{"id":"F2007B00680","name":"National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 15 of 2004)","slug":"national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":62473,"registerId":"commonwealth-F2007B00680-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Sch 1","sectionType":"schedule","heading":"DISKETTE CLAIM FORMAT – VERSION 1","content":"SCHEDULE 1: DISKETTE CLAIM FORMAT – VERSION 1\n\n","sortOrder":0},{"sectionNumber":"Part 1","sectionType":"part","heading":"CLAIM PART HEADER RECORD","content":"PART 1 — CLAIM PART HEADER RECORD\n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| ------------------------- | ------------- | ----------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Record Type | 1 | 1 | One byte alphabetic, value “H”, to identify this record as being a claim part header record; there will be one of these for each claim part |\n| Claim Reference | 2 | 5 | Four bytes numeric, consisting of the last two digits of the year followed by the number of the claim submitted by the approved supplier during that calendar year |\n| Approval Number | 6 | 11 | Six bytes alphanumeric, being the number allotted to the approved supplier under regulation 8A of the Regulations, and contained within the software in the approved supplier’s computer system |\n| Claim Part Number | 12 | 13 | Two bytes numeric, values 01 to 99, representing the number of the claim part within the claim |\n| Rest of Claim Part Header | 14 | 128 | One hundred and fifteen bytes of space |\n\n","sortOrder":1},{"sectionNumber":"Part 2","sectionType":"part","heading":"CLAIM PART TRAILER RECORD","content":"PART 2 — CLAIM PART TRAILER RECORD\n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| -------------------------- | ------------- | ----------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Record Type | 1 | 1 | One byte alphabetic, value “T”, to identify this record as being a claim part trailer record; there will be one of these for each claim part |\n| Claim Reference | 2 | 5 | Four bytes numeric, consisting of the last two digits of the year followed by the number of the claim submitted by the approved supplier during that calendar year |\n| Approval Number | 6 | 11 | Six bytes alphanumeric, being the number allotted to the approved supplier under regulation 8A of the Regulations, and contained within the software in the approved supplier’s computer system |\n| Number of Prescriptions | 12 | 16 | Five bytes numeric, right justified, zero filled, being the number of prescription records in this claim part |\n| Rest of Claim Part Trailer | 17 | 128 | One hundred and twelve bytes of space |\n\n","sortOrder":2},{"sectionNumber":"Part 3","sectionType":"part","heading":"CLAIM TRAILER RECORD","content":"PART 3 — CLAIM TRAILER RECORD\n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| --------------------- | ------------- | ----------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Record Type | 1 | 1 | One byte alphabetic, value “Z” to identify this record as being a claim trailer record; there will be one of these for each claim part |\n| Claim Reference | 2 | 5 | Four bytes numeric, consisting of the last two digits of the year followed by the number of the claim submitted by the approved supplier during that calendar year |\n| Approval Number | 6 | 11 | Six bytes alphanumeric, being the number allotted to the approved supplier under regulation 8A of the Regulations, and contained within the software in the approved supplier’s computer system |\n| Number of Parts | 12 | 13 | Two bytes numeric, values 01 to 99, being the total number of parts in the claim |\n| Rest of Claim Trailer | 14 | 128 | One hundred and fifteen bytes of space |\n\n \n","sortOrder":3},{"sectionNumber":"Part 4","sectionType":"part","heading":"PRESCRIPTION RECORD","content":"PART 4 — PRESCRIPTION RECORD\n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| -------------------------------------------- | ------------- | ----------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Record Type | 1 | 1 | One byte alphabetic, value “P”, to identify this record as being a prescription record; there will be one of these for each prescription |\n| Card Issue Number | 2 | 2 | One byte numeric, being the tenth digit of the medicare number or special number that applies to the person for whose treatment the prescription was written |\n| Individual’s Reference Number | 3 | 3 | One byte numeric, being the eleventh digit of the medicare number or special number that applies to the person for whom the prescription was written |\n| First Two Digits of Hospital Provider Number | 4 | 5 | Two bytes numeric, being the second and third characters of the hospital provider number where the pharmaceutical benefit was supplied by a public hospital authority; otherwise “00” |\n| Form Category | 6 | 6 | One byte numeric, using the following values:original prescription 1repeat authorisation 2original authority prescription 3repeat authorisation relating to authority prescription 4deferred supply authorisation 5prescription written by a participating dental practitioner 6doctor’s bag form 7 |\n| Payment Category | 7 | 7 | One byte numeric, using the following values:general benefit 1entitlement card 2concessional benefit and concession card 3doctor’s bag form 5 |\n| Serial Number | 8 | 12 | Five bytes numeric, right justified, zero filled, marked upon the prescription in respect of the pharmaceutical benefit supplied by the approved supplier, that uniquely identifies that pharmaceutical benefit within the payment category, pursuant to subsubparagraph 3(g)(iii) of these Rules |\n| Prescriber Number | 13 | 19 | Seven bytes numeric, right justified, zero filled, being the prescriber number of the prescribing medical practitioner or participating dental practitioner, issued by the Commission in pursuance of the function granted to it by paragraph 3C(a) of the Health Insurance Commission Regulations 1975, except in respect of a prescription that was written by a medical practitioner where that prescriber number was not available to the approved supplier at the time of the supply of the pharmaceutical benefit, in which case the field shall be zero filled |\n| Date Prescribed | 20 | 25 | Six bytes numeric in the format DDMMYY to represent the date on which the prescription was written upon the presentation of which the pharmaceutical benefit was supplied, where DD may have values 01 to 31 (day of month), MM may have values 01 to 12 (month of year) and YY may have values 00 to 99 (last two digits of year) |\n| Date Supplied | 26 | 31 | Six bytes numeric in the format DDMMYY to represent the date on which the pharmaceutical benefit was supplied, where DD may have values 01 to 31 (day of month), MM may have values 01 to 12 (month of year) and YY may have values 00 to 99 (last two digits of year) |\n| Filler | 32 | 32 | One byte numeric, value “0” |\n| Drug Code | 33 | 37 | Five bytes, four bytes numeric followed by one byte alphabetic check character, being the code for the pharmaceutical benefit that appears in the Schedule of Pharmaceutical Benefits published by the Department of Ageing |\n\n \n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| ------------------------------------------- | ------------- | ----------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Brand | 38 | 39 | Two bytes alphabetic, being the manufacturer’s code that represents the brand of the pharmaceutical benefit in the determination made under subsection 85(6) of the Act, in the case of a prescription that identifies the pharmaceutical benefit by reference to a brand; or two spaces, in the case of a prescription that does not identify the pharmaceutical benefit by reference to a brand |\n| Quantity | 40 | 44 | Five bytes numeric, right justified, zero filled, to represent the quantity supplied; must be the total quantity supplied where supply of the original prescription and the repeat or repeats is made at the one time pursuant to regulation 24 of the Regulations |\n| Price | 45 | 50 | Six bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved supplier in accordance with an election pursuant to paragraph 39 of the determination made under paragraph 98B(1) a) of the Act or priced by the approved supplier as exceptional prescriptions |\n| Pricing Election | 51 | 51 | One byte alphabetic; value “Y” where the approved supplier has made an election pursuant to paragraph 39 of the determination made under paragraph 98B(1)(a) of the Act; otherwise “N” |\n| Number of Repeats | 52 | 53 | Two bytes numeric, right justified, zero filled; must be the number of repeats prescribed, subject to the maximum allowable, for original prescriptions, original authority prescriptions, repeat authorisations and deferred supply authorisations; must be the number of repeats that are required where supply of the original prescription and the repeat or repeats is made at the one time pursuant to regulation 24 of the Regulations |\n| Number of Previous Supplies | 54 | 55 | Two bytes numeric, right justified, zero filled, to represent the number of times that the pharmaceutical benefit has previously been supplied; required for repeat authorisations, repeat authorisations relating to authority prescriptions and deferred supply authorisations; must be “00” for deferred supply authorisation |\n| Regulation 24 | 56 | 56 | One byte alphabetic; value “Y” if supply of the original prescription and the repeat or repeats is made at the one time pursuant to regulation 24 of the Regulations; otherwise “N” |\n| Check Character of Hospital Provider Number | 57 | 57 | One byte alphabetic, being the eighth character of the hospital provider number where the pharmaceutical benefit was supplied by a public hospital authority; otherwise blank |\n| Glass Bottle | 58 | 58 | One byte alphabetic; value “Y” if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the prescriber or considered necessary by the approved supplier; otherwise “N” |\n| Authority Number | 59 | 66 | Eight bytes numeric, right justified, zero filled; required for original authority prescriptions and repeat authorisations relating to authority prescriptions; being, in the case of an original authority prescription, the number preprinted on that form, or, in the case of a repeat authorisation relating to an authority prescription, the number preprinted on the original authority prescription form to which the repeat authorisation relates |\n| Early Re-supply | 67 | 67 | One byte alphabetic; value “Y” if the pharmaceutical benefit was supplied pursuant to paragraph 25(3)(b) or (c) or (4)(b) or (c) of the Regulations; otherwise “N” or blank |\n\n \n\n| Column 1Field | Column 2Start | Column 3End | Column 4Specifications for field |\n| -------------------------------------------- | ------------- | ----------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Entitlement Identifier | 68 | 78 | Eleven bytes alphanumeric, left justified, space filled; for concessional benefit prescriptions, the number of the Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card that applies to the person for whom the prescription was written; for concession card prescriptions, the number of the Safety Net Concession Card that applies to the person for whom the prescription was written; for entitlement card prescriptions, the number of the Pharmaceutical Benefits Entitlement Card that applies to the person for whom the prescription was written; for general benefit prescriptions, blank |\n| Medicare Number Stem | 79 | 87 | Nine bytes numeric, being the first nine digits of the medicare number or special number that applies to the person for whose treatment the prescription was written |\n| Name Type | 88 | 88 | One byte alphabetic; value “D” |\n| Surname | 89 | 112 | Twenty-four bytes alphabetic, left justified, blank filled; being the surname of the person for whom the prescription was written |\n| Given Name | 113 | 124 | Twelve bytes alphabetic, left justified, blank filled; being the given name of the person for whom the prescription was written |\n| Last Four Digits of Hospital Provider Number | 125 | 128 | Four bytes numeric, being the fourth to seventh characters of the hospital provider number where the pharmaceutical benefit was supplied by a public hospital authority; otherwise four blanks |\n\n \n\n","sortOrder":4},{"sectionNumber":"Sch 2","sectionType":"schedule","heading":"DISKETTE CLAIM FORMAT – VERSION 4.1, 2004","content":"SCHEDULE 2: DISKETTE CLAIM FORMAT – VERSION 4.1, 2004\n\nPART 1 — CLAIM PART HEADER RECORD\n\nThe Claim Header Record occurs for each claim submitted in the electronic message. It details the sequential number this claim represents for all the claims sent in by the client for the year, the client’s Regulation 8A approval number and the unique sequential number of this claim within the message.\n\n| Column 1 | 2 | 3 | 4 | 5 | Column 6 |\n| -------------------------------------------- | ----- | --- | --- | ---- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Field | Start | End | CH | Type | Description |\n| Record type | 1 | 1 | 1 | A | One byte alphabetic, value 'H', to identify this record as being a claim header record.H = PBS CTS claim file header |\n| HIC File Format Specification Version Number | 2 | 3 | 2 | N | Two bytes numeric that identifies the version of the file format specification so that formats can be introduced without impacting existing systems. |\n| Approval number | 4 | 9 | 6 | A/N | Six bytes alpha/numeric, right justified, zero filled, being the approval number allotted to the approved pharmacist or approved medical practitioner under regulation 8A of the regulations, and contained within the software in the approved pharmacist's or approved medical practitioner's computer system. |\n| Claim Period Number | 10 | 13 | 4 | N | Four bytes numeric, consisting of the last 2 digits of the year followed by the number of the claim submitted by the approved pharmacist or approved medical practitioner during that calendar year. This number is given to the claim to identify the paperwork. |\n| Claim reference | 14 | 17 | 4 | N | Four bytes numeric, values 01 to 9999, representing the number of claims within a claim period. |\n| Pharmacy Software Name | 18 | 19 | 2 | A | Identifies the pharmacy software system used to build the CTS file. This will allow for more efficient help desk support. Vendors will be advised of their code/s. |\n| Pharmacy Software Version Number | 20 | 29 | 10 | A/N | Ten bytes alpha/numeric to help identify the version of pharmacy software used to build the CTS file. This will allow for more efficient help desk support. |\n| Carriage return and line feed | N/a | N/a | N/a | N/a | End of record |\n\n \nPART 2 — PRESCRIPTION RECORD\n\nThe Prescription Record contains information on the identification of the patient and details on the claimed services provided by the practitioner or pharmacist to the patient. The prescription record is not a fixed length. As changes are quite prevalent in PBS, the record length is to be variable to allow for any future changes.\n\nThe prescription record is as follows:\n\n| Column 1 | 2 | 3 | 4 | 5 | Column 6 |\n| ----------------------------------- | ----- | --- | --- | ---- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Field | Start | End | CH | Type | Description |\n| Record Type | 1 | 1 | 1 | A | One byte alphabetic, value 'P' upper case, to identify this record as being a prescription record; there will be one of these for each prescription. |\n| Form Category | 2 | 2 | 1 | A/N | One byte numeric, using the following values:1 = original2 = repeat3 = original authority4 = repeat authorisation relating to an authority5 = deferred supply authorisation6 = prescription written by a participating dental practitioner7 = doctor's bag order form8 = DVA authority original form9 = DVA authority repeat form |\n| Payment Category | 3 | 3 | 1 | N | One byte numeric, batch category:1 = general benefit2 = PBS Safety net (free)3 = concessional benefit4 = repatriation5 = doctor's bag order form |\n| Unique Pharmacy Prescription Number | 4 | 23 | 20 | A/N | Twenty bytes alpha/numeric, right justified, space filled. This is a unique number allocated by the PDS and stays with that prescription throughout its lifecycle**. An individual prescription will only ever have one number allocated to it and that number will not be re-allocated to other prescriptions. |\n| Serial Number | 24 | 28 | 5 | N | Five bytes numeric, right justified, zero filled. Allocated to the prescription by the approved pharmacists or approved medical practitioner that uniquely identifies that prescription within the payment category. |\n| Hospital