6Claims Transmission System—procedures

6 Claims Transmission System—procedures

(1) For paragraphs 98AC(4)(b) (under co‑payment data) and 99AAA(8)(c) (claims for payment) of the Act, this rule defines the procedures to be followed by an approved supplier in giving information to the Secretary by electronic means.

Note 1: The procedures defined in this rule constitute the Claims Transmission System.

Note 2: The Claims Transmission System may contain modifications due to the effect of special arrangements under section 100 of the Act, or to facilitate the payment of additional fees to approved suppliers that are not paid as a claim under section 99AAA of the Act.

(2) The approved supplier must give the information to the Chief Executive Medicare, on behalf of the Secretary: (a) in writing; and (b) by means of an electronic communication; and (c) in accordance with any other requirements that would need to be met in order for the requirement to give the information in writing to be taken to have been met under the Electronic Transactions Act 1999.

Note: Under that Act, the Chief Executive Medicare may require the information to be given in accordance with particular information technology requirements or by means of a particular kind of electronic communication (or both).

(3) The information must be generated using one or more computer programs that ensure the following: (a) that the approved supplier is prevented from altering the description in the computer program of the pharmaceutical benefit or its PBS item code under Schedule 1; (b) that the information in the computer program for each pharmaceutical benefit is: (i) in accordance with the Act, and instruments made under the Act, as in force at the time the pharmaceutical benefit was supplied; and (ii) encrypted when it is given to the Chief Executive Medicare; (c) that the approved supplier is able to take all reasonable precautions to ensure that information relating to the supply of a substance that was not, in the circumstances, a pharmaceutical benefit, or that was a pharmaceutical benefit but was supplied contrary to section 89 of the Act, is not included; (d) that, if the approved supplier makes the certification required by subrule 5(1A) otherwise than in a form mentioned in paragraph 5(1)(a): (i) the Chief Executive Medicare is notified of the certification; and (ii) the approved supplier is warned, before the certification is made, that giving false or misleading information is a serious offence under section 137.1 of the Criminal Code.