Schedule Sch 3 - National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 15 of 2004) - – ONLINE CLAIMING FORMATS

Sch 3– ONLINE CLAIMING FORMATS

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Turn the raw legal text into a practical explanation grounded in National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 15 of 2004).

SCHEDULE 3 – ONLINE CLAIMING FORMATS

Part 1 - PBS Input elements Reconcilation Statement

(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.)

Element Name	Size	Type	O/M/C/N	Format / Validation	Description
approvalNumber	6	A	Preassessment : MClaiming : M		Use: Preassessment, ClaimingLevel: HeaderThe pharmacy's unique approval number.
authorityNumber	8	N	Preassessment : M/CClaiming : M/C		Use: Preassessment, ClaimingLevel: Prescription RecordThe authority number relating to the item, if applicable.
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.
claimPeriod	4	N	Preassessment : NClaiming : M		Use: ClaimingLevel: HeaderThe number of the transmission part within the claim.
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.
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.
dateOfSupply

Element Name	Size	Type	O/M/C/N	Format / Validation	Description
ApprovalNum	6	A/N	Preassessment : MClaiming : MCancellation : M		Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier's approval number.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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'.
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.
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.
PrescriberId	7	A/N	Preassessment : MClaiming : MCancellation : N		Use: Preassessment, ClaimingLevel: Prescription RecordThe prescriber number of the prescribing medical or dental practitioner.
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.
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.
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).
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.
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.
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.
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.

Element Name

Size

Type

O/M/C/N

Format / Validation

Description

ApprovalNum

A/N

Preassessment : MClaiming : MCancellation : M

Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier's approval number.

AuthorityApprovalNum

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.

AuthorityPrescriptionNum

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.

Brand

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.

ClaimPeriodNum

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.

ClaimReference

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.

DateOfDispensing

Preassessment : MClaiming : MCancellation : N

Values :Date represented in numeric format as DDMMCCYY.

Use : Preassessment, ClaimingLevel : Prescription RecordThe date on which the prescription was dispensed.

DateOfPrescribing

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.

DateOfPreviousSupply

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.

DateOfSupply

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.

EntitlementId

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.

FamilyName

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.

FormCategory

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.

GivenName

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.

GlassBottleInd

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.

HospitalProviderNum

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.

ImmediateSupplyNecessaryInd

Preassessment : MClaiming : MCancellation : N

Values:Y = TrueN = False

Use: Preassessment, ClaimingLevel: Prescription RecordIndicates that immediate supply was necessary as per regulation 25.

MedicareNum

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.

NumberOfRepeats

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.

OriginalApprovalNum

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.

OriginalUniquePharmacyPrescriptionNum

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.

PatientCategory

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.

PaymentCategory

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.

PbsItemCode

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'.

PbsReferenceNum

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.

PharmacyProcessingCode

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.

PrescriberId

A/N

Preassessment : MClaiming : MCancellation : N

Use: Preassessment, ClaimingLevel: Prescription RecordThe prescriber number of the prescribing medical or dental practitioner.

PreviousSupplies

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.

Price

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.

Quantity

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).

Regulation24Ind

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.

ResubmissionInd

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.

SerialNum

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.

UniquePharmacyPrescriptionNum

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.

Element Name	Size	Type	Y/N/P	Format / Validation	Description
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).
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.
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.
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.
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.
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.
DateOfPreparation	8	N	Statement: Y	Date represented in numeric format as DDMMCCYY.	Level : HeaderDate that the response was prepared (Canberra time).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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').
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.
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.
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.
PBSReferenceNum	12	N	Statement: Y		Level: Prescription RecordHIC unique number.
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.
Result	1	A	Statement: Y	STATEMENTA = adjustmentP = payment requestedX = prescription cancelledR = Rejected	Level: Prescription RecordIndicates the status of a prescription after processing.
TimeOfPreparation	6	A/N	Statement: Y	Time (24-hour) represented in string format as HHMMSS.	Level: HeaderTime that the response was prepared (Canberra time).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

Element Name

Size

Type

Y/N/P

Format / Validation

Description

AdjustedPrice

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).

ApprovalNum

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.

Brand

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.

ClaimPeriodNum

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.

ClaimReference

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.

CorrectedMedicareNum

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.

DateOfPreparation

Statement: Y

Date represented in numeric format as DDMMCCYY.

Level : HeaderDate that the response was prepared (Canberra time).

DispensedPrice

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.

EntitlementIdNotificationEndDate

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.

FamilyName

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.

GivenName

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.