Provider Number | 29 | 36 | 8 | A/N | Eight bytes, the first seven numeric and the eighth alphabetic, being characters of the hospital provider number where the pharmaceutical benefit was supplied by a public hospital authority; otherwise space filled if not supplied by a public hospital authority. |\n| Prescriber Id | 37 | 43 | 7 | A/N | Seven bytes alpha/numeric, right justified, space filled being the prescriber number of the prescribing medical or dental practitioner. |\n| Date of Prescribing | 44 | 51 | 8 | N | Eight bytes numeric in the format DDMMCCYY to represent the date on which the prescription was prescribed, where DD may have values 01 to 31 (day of month), MM may have values 01 to 12 (month of year) and CCYY may have values 0000 to 9999. This field should not default to the current date however should default for DBOF. This field is mandatory. |\n\n \n\n| Column 1 | 2 | 3 | 4 | 5 | Column 6 |\n| ------------------ | ----- | --- | --- | ---- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| Field | Start | End | CH | Type | Description |\n| Date of Dispensing | 52 | 59 | 8 | N | Eight bytes numeric in the format DDMMCCYY to represent the date on which the prescription was dispensed, where DD may have values 01 to 31 (day of month), MM may have values 01 to 12 (month of year) and CCYY may have values 0000 to 9999. This field is mandatory. |\n| Date of Supply | 60 | 67 | 8 | N | Eight bytes numeric in the format DDMMCCYY to represent the date on which the Pharmaceutical benefit was supplied, where DD may have values 01 to 31 (day of month), MM may have values 01 to 12 (month of year) and CCYY may have values 0000 to 9999. In the case of owing prescriptions, this field should be protected. This field is mandatory. |\n| Patient Category | 68 | 68 | 1 | A/N | One byte alpha/numeric, identifies the patient category type:Valid values are:‘H’ = paperless private hospital patient.‘B’ = public hospital patient.‘N’ = nursing home patient.‘C’ = paperless public hospital patient.‘0’ (zero) = community patient.Blank/space is an invalid value. |\n| PBS/RPBS Item Code | 69 | 74 | 6 | A/N | Six bytes, right justified, zero filled, five bytes numeric followed by one byte alphabetic check character, being the code for the pharmaceutical benefit which appears in the Schedule of Pharmaceutical Benefits for Approved Pharmacists published by the Department of Health and Ageing. A zero code is to be used in the case of Repatriation items which are not included in the Schedule but have been prior approved by the Department of Veterans’ Affairs. |\n| Brand | 75 | 76 | 2 | A | Two bytes alphabetic, being the manufacturer's code which represents the brand of the pharmaceutical benefit in the Determination made under sub-section 85(6) of the Act, in the case of a prescription which identifies the pharmaceutical benefit by reference to a brand; or two spaces, in the case of a prescription which does not identify the pharmaceutical benefit by reference to a brand. |\n| Quantity | 77 | 81 | 5 | N | Five bytes numeric, right justified, zero filled, to represent the quantity supplied. The value must be the total quantity supplied where supply of the original prescription and the repeat(s) is made at the one time pursuant to Regulation 24 of the Regulations. A value must be present for all items. |\n| Price | 82 | 88 | 7 | N | Seven bytes numeric, right justified, zero filled, value in cents; for prescriptions priced by the approved pharmacist or approved medical practitioner in accordance with an election pursuant to paragraph 37 of the Determination made under sub-section 98B(1) of the Act or priced by the approved pharmacist or approved medical practitioner as exceptional prescriptions or items that do not appear in the Schedules of PBS or RPBS Pharmaceutical Benefits and have been prior approved by the Department of Veterans’ Affairs must be priced. |\n| Number of repeats | 89 | 90 | 2 | N | Two bytes numeric, right justified, zero filled; must be the number of repeats prescribed, subject to the maximum allowable, for original prescriptions, repeat authorisations, original authorities, authority repeats and deferred supply authorisations; must be the number of repeats which are required where supply of the original prescription and the repeat(s) is made at the one time pursuant to regulation 24 of the Regulations. |\n\n \n\n| Column 1 | 2 | 3 | 4 | 5 | Column 6 |\n| ---------------------------------------------- | ----- | --- | --- | ---- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n| Field | Start | End | CH | Type | Description |\n| *Original PBS Approval Number | 91 | 96 | 6 | A/N | Six bytes alpha/numeric, right justified, zero filled; this being the field printed on a repeat authorisation in the box “Original Prescription Details” that is the approval number allotted to the approved pharmacist or approved medical practitioner under regulation 8A of the regulations, that supplied the original prescription. If not present in PDS, value is null. |\n| * Original Unique Pharmacy Prescription Number | 97 | 116 | 20 | A/N | Twenty bytes alpha/numeric, right justified, space filled. This is the field printed on a repeat authorisation in the box “Original Prescription Details” that is the unique pharmacy prescription number allocated by the approval that supplied the original prescription. If not present in PDS, value is null. |\n| *Date of previous supply | 117 | 124 | 8 | N | Eight bytes, numeric, in the format DDMMCCYY; that is the date printed on a repeat authorisation in the box “Name and PBS Approval number of the pharmacist issuing this authorisation” (where it is called “Date this Authorisation Prepared”). If not present in PDS, value is null. |\n| Previous Supplies | 125 | 126 | 2 | N | Two byte numeric field, right justified, zero filled. This field is required on all repeats, authority repeats and deferred supply forms. It is the number of times (including the original supply) that the item has been supplied prior to this supply. Should be '00' for all deferred supply forms. |\n| Regulation 24 | 127 | 127 | 1 | A | One byte alphabetic, value 'Y' if supply of the original prescription and the repeat(s) is made at the one time pursuant to regulation 24 of the Regulations; otherwise 'N'. |\n| Glass Bottle | 128 | 128 | 1 | A | One byte alphabetic, value 'Y' if, in a prescription for extemporaneously-prepared ear drops, eye drops or nasal instillations, a glass bottle is ordered by the prescriber or considered necessary by the approved pharmacist or approved medical practitioner; otherwise 'N'. |\n| Authority Prescription Number | 129 | 136 | 8 | N | Numeric field, right justified, zero filled. This field is required for all authority and all authority repeat forms. It is the number that appears at the top right of the authority form and is transferred to the authority repeat form. |\n| Authority Approval Number | 137 | 144 | 8 | A/N | For Future Use. To be sent to HIC space filled until required. Associated check digit routines/formats will be provided in the future. |\n| Immediate Supply Necessary | 145 | 145 | 1 | A | One byte alphabetic field. Acceptable values for this field are; 'Y' 'N'. Where immediate supply was necessary the value will be 'Y' otherwise 'N' or blank. 