5Procedures

5 Procedures

(1) For the purposes of paragraphs 99AAA(8)(a) and 98AC(4)(b) of the Act, an approved supplier, when providing information to the Chief Executive Medicare on behalf of the Secretary, whether making a claim under section 99AAA, or, providing under co‑payment data in accordance with subsection 98AC(1), is to follow these procedures: (a) the information shall be given in accordance with the relevant form approved by the Chief Executive Medicare (if any); and (b) except as provided in subparagraph (d), the information shall be given in respect of pharmaceutical benefits supplied during a period not exceeding 35 days; and (c) except as provided in subparagraph (d), the information shall be furnished to the Chief Executive Medicare not more than 30 days after the last day of the period in respect of which previous information was supplied; and (d) where the Chief Executive Medicare is satisfied that an approved supplier was unable, through circumstances outside the approved supplier’s control, to comply with paragraphs (b) or (c), the information may be given outside the requirements of those paragraphs; and (e) except as provided in paragraph (f), the information shall not be furnished to the Chief Executive Medicare during the same calendar month as any previous information relating to supplies of pharmaceutical benefits; and (f) notwithstanding paragraph (e), the information may be given to the Chief Executive Medicare in the same calendar month as the previous information in accordance with an arrangement between the approved supplier and the Chief Executive Medicare in which the approved supplier has proposed that additional information be accepted in a calendar month and which the Chief Executive Medicare, provided that he or she is satisfied that the arrangement will not impose additional administrative expenses on the Chief Executive Medicare, has accepted. Certification (1A) The approved supplier must certify: (a) that each pharmaceutical benefit to which the information relates was supplied by, or on behalf of, the approved supplier in accordance with the National Health Act 1953 and the instruments made under it, or the RPBS; and (b) that the information is correct.

Note: Paragraph 6(3)(d) sets out requirements for the Claims Transmission System about warnings and notifications that apply if the certification is not included in a form mentioned in paragraph (1)(a).

(1B) The approved supplier may make the certification in a form mentioned in paragraph (1)(a) or in another manner. (1C) In certifying for the purposes of paragraph (1A)(a), the approved supplier must: (a) identify the range of the serial numbers for each payment category referred to in Schedule 1 allotted in respect of the pharmaceutical benefits; and (b) specify the total number of pharmaceutical benefits for each of those payment categories; and (c) identify the claim period number, and the claim reference, referred to in Schedule 1 in relation to which the information is given. Additional procedure if claim made using the manual system (2) If the approved supplier is making a claim using the manual system, the information must be accompanied by the prescriptions: (a) upon the presentation of which the pharmaceutical benefits that are the subject of the claim were supplied; and (b) on each of which that is not an authority prescription, a repeat authorisation, a deferred supply authorisation or a prescriber bag supply form, shall be marked a stamp format in the area on the extreme left of the prescription, horizontally aligned with the pharmaceutical benefit to which it relates in such a way as to avoid obliterating any other information on the prescription; and (c) on each of which shall be marked in the S section or S sections one or more serial numbers by the approved supplier, allotted in respect of each pharmaceutical benefit as follows: (i) in respect of general benefit prescriptions—commencing at “1” in each claim and continuing consecutively in respect of that claim; and (ii) in respect of concessional benefit prescriptions and concession card prescriptions—commencing at “C1” in each claim and continuing consecutively in respect of that claim; and (iii) in respect of entitlement card prescriptions—commencing at “E1” in each claim and continuing consecutively in respect of that claim; and (iv) in respect of prescriber bag supply forms—commencing at “1” in each claim and continuing consecutively in respect of that claim; and