HicStatementVersion

Statement: Y

Value = 01

Level: Header2-digit identifier that identifies the version of the statement format. The version number will increase for subsequent releases.

InformationWarningErrorCode1

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.

InformationWarningErrorCode10

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.

InformationWarningErrorCode2

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode3

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode4

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode5

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode6

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode7

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode8

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

InformationWarningErrorCode9

A/N

Statement: P

Values:Reason type, thenSpace, thenThree-character reason code.eg. ‘W 123’Constraints:Will be null if not applicable.

MedicareNumberNotificationEndDate

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.

MedicareNumberValidToDate

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.

NetPrice

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').

PaymentCategory

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.

PBSPaymentID

Statement: Y

Level: Prescription RecordA unique payment identifier generated by HIC’s Claim Processing System which is used to uniquely identify the payment transaction.

PBSItemCode

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.

PBSReferenceNum

Statement: Y

Level: Prescription RecordHIC unique number.

SerialNum

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.

Result

Statement: Y

STATEMENTA = adjustmentP = payment requestedX = prescription cancelledR = Rejected

Level: Prescription RecordIndicates the status of a prescription after processing.

TimeOfPreparation

A/N

Statement: Y

Time (24-hour) represented in string format as HHMMSS.

Level: HeaderTime that the response was prepared (Canberra time).

TotalConcessionalBenefitPrescriptions

Statement: Y

The amount will be padded with leading zeros to meet the length requirement.

Level: Summary RecordTotal number of Concessional benefit items rebated.

TotalConcessional BenefitRebate

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.

TotalDoctorsBag BenefitPrescriptions

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.

TotalDoctorsBagBenefitRebate

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.

TotalEntitledBenefitRebate

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.

TotalEntitledBenefitPrescriptions

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.

TotalGeneralBenefitPrescriptions

Statement: Y

The amount will be padded with leading zeros to meet the length requirement.

Level: Summary RecordTotal number of General benefit items rebated.

TotalGeneralBenefitRebate

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.

TotalNumberPrescriptions

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.

TotalRebates

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.

TotalRepatriationBenefitPrescriptions

Statement: Y

The amount will be padded with leading zeros to meet the length requirement.

Level: Summary RecordTotal number of Repatriation benefit items rebated.

TotalRepatriationBenefitRebate

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.

UniquePharmacyPrescriptionNum

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.

Element Name	Size	Type	Y/N/P	Format / Validation	Description
ApprovalNum	6	A/N	Preassessment : YClaiming : YCancellation : Y		Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier’s unique approval number.
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.
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.
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.
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.
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).
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.
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)
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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)
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.
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.
PbsCancelNum	12	N	Preassessment : NClaiming : NCancellation : Y		Use: CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was cancelled.
PbsReferenceNum	12	N	Preassessment : YClaiming : YCancellation : Y		Use: Preassessment, Claiming, CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was pre-assessed.
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.
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).
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.

Element Name

Size

Type

Y/N/P

Format / Validation

Description

ApprovalNum

A/N

Preassessment : YClaiming : YCancellation : Y

Use: Preassessment, Claiming, CancellationLevel: HeaderThe approved supplier’s unique approval number.

Brand

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.

ClaimPeriodNum

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.

ClaimReference

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.

CorrectedMedicareNum

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.

DateOfPreparation

Preassessment : YClaiming : YCancellation : Y

Values:Date represented in numeric format as DDMMCCYY.

Use: Preassessment, Claiming, CancellationLevel : HeaderDate that the response was prepared (Canberra time).

DispensedPrice

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.

EntitlementIdNotificationEndDate

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)

InformationWarningErrorCode1

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

InformationWarningErrorCode10

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.

InformationWarningErrorCode2

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.

InformationWarningErrorCode3

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.

InformationWarningErrorCode4

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.

InformationWarningErrorCode5

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.

InformationWarningErrorCode6

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.

InformationWarningErrorCode7

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.

InformationWarningErrorCode8

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.

InformationWarningErrorCode9

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.

PbsItemCode

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.

MedicareNumberNotificationEndDate

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)

MedicareNumberValidToDate

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.

NetPrice

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.

PbsCancelNum

Preassessment : NClaiming : NCancellation : Y

Use: CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was cancelled.

PbsReferenceNum

Preassessment : YClaiming : YCancellation : Y

Use: Preassessment, Claiming, CancellationLevel: Prescription RecordUnique identifier created by the HIC when the prescription was pre-assessed.

Result

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.

TimeOfPreparation

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).

UniquePharmacyPrescriptionNum

A/N

Preassessment : YClaiming : YCancellation : Y