'Y' indication does not remove the need for physical endorsement of the prescription. This field is required to identify prescriptions endorsed and supplied within the 4 and 20 day period (Reg 25).NB Blank/space is an invalid value. |\n| Medicare Number | 146 | 156 | 11 | N | Eleven bytes numeric, being made up of the first nine digits of the Medicare card number (Medicare number stem). The tenth digit being the card issue number and the eleventh digit being the individuals reference number. The Medicare number can also be a special Medicare number which applies to the person for whose treatment the prescription was written. For RPBS prescriptions where an entitlement number is supplied or doctors’ bag order forms, this field is zero filled. |\n| Entitlement id | 157 | 167 | 11 | A/N | For concessional benefit prescriptions, the entitlement number from the Health Care Card, Pensioner Concession Card, Repatriation Health Card (Specific Conditions), Repatriation Health Card (All Conditions), Commonwealth Seniors Health Card, Repatriation Pharmaceutical Benefits Card or PBS Safety Net Entitlement Card or PBS Safety Net Concessional Card which applies to the patient. For general benefit prescriptions or doctors’ bag order forms, this field is space filled. |\n| Family name | 168 | 207 | 40 | A | Alphabetic field, left justified, blank filled; being the surname of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For doctors’ bag order forms this field is space filled. |\n| Given name | 208 | 247 | 40 | A | Alphabetic field, left justified, blank filled; being the given name, or the first letter of that name, of the person for whom the prescription was written. This being the name on the Medicare card or equivalent DVA card. For doctors’ bag order forms this field is space filled. |\n| Resubmission Flag | 248 | 248 | 1 | A | Alphabetic field, right justified; being a field which indicates that this prescription was rejected in a former claim and is being resubmitted for payment. Acceptable values for this field are; 'Y' or 'N', with ‘N’ being the default. |\n| Pharmacy Processing Code | 249 | 250 | 2 | A/N | Alphanumeric field, right justified; being a field which indicates that the Pharmacy has reason to contest the response from HIC. These will be in the form of a processing code (supplied to pharmacy by HIC). The following are acceptable values:00 – Processing code not required (default)01 – Entitlement Validation Indicator02 – ISP not available*03 - Safety Net*** The pharmacy has sighted information showing that the consumer is a new customer to Centrelink, that day and is actually entitled to PBS at the concessional rate. |\n| PBS Reference Number | 251 | 262 | 12 | A/N | Alpha/numeric field, right justified; being a number created by HIC when a pre-assessment was requested by pharmacy. This number will be used to honour pharmacy payment where entitlement details may have changed since the pre-assessment was completed only if the pre-assessment was supplied on the same day. |\n| Carriage return and line feed | N/a | N/a | N/a | N/a | End of record |\n\n\\* New or enhanced fields.\n\n\\*\\*Each script is treated as an individual i.e. for example an original and five repeats, each repeat is regarded as a new script for this purpose.\n\n \nPART 3 – CLAIM TRAILER RECORD\n\nThis details the end of the claim reiterating the claim number for the year and listing the number of prescription records in the claim.\n\n| Column 1 | 2 | 3 | 4 | 5 | 6 |\n| ----------------------------- | ----- | --- | --- | ---- | ------------------------------------------------------------------------------------------ |\n| Field | Start | End | CH | Type | Description |\n| Record type | 1 | 1 | 1 | A | One byte alphabetic, value 'Z', to identify this record as being a claim trailer record. |\n| Number of scripts | 2 | 6 | 5 | N | Five bytes numeric, values 00001 to 99999, being the total number of scripts in the claim. |\n| Carriage return and line feed | N/a | N/a | N/a | N/a | End of record |\n\n \n\n","sortOrder":5},{"sectionNumber":"Sch 3","sectionType":"schedule","heading":"– ONLINE CLAIMING FORMATS","content":"SCHEDULE 3 – ONLINE CLAIMING FORMATS\n\nPart 1 - PBS Input elements Reconcilation Statement\n\n(Note in the O/M/C/N column – O stands for ‘Optional – optionally supplied’, M stands for ‘Mandatory – always supplied’, C stands for ‘Conditional – dependent upon business condition or presence of another field’ and N stands for ‘No – never supplied’. M/C indicates that the field must be supplied if another field is supplied or a business condition is true. O/C indicates that the field may be supplied if another field is supplied or a business condition is true.)\n\n| Element Name | Size | Type | O/M/C/N | Format / Validation | Description |\n| ----------------- | ---- | ---- | --------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| approvalNumber | 6 | A | Preassessment : MClaiming : M | | Use: Preassessment, ClaimingLevel: HeaderThe pharmacy's unique approval number. |\n| authorityNumber | 8 | N | Preassessment : M/CClaiming : M/C | | Use: Preassessment, ClaimingLevel: Prescription RecordThe authority number relating to the item, if applicable. |\n| brand | 2 | A | Preassessment : M/CClaiming : M/C | Should match the manufacturer's code if the prescription refers to an item by brand. | Use: Preassessment, ClaimingLevel: Prescription RecordThe manufacturer's code relating to the brand of the item. |\n| claimPeriod | 4 | N | Preassessment : NClaiming : M | | Use: ClaimingLevel: HeaderThe number of the transmission part within the claim. |\n| claimPeriodNumber | 4 | A | Preassessment : NClaiming : M | Values :YYSQ where YY is the last two digits of the year, and SQ is the number indicating the number of the claim submitted this calendar year. If SQ <= 9, it should be prefixed with a 0. | Use: ClaimingLevel: HeaderIndicates the sequential and calendar year of the claim. |\n| dateOfPrescribing | 8 | A | Preassessment : MClaiming : M | Values :Date represented in string format as DDMMCCYY.Should not default to the current date. | Use: Preassessment, ClaimingLevel: Prescription RecordThe date that the doctor wrote the prescription. |\n| dateOfSupply | 8 | N | Preassessment : NClaiming : M | Values :Date represented in string format as DDMMCCYY. | Use: ClaimingLevel: Prescription RecordDate of supply of the medicine to the patient by the pharmacist. |\n| entitlementID | 11 | A | Preassessment : M/CClaiming : M/C | | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates the number of the Health Care Card, Pensioner Concession Card, Repatriation Health Card (Specific or All Conditions), Commonwealth Seniors Health Card, Repatriation Pharmaceutical Benefits Card or free Safety Net. |\n| ApprovalNum | 6 | A/N | Statement : M | | Level: HeaderThe Approved Supplier's approval number.If only the approval number is supplied, the oldest statement that has not been sent before for that approval number will be returned. If there are no outstanding statements for the approval number, a reason code will be returned. |\n| ClaimPeriodNum | 4 | N | Statement: O | Values :YYSQ where YY is the last two digits of the year, and SQ is the number indicating the number of the claim submitted this calendar year. If SQ <= 9, it should be prefixed with a 0. | Level: HeaderIf the approval number and claim period number are supplied, a duplicate statement for the requested claim period number will be returned. If the statement does not exist for the claim period number, a reason code will be returned. |\n\n \n\nPart 2 - PBS Input Elements\n\n| Element Name | Size | Type | O/M/C/N | Format / Validation | Description |\n| ------------------------------------- | ---- | ---- | ------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| ApprovalNum | 6 | A/N | Preassessment : MClaiming : MCancellation : M | | Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier's approval number. |\n| AuthorityApprovalNum | 8 | A/N | Preassessment : M/CClaiming : M/CCancellation : N | THIS FIELD IS FOR FUTURE USE. | Use : Preassessment, ClaimingLevel : Prescription RecordThe authority number allocated by HIC and given to the prescriber, if applicable. |\n| AuthorityPrescriptionNum | 8 | N | Preassessment : M/CClaiming : M/CCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordThe authority number relating to the item, if applicable. Required if the item is prescribed under an authority number.This is the number that appears on the top right of the authority prescription form and is transferred to the authority repeat form. |\n| Brand | 2 | A | Preassessment : O/CClaiming : O/CCancellation : N | Constraints:Required only if the prescription refers to an item by brand.Must match the published manufacturer's code. | Use: Preassessment, ClaimingLevel: Prescription RecordThe manufacturer's code relating to the brand of the item. |\n| ClaimPeriodNum | 4 | N | Preassessment : NClaiming : MCancellation : M | Values :YYSQ where YY is the last two digits of the year, and SQ is the number indicating the number of the claim submitted this calendar year. If SQ <= 9, it should be prefixed with a 0. | Use: Claiming, CancellationLevel: HeaderIndicates the sequential order and calendar year of the claim. |\n| ClaimReference | 4 | N | Preassessment : NClaiming : MCancellation : M | Values:Range of 0001 to 9999. | Use: Claiming, CancellationLevel: