims by changing the number of months of data displayed at the top of the screen. When a claim period is selected, the PBS Claim Statistics for the claim is shown to the right of the PBS Claims, this gives an overview of the script count and dollar value claimed for each category.

Close Claim Period
To close the current PBS claim period:

1.Select the current claim

2.Click on the Close Claim Period button in the bottom right corner of the screen

3.Click No on the prompt to Review PBS Rejected Scripts report

4.Click I acknowledge the certification

5.Click Confirm

A new claim will automatically be created after the previous claim has been closed successfully.

Note: If there are prescriptions pending and you click on Close Claim Period, a Pending PBS Scripts alert will be displayed. When the claim is closed with scripts pending, these pending scripts will reject from PBS. Contact Dispense Works support if you encounter this issue.

Claim Period Limit

When the pharmacy has exceeded 3500 PBS submissions for the current claim period, a preflight check will be displayed each time Dispense Works is started until the claim period is closed.

PBS has a maximum claim reference limit of 9,999, which includes scripts that have been cancelled from PBS. When the claim limit is reached, PBS is unable to transmit scripts appropriately and PBS scripts will go into pending.

View and Edit a PBS claim

To view a claim period, you can:

Double click on a claim, or
Select a claim, then click on the View Claim Period button in the bottom right corner of the screen

This will open the selected claim period and an overview of claim totals will appear on the right side of the screen.

Please note that the serial numbers in Dispense Works begin with the following letters:

Serial No.

Claim Type

General

Concession

Repatriation Schedule of Pharmaceutical Benefits (RPBS)

Safety Net Entitlement

Under Co-Payment

Under Co-Payment Concession

Under Co-Payment RPBS

Prescribers (doctors bag)

For example, to search for claimable prescriptions that have been rejected:

1.Increase the Minimum Recovery to an amount greater than $0.00 to search for claimable prescriptions only

2.Under Results, untick all of the checkboxes except for Rejected

Fix a Rejected Script

You can quickly edit a script from PBS Claims, instead of going back to the Home screen and searching for the patient. To do so:

1.Click on the claim/script to be edited

2.Click on the Details button located in the bottom right corner of the screen

3.Click on the Fix button located in the bottom right corner of the screen

4.This will open up the prescription in edit mode to make the required changes

5.Continue dispensing as normal to finalise the prescription

Hold a Script

You can place a claimable script on hold to exclude it from the current claim period so that the script can be resubmitted at a later date.

To hold a script:

1.Click on the claim/script to be held

2.Click on the Hold Script button located in the bottom right corner of the screen

3.A Resubmit button will now show and be pressed at a later date to resubmit the script to the PBS

Resubmit a Script

You can reclaim a script that has been held in a previous PBS Claim by resubmitting the script in the current claim period.

To resubmit a script:

1.Open the claim period the prescription was held in - usually this is the previous claim period

2.Search for the held script - you can search for scripts on hold using the results checkboxes

3.Select the required script that has been placed on hold

4.Click the Resubmit button in the bottom right corner of the screen - this will print a new dispensing label with a new claim serial number and will make the script available in the current claim period.

PBS Reports

PBS Reports can be run in Dispense Works when an Interim or Complete Statement type is displayed in PBS Claims. Dispense Works automatically requests these statements and they can also be requested by selecting the required claim period and clicking Request Statement in the bottom right corner of the screen.

The Statement types are as follows:

N/A - No PBS Statement has been requested for this claim period
Interim - PBS has not finalised the processing of this claim period
Complete - PBS has finalised the processing of this claim period and the statement request is complete

Note: The Statement type reflects what has been supplied by PBS. Please contact PBS if there are issues with the statement type available in Dispense Works.

When an Interim or Complete statement type is available, you can run the following PBS Reports by clicking on the Reports tab at the top of Dispense Works and selecting PBS Reports.

Report

Description

Claim Analysis

Claim Analysis is a summarised view of the script totals that are claimed through PBS in a chosen claim period, broken down via Payment Category.

PBS Detailed Claim

The PBS Detailed Claim Report outlines all of the transactions in the selected claim period that were sent to PBS. This report can be used to identify differences between the estimated rebate and actual rebate that was received.

PBS Rejected Scripts

The PBS Rejected Scripts Report identifies prescriptions that have been rejected in a specified claim period. This report can be grouped by Payment Category or Patient.

PBS Summary Reconciliation

The PBS Summary Reconciliation Report provides a summary of the payments received from PBS for the selected claim period. This report is broken down by PBS Payment ID and Bank Reference and can be used to ensure the correct payments were received.

PBS Weekly Payment

The PBS Weekly Payment Report shows the scripts that were debited or credited in each weekly payment. This report is generated using the Bank Reference Number and is broken down into PBS Payment ID and Claim Period.

Produced by Dispense Works: https://dkb.posworks.com.au/Content/Home.htm