Schedule Sch 2 - National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 15 of 2004) - DISKETTE CLAIM FORMAT – VERSION 4.1, 2004

Sch 2DISKETTE CLAIM FORMAT – VERSION 4.1, 2004

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SCHEDULE 2: DISKETTE CLAIM FORMAT – VERSION 4.1, 2004

PART 1 — CLAIM PART HEADER RECORD

The 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.

Column 1	2	3	4	5	Column 6
Field	Start	End	CH	Type	Description
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
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.
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.
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.
Claim reference	14	17	4	N	Four bytes numeric, values 01 to 9999, representing the number of claims within a claim period.
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.
Pharmacy Software Version Number

Column 1

Column 6

Field

Start

End

Type

Description

Record Type

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.

Form Category

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

Payment Category

One byte numeric, batch category:1 = general benefit2 = PBS Safety net (free)3 = concessional benefit4 = repatriation5 = doctor's bag order form

Unique Pharmacy Prescription Number

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.

Serial Number

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.

Hospital Provider Number

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.

Prescriber Id

A/N

Seven bytes alpha/numeric, right justified, space filled being the prescriber number of the prescribing medical or dental practitioner.

Date of Prescribing

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.

Column 1

Column 6

Field

Start

End

Type

Description

Date of Dispensing

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.

Date of Supply

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.

Patient Category

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.

PBS/RPBS Item Code

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.

Brand

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.

Quantity

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.

Price

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.

Number of repeats

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.

Column 1

Column 6

Field

Start

End

Type

Description

*Original PBS Approval Number

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.

* Original Unique Pharmacy Prescription Number

116

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.

*Date of previous supply

117

124

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.

Previous Supplies

125

126

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.

Regulation 24

127

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'.

Glass Bottle

128

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'.

Authority Prescription Number

129

136

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.

Authority Approval Number

137

144

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.

Immediate Supply Necessary

145

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.

Medicare Number

146

156

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.

Entitlement id

157

167

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.

Family name

168

207

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.

Given name

208

247

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.

Resubmission Flag

248

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.

Pharmacy Processing Code

249

250

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 available03 - 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.

PBS Reference Number

251

262

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.

Carriage return and line feed

N/a

End of record