HeaderA sequential number generated for each claim submitted within a claim period. |\n| DateOfDispensing | 8 | N | Preassessment : MClaiming : MCancellation : N | Values :Date represented in numeric format as DDMMCCYY. | Use : Preassessment, ClaimingLevel : Prescription RecordThe date on which the prescription was dispensed. |\n| DateOfPrescribing | 8 | N | Preassessment : MClaiming : MCancellation : N | Values :Date represented in numeric format as DDMMCCYY.Constraints:The Client System software should not default this field to the current date except for DBOF | Use: Preassessment, ClaimingLevel: Prescription RecordThe date that the prescriber wrote the prescription. |\n| DateOfPreviousSupply | 8 | N | Preassessment: OClaiming: O | Format: DDMMCCYY | Use: Preassessment, ClaimingLevel: Prescription RecordThis is the date printed on a repeat authorisation in the box “Name and PBS Approval number of the pharmacist issuing this authorisation” (where it is called “Date this Authorisation Prepared”).If not present in the PDS, do not specify the element. |\n| DateOfSupply | 8 | N | Preassessment : NClaiming : MCancellation : N | Values :Date represented in numeric format as DDMMCCYY.Constraints:This field is required at claiming if the item has been supplied to the patient. | Use: ClaimingLevel: Prescription RecordThe date on which the pharmaceutical benefit was supplied. |\n| EntitlementId | 11 | A/N | Preassessment : M/CClaiming : M/CCancellation : N | Values :Must match the appropriate format for the entitlement identifier being used.Constraints:This field is not required for payment categories 1 (General) and 5 (Doctor’s Bag Order Forms). | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates the number of the Health Care Card, Pensioner Concession Card, Repatriation Health Card (Specific or All Conditions), Commonwealth Seniors Health Card, Repatriation Pharmaceutical Benefits Card, or free Safety Net Entitlement or Safety Net Concession card. |\n| FamilyName | 40 | A | Preassessment : M/CClaiming : M/CCancellation : N | Values:The family name as per the Medicare or DVA card.Constraints:This field is not required for Doctor's Bag Order Forms. | Use: Preassessment, ClaimingLevel: Prescription RecordThe surname of the person for whom the prescription was written sourced from Medicare card or equivalent DVA card. |\n| FormCategory | 1 | A/N | Preassessment : MClaiming : MCancellation : N | Values :1 = Original2 = Repeat3 = Original authority4 = Repeat authorisation relating to an authority5 = Deferred supply authorisation6 = Prescription written by a participating dental practitioner7 = Doctor's bag order form8 = DVA Authority9 = DVA Authority Repeat Form | Use: Preassessment, ClaimingLevel: Prescription RecordIdentifies the prescription form type. |\n| GivenName | 40 | A | Preassessment : M/CClaiming : M/CCancellation : N | Values:The given name as per the Medicare or DVA card.Constraints:This field is not required for Doctor's Bag Order Forms. | Use: Preassessment, ClaimingLevel: Prescription RecordThe given name of the person for whom the prescription was written sourced from their Medicare card or equivalent DVA card. |\n| GlassBottleInd | 1 | A | Preassessment : MClaiming : MCancellation : N | Values:Y = TrueN = False | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates whether or not a glass bottle is being claimed for the medicine. This is only applicable for the following extemporaneously prepared items: eye drops, ear drops and nasal instillations where the standard polythene container is not appropriate. |\n| HospitalProviderNum | 8 | A/N | Preassessment : M/CClaiming : M/CCancellation : N | Constraints:This field is only required if the benefit was supplied in an approved public hospital. | Use: Preassessment, ClaimingLevel: Prescription RecordProvider number of the public hospital where the prescription originated. |\n| ImmediateSupplyNecessaryInd | 1 | A | Preassessment : MClaiming : MCancellation : N | Values:Y = TrueN = False | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates that immediate supply was necessary as per regulation 25. |\n| MedicareNum | 11 | N | Preassessment : M/CClaiming : M/CCancellation : N | Constraints:Not required for payment categories 5 (Doctor’s Bag Order Forms) and 4 (where a DVA File Number is used). | Use: Preassessment, ClaimingLevel: Prescription RecordThe Medicare card number (including card issue number and individual reference number) of the person for whom the prescription was written. |\n| NumberOfRepeats | 2 | N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates the number of repeats ordered by the prescriber.Zero is an acceptable value for this field, if applicable. |\n| OriginalApprovalNum | 6 | A/N | Preassessment: OClaiming: O | | Use: Preassessment, ClaimingLevel: Prescription RecordThis is the field printed on a repeat authorisation in the box “Original Prescription Details” that is the approval number allotted to the approved pharmacist or approved medical practitioner under regulation 8A of the regulations, that supplied the original prescription.If not present in the PDS, the value is null. |\n| OriginalUniquePharmacyPrescriptionNum | 20 | A/N | Preassessment: OClaiming: O | | Use: Preassessment, ClaimingLevel: Prescription RecordThis is the field printed on a repeat authorisation in the box “Original Prescription Details” that is the unique pharmacy prescription number allocated by the approval that supplied the original prescription.If not present in the PDS, the value is null. |\n| PatientCategory | 1 | A/N | Preassessment : MClaiming : MCancellation : N | Values :H = Private hospital patient (paperless)B = Public hospital patientN = Nursing home patientC = Paperless public hospital patient0 (Zero) = Community patient | Use: Preassessment, ClaimingLevel: Prescription RecordIdentifies the patient category. |\n| PaymentCategory | 1 | N | Preassessment : MClaiming : MCancellation : N | Values :1 = General benefit2 = PBS Safety Net (free)3 = Concessional benefit4 = Repatriation5 = Doctor's bag order form | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates the type of benefit and level of patient co-payment. |\n| PbsItemCode | 6 | A/N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordItem code of the medication, which appears in the Schedule of Pharmaceutical Benefits.For unlisted RPBS benefits this field should be completed '000000'. |\n| PbsReferenceNum | 12 | A/N | Preassessment : NClaiming : M/CCancellation : M | Constraints:Not required at claiming if item has not been pre-assessed. | Use: Claiming, CancellationLevel: Prescription RecordA number created by HIC when a pre-assessment was requested by pharmacy. |\n| PharmacyProcessingCode | 2 | A/N | Preassessment : NClaiming : MCancellation : N | Values :Range of 00 to 99.For example:00 - No override01 - New Centrelink customer**02 - ISP not available | Use : ClaimingLevel : Prescription RecordIndicates that the approved supplier has reason to contest the response from HIC concerning the consumers’ concessional entitlement.** The pharmacy has sighted information showing that the consumer is a new customer to Centrelink that day and is actually entitled to PBS at the concessional rate. |\n| PrescriberId | 7 | A/N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordThe prescriber number of the prescribing medical or dental practitioner. |\n| PreviousSupplies | 2 | N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordNumber of times that this set of an original prescription and its repeats have already been supplied.Zero is an acceptable value for this field, if applicable. |\n| Price | 7 | N | Preassessment : MClaiming : MCancellation : N | Values:The price of the item in cents.Constraints:Where :1. Pharmacy has elected to price all non-standard extemporaneously prepared items, or2. Pharmacy has elected to claim an exceptionally priced extemporaneously prepared item, or3. Where the item does not appear in either the Schedule of PBS or RPBS benefits and it has been prior approved by DVA (an unlisted RPBS item),This field should contain the price of the item in cents.If none of these circumstances apply, this field should be set to 0 (zero). | Use: Preassessment, ClaimingLevel: Prescription RecordThe price of the item. |\n| Quantity | 5 | N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordQuantity of the item supplied. For Regulation 24 this is the total quantity supplied (the original plus repeats). |\n| Regulation24Ind | 1 | A | Preassessment : MClaiming : MCancellation : N | Values:Y = TrueN = False | Use: Preassessment, ClaimingLevel: Prescription RecordIndicates whether the supply of the original prescription and repeat(s) is made at one time pursuant to Regulation 24. |\n| ResubmissionInd | 1 | A | Preassessment : NClaiming : MCancellation : N | Values:Y = TrueN = False | Use: ClaimingLevel: Prescription RecordIndicates whether this prescription was previously rejected in another claim and is being resubmitted. |\n| SerialNum | 5 | N | Preassessment : MClaiming : MCancellation : N | | Use: Preassessment, ClaimingLevel: Prescription RecordThe serial number must start at 1 for each payment category within a claim period and run sequentially within that claim period. |\n| UniquePharmacyPrescriptionNum | 20 | A/N | Preassessment : MClaiming : MCancellation : M | | Use : Preassessment, Claiming, CancellationLevel : Prescription RecordThis is a unique number allocated by the PDS and stays with that prescription throughout its lifecycle. An individual prescription will only ever have one number allocated to it and that number will not be re-allocated to other prescriptions.Note:The UniquePharmacyPrescriptionNum is set when the object is created. |\n\nPart 3 - PBS Output Elements – PBS Reconciliation Statement\n\n(Note that in the Y/N/P column – Y stands for ‘Yes – Always present’, N stands for ‘No – Never present’, P stands for ‘Potentially – may be present or null’)\n\n| Element Name | Size | Type | Y/N/P | Format / Validation | Description |\n| ------------------------------------- | ---- | ---- | ------------ | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n| AdjustedPrice | 9 | N | Statement: P | Only returned if the prescription was adjusted after the statement for the claim period was generated. | Level: Prescription RecordThe difference between the rebate amount for the original prescription and each of its adjustments (ie what is paid in total to the approved supplier after adjustment). |\n| ApprovalNum | 6 | A/N | Statement: Y | ASN for Doctors:D alpha(state based) NNN alpha(check digit)ASN for Hospitals:H alpha(state based) NNN alpha (check digit)ASN for Pharmacies:NNNNN alpha (check digit) | Level: HeaderThe Approved Supplier's approval number. |\n| Brand | 2 | A | Statement: P | This is returned as space-filled if item is prescribed generically.Will match the manufacturer's code if the prescription refers to an item by brand. | Level: Prescription RecordThe manufacturer’s code relating to the brand of the item.NB: Returned as supplied or as translated during processing. |\n| ClaimPeriodNum | 4 | N | Statement: Y | Values:YYSQ where YY is the last two digits of the year, and SQ is the number indicating the number of the claim submitted this calendar year. If SQ <= 9, it should be prefixed with a 0. | Level: Header and Prescription RecordIndicates the calendar year and sequential order of the claim period within that year. |\n| ClaimReference | 4 | N | Statement: Y | Range of 0001 to 9999. | Level: Prescription RecordA sequential number generated for each claim transaction submitted within a claim period. This number is generated and sent by the Approved Supplier's software.NB: Each claim transaction may consist of one or more prescriptions. |\n| CorrectedMedicareNum | 11 | N | Statement: P | This field will only be populated where the prescription is payable and a relevant reason code has been issued and under conditions where it is possible to determine and return a correct Medicare number. | Level: Prescription RecordCorrected Medicare number as supplied by HIC to Approved Supplier. Can be used to update customer profile. |\n| DateOfPreparation | 8 | N | Statement: Y | Date represented in numeric format as DDMMCCYY. | Level : HeaderDate that the response was prepared (Canberra time). |\n| DispensedPrice | 9 | N | Statement: P | Will be null if prescription was rejected, cancelled or pended.The amount will padded with leading zeros to meet the length requirement. | Level: Prescription RecordThe dispensed price (stored in cents) of the medication including any patient contribution, but excluding brand price premiums and therapeutic group premiums. |\n| EntitlementIdNotificationEndDate | 8 | N | Statement: P | DDMMCCYYThis field will only be populated where the prescription is payable and a concession reason code has been issued and a notification end date is appropriate. | Level: Prescription RecordA notification date is set when an entitlement number is first given the relevant reason code.Supply after this date using this entitlement number may result in a rejection.Returned for a 'timed warning' only. If rejected after a timed warning, the date will continue to be returned. |\n| FamilyName | 40 | A | Statement: P | This field is not retuned for Doctor's Bag Order Forms of for a pended prescription. | Level : Prescription RecordThe surname of the person for whom the prescription was written as supplied by the Approved Supplier. |\n| GivenName | 40 | A | Statement: P | This field is not retuned for Doctor's Bag Order Forms of for a pended prescription. | Level : Prescription RecordThe given name of the person for whom the prescription was written as supplied by the Approved Supplier. |\n| HicStatementVersion | 2 | N | Statement: Y | Value = 01 | Level: Header2-digit identifier that identifies the version of the statement format. The version number will increase for subsequent releases. |\n| InformationWarningErrorCode1 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or reject code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode10 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode2 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode3 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode4 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode5 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode6 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode7 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode8 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| InformationWarningErrorCode9 | 5 | A/N | Statement: P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Level: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. The format of the InformationWarningErrorCode1 includes the reason type, a space, and the reason code. |\n| MedicareNumberNotificationEndDate | 8 | N | Statement: P | DDMMCCYYThis field will only be populated where where the prescription is payable and a Medicare reason code has been issued and a notification end date is appropriate. | Level: Prescription RecordA notification date is set when a Medicare number is first given the relevant reason code.Supply after this date using this Medicare number may result in a rejection.Returned for a 'timed warning' only. If rejected after a timed warning, the date will continue to be returned. |\n| MedicareNumberValidToDate | 8 | N | Statement: P | DDMMCCYYThis field will only be populated where a corrected Medicare number is returned. | Level: Prescription RecordThe absolute end date for a corrected Medicare card. Can be used to update customer profile. |\n| NetPrice | 9 | N | Statement: P | Will be null if prescription was rejected, cancelled or pended.The amount will be padded with leading zeros to meet the length requirement | Level: Prescription RecordThe PBS rebate to the Approved Supplier in cents. This price excludes any patient contribution, brand price premiums and therapeutic group premiums. (ie. it is the 'dispensed price' – 'relevant patient contribution'). |\n| PaymentCategory | 1 | N | Statement: Y | 0 = invalid category1 = general benefit2 = entitled (free)3 = concessional benefit4 = repatriation5 = doctor's bag order form | Level: Prescription RecordPayment category in which the prescription was claimed.Secondary prescription identifier used in conjunction with the serial number. |\n| PBSPaymentID | 12 | N | Statement: Y | | Level: Prescription RecordA unique payment identifier generated by HIC’s Claim Processing System which is used to uniquely identify the payment transaction. |\n| PBSItemCode | 6 | A/N | Statement: P | 01234AZeros for non-scheduled repatriation items. | Level: Prescription RecordItem code as published in the Schedule of Pharmaceutical Benefits.NB: Returned as supplied or as translated during processing. |\n| PBSReferenceNum | 12 | N | Statement: Y | | Level: Prescription RecordHIC unique number. |\n| SerialNum | 5 | N | Statement: Y | 5-character numericpadded with leading zeros if actual serial number is shorter than five digits. | Level: Prescription RecordGenerated by the Approved Supplier’s PDS. The serial number supplied by the Approved Supplier must start at 1 for each payment category within a claim period and run sequentially within that claim period.Secondary prescription identifier used in conjunction with the payment category. NB: The Payment Category and Serial Number fields are used to group the prescriptions in the paper statement. |\n| Result | 1 | A | Statement: Y | STATEMENTA = adjustmentP = payment requestedX = prescription cancelledR = Rejected | Level: Prescription RecordIndicates the status of a prescription after processing. |\n| TimeOfPreparation | 6 | A/N | Statement: Y | Time (24-hour) represented in string format as HHMMSS. | Level: HeaderTime that the response was prepared (Canberra time). |\n| TotalConcessionalBenefitPrescriptions | 5 | N | Statement: Y | The amount will be padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal number of Concessional benefit items rebated. |\n| TotalConcessional BenefitRebate | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of Concessional benefit rebates. |\n| TotalDoctorsBag BenefitPrescriptions | 5 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal number of Doctor’s Bag benefit items rebated. |\n| TotalDoctorsBagBenefitRebate | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of Doctor’s Bag benefit rebates. |\n| TotalEntitledBenefitRebate | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of Entitled (Free) benefit rebates. |\n| TotalEntitledBenefitPrescriptions | 5 | N | Statement: Y | The amount will be padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal number of Entitled (Free) benefit items rebated. |\n| TotalGeneralBenefitPrescriptions | 5 | N | Statement: Y | The amount will be padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal number of General benefit items rebated. |\n| TotalGeneralBenefitRebate | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of General benefit rebates. |\n| TotalNumberPrescriptions | 5 | N | Statement: Y | | Level: Summary RecordNumber of individual prescription reconciliation records in this statement.Note:The total number of prescriptions for a statement will be returned. Some scripts could be for different pay periods, for example: adjustments. |\n| TotalRebates | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of PBS rebates paid for this statement. This total does not include GST components for the DBOF payment category. |\n| TotalRepatriationBenefitPrescriptions | 5 | N | Statement: Y | The amount will be padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal number of Repatriation benefit items rebated. |\n| TotalRepatriationBenefitRebate | 11 | N | Statement: Y | The amount will be represented in cents and padded with leading zeros to meet the length requirement. | Level: Summary RecordTotal value (Net Price) of Repatriation benefit rebates. |\n| UniquePharmacyPrescriptionNum | 20 | A/N | Statement: Y | | Level : Prescription RecordThis is a unique number allocated by the Approved Supplier’s PDS. An individual prescription will only ever have one number allocated to it and that number will not be re-allocated to other prescriptions. |\n\nPart 4 - PBS Output Elements\n\n(Note that in the Y/N/P column – Y stands for ‘Yes – Always present’, N stands for ‘No – Never present’, P stands for ‘Potentially – may be present or null’)\n\n| Element Name | Size | Type | Y/N/P | Format / Validation | Description |\n| --------------------------------- | ---- | ---- | --------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| ApprovalNum | 6 | A/N | Preassessment : YClaiming : YCancellation : Y | | Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier’s unique approval number. |\n| Brand | 2 | A | Preassessment : PClaiming : PCancellation : N | Values:Will match the manufacturer's code if the prescription refers to an item by brand.This is returned as space-filled if item is prescribed generically. | Use: Preassessment, ClaimingLevel: Prescription RecordThe manufacturer's code relating to the brand of the item. |\n| ClaimPeriodNum | 4 | N | Preassessment : NClaiming : YCancellation : Y | Values:YYSQ where YY is the last two digits of the year, and SQ is the number indicating the number of the claim submitted this calendar year. If SQ <= 9, it should be prefixed with a 0. | Use: Claiming, CancellationLevel: HeaderIndicates the calendar year and sequential order of the claim period. |\n| ClaimReference | 4 | N | Preassessment : NClaiming : YCancellation : Y | Values:Range of 0001 to 9999. | Use: Claiming, CancellationLevel: HeaderA sequential number generated for each claim submitted within a claim period. |\n| CorrectedMedicareNum | 11 | N | Preassessment : PClaiming : PCancellation : N | Constraints:Will be null if not applicable. | Use: Preassessment, ClaimingLevel: Prescription RecordCorrected Medicare number as supplied by HIC to the Approved Supplier. This field will only be populated where a relevant reason code has been issued and under conditions where it is possible to determine and return a corrected Medicare number. |\n| DateOfPreparation | 8 | N | Preassessment : YClaiming : YCancellation : Y | Values:Date represented in numeric format as DDMMCCYY. | Use: Preassessment, Claiming, CancellationLevel : HeaderDate that the response was prepared (Canberra time). |\n| DispensedPrice | 9 | N | Preassessment : PClaiming : PCancellation : N | Values:The price of the item in cents.Constraints: Will be null if not applicable. | Use: Preassessment, ClaimingLevel: Prescription RecordThe dispensed price (in cents) of the medication including any patient contribution, but excluding brand price premiums and therapeutic group premiums. |\n| EntitlementIdNotificationEndDate | 8 | N | Preassessment : PClaiming : PCancellation : N | Values:Date represented in numeric format as DDMMCCYY.Constraints:Will be null if not applicable. | Use: ClaimingLevel: Prescription RecordA notification date is set when an entitlement number is first given a reason code. Supply after this date using this entitlement number will result in a rejection. If rejected after a timed warning, a date will continue to be returned. (Returned for ‘timed warning’ only) |\n| InformationWarningErrorCode1 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or reject code relating to this item. The reason code will only be returned if it is flagged to be returned to Approved Supplier |\n| InformationWarningErrorCode10 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode2 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode3 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode4 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode5 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode6 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode7 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode8 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| InformationWarningErrorCode9 | 5 | A/N | Preassessment : PClaiming : PCancellation : P | Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable. | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordIndicates the presence of a warning, information or error code relating to this item. |\n| PbsItemCode | 6 | A/N | Preassessment : PClaiming : PCancellation : N | Values:Will be populated with zeros for non-scheduled repatriation items.Constraints:Will be null if not applicable. | Use: Preassessment, ClaimingLevel: Prescription RecordItem code as published in the Schedule of Pharmaceutical Benefits. |\n| MedicareNumberNotificationEndDate | 8 | N | Preassessment : PClaiming : PCancellation : N | Values:Date represented in numeric format as DDMMCCYY.Constraints :Will be null if not applicable.This field will only be populated where a Medicare reason code has been issued and an end date is appropriate. | Use: ClaimingLevel: Prescription RecordA notification date is set when a Medicare number is first given the relevant reason code. Supply after this date using this Medicare number will result in a rejection. If rejected after a timed warning, a date will continue to be returned. (Returned for a ‘timed warning’ only) |\n| MedicareNumberValidToDate | 8 | N | Preassessment : PClaiming : PCancellation : N | Values:Date represented in numeric format as DDMMCCYY.Constraints:Will be null if not applicable. | Use: Preassessment, ClaimingLevel: Prescription RecordThe absolute end date for a corrected Medicare card. This represents the last date for which the returned corrected Medicare number is valid. This field will only be populated where a corrected Medicare number is returned. |\n| NetPrice | 9 | N | Preassessment : PClaiming : PCancellation : N | The price of the item in cents.Constraints:Will be null if not applicable. | Use: Preassessment, ClaimingLevel: Prescription RecordThe PBS rebate to the Approved Supplier. This price excludes any patient contribution, brand price premiums and therapeutic group premiums. |\n| PbsCancelNum | 12 | N | Preassessment : NClaiming : NCancellation : Y | | Use: CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was cancelled. |\n| PbsReferenceNum | 12 | N | Preassessment : YClaiming : YCancellation : Y | | Use: Preassessment, Claiming, CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was pre-assessed. |\n| Result | 1 | A | Preassessment : YClaiming : YCancellation : Y | Values:1-character alphaCLAIMA = Original Item claim accepted for payment please forward prescription at end of claim periodR = Original Item claim rejected for payment do not send hard copy prescriptionS = Original Item claim paperwork required prior to paymentF = Financial adjustmentG= Non-financial adjustmentH = Original Item claim rejected, processing code present, adjust prescription and resubmit or send hard copy prescription for HIC evaluationPRE-ASSESMENTP = Item claim okay at pre-assessmentQ = Item claim failed CEV check at pre-assessmentM = Item claim failed generic, non-CEV check at pre-assessmentN = Item claim failed both CEV and generic non-CEV checks at pre-assessmentCANCELC = Item claim cancelledB = Item cannot be cancelled | Use : Preassessment, Claiming, ResultLevel : Prescription recordThis indicates the pre-assessment, claiming or cancellation result status of an item. |\n| TimeOfPreparation | 6 | A/N | Preassessment : YClaiming : YCancellation : Y | Values:Time (24-hour) represented in string format as HHMMSS. | Use : Preassessment, Claiming, CancellationLevel: HeaderTime that the response was prepared (Canberra time). |\n| UniquePharmacyPrescriptionNum | 20 | A/N | Preassessment : YClaiming : YCancellation : Y | | Use : Preassessment, Claiming, CancellationLevel : Prescription RecordThis is a unique number allocated by the PDS and stays with that prescription throughout its lifecycle. An individual prescription will only ever have one number allocated to it and that number will not be re-allocated to other prescriptions. |","sortOrder":6}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":2621},"content_quality":"ok","complexity_score":9,"scope_assessment":{"changed":false,"description":"The Rules remain within the scope of subsection 99AAA(8) of the National Health Act 1953, which authorises the Minister to make rules regarding claims procedures, information requirements, and electronic claiming. While the 2004 update introduces modern online claiming capabilities and maintains multiple technical file format versions (including legacy diskette formats), this represents technological evolution and administrative modernisation within the existing statutory framework rather than an expansion of substantive scope."},"complexity_factors":["18 defined terms including technical distinctions between prescription types (authority, repeat authorisation, deferred supply, extemporaneously-prepared benefits)","Three incompatible claiming methods (manual paper, diskette, online) with different procedural requirements","Two distinct diskette file format versions (Schedule 1 Version 1 and Schedule 2 Version 4.1) maintained simultaneously, plus online formats","Byte-level field positioning specifications (e.g., 'positions 33-37' for drug codes, 'positions 79-87' for Medicare numbers)","Over 50 distinct data fields required across different prescription record formats","Extensive cross-referencing to the National Health Act 1953, the National Health (Pharmaceutical Benefits) Regulations 1960, and multiple determinations under sections 85, 85A, 88 and 98B","Nested conditional logic for pricing calculations, exceptional prescriptions, and container specifications (glass bottles for eye/ear drops)","Specific serial number allocation rules varying by payment category (general, concessional, entitlement card, doctor's bag)"],"plain_english_summary":"These Rules tell pharmacists, approved medical practitioners and hospital suppliers how to claim PBS reimbursements from the Health Insurance Commission (Services Australia). They set mandatory formats, time limits and data requirements for submitting prescription claims (paper, electronic and diskette), and cover special authorisations and supply arrangements.\n\nThey matter because they enable automated, auditable processing of subsidy payments so suppliers are paid and public funds are verified."},"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"These Rules repeal and replace the earlier PB 8 of 2002 (preliminary rule 1(b)) and expand and modernise procedural and technical requirements for claiming PBS payments. They add detailed electronic claim formats and online/diskette protocols (rules 5–7; Schedules 1–3), tighten data‑validation and program constraints (rule 5(d)(ii)–(iii)), formalise serialisation, bundling and original‑prescription submission (rule 3(g)–(h)), and confirm Commission processing and EFT payment procedures (rules 9–10)."},"complexity_factors":["Highly prescriptive fixed‑position and variable electronic file formats with many fields and conditional rules (Schedules 1–3).","Multiple claim channels and versions: manual, diskette (two format versions), and online, each with distinct requirements (rules 5–7; Schedules).","Serial‑numbering and bundle‑sorting rules that differ by payment category (rule 3(g)(iii)–(h)).","Detailed data‑validation and program behaviour constraints (rule 5(d)(ii)–(iii)) to prevent local alteration of drug codes and ensure legal compliance.","Timing and frequency constraints on claims with carve‑outs and discretionary exceptions vested in the Managing Director (rule 3(b)–(f), 3(d), 3(f)).","Interplay with multiple external instruments (National Health Act, Regulations, Determinations and Declarations) increasing cross‑reference complexity (definition clause).","Operational compliance burdens: retention and submission of original prescriptions, paper‑bundle organisation, and EFT/payment account nominations (rule 3(g), 10(a)).","Versioning/backwards compatibility requirements (Schedule 2 versioning field) and numerous conditional fields for different patient categories and entitlement types.","Rejection/resubmission and processing checks imposed on the Commission (rule 9) and corresponding record‑keeping/technical obligations on suppliers."],"plain_english_summary":"These Rules prescribe how approved suppliers (pharmacists, participating medical/dental practitioners and hospital authorities) must make and support claims for Pharmaceutical Benefits — by paper, diskette or online — and how prescriptions must be marked, bundled and numbered (rules 3, 5–7). They appoint the Health Insurance Commission (via the Managing Director) to check, process and pay claims by EFT, set detailed electronic file layouts and data-validation requirements (Schedules 1–3), and allow limited discretion to accept late or extra monthly claims (rule 3d,f; rules 9–10)."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004","history":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004/history","analysis":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004/analysis","conflicts":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004/conflicts","importantCases":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004/important-cases","documents":"/api/acts/national-health-act-1953-rules-under-subsection-99aaa-8-no-pb-15-of-2004/documents"}}