National Health Act 1953 - Amendment Rules under subsection 99AAA(8) (No. PB 85 of 2008) (Cth)
I, DECLAN JAMES O’CONNOR-COX, Assistant Secretary, Access and Systems Branch, Pharmaceutical Benefits Division, Department of Health and Ageing and Delegate of the Minister for Health and Ageing, pursuant to subsection 99AAA(8) of the
31 July 2008
____________________________________
Declan O’Connor-Cox
Assistant Secretary
Access and Systems Branch
Pharmaceutical Benefits Division
Department of Health and Ageing
These Rules are the
National Health Act 1953 - Amendment Rules under subsection 99AAA(8) No. PB 85 of 2008 .
These Rules commence on 1 August 2008 .
3. Amendment of the National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 49 of 2008) The Schedule amends the
National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 49 of 2008)
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.
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 |
Medicare Australia 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. Valid values include: 00-99 |
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. Valid values include: 00000-99999, A – Z Alpha character must be in upper case. |
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. Valid values include: 0000-9999 |
Claim reference | 14 | 17 | 4 | N | Four bytes numeric, values 01 to 9999, representing the number of claims within a claim period. Valid values include: 0000-9999 |
Pharmacy Software Name | 18 | 19 | 2 | A | Vendors will be advised of their code/s. Valid values include: AA-ZZ |
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. -. ( ) |
Carriage return and line feed | N/a | N/a | N/a | N/a | End of record |
PART 2 – PRESCRIPTION RECORD
The 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.
The prescription record is as follows:
Column 1 | 2 | 3 | 4 | 5 | Column 6 |
Field | Start | End | CH | Type | Description |
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. |
Form Category | 2 | 2 | 1 | A/N | One byte numeric, using the following values: 1 = original 2 = repeat 3 = original authority = repeat authorisation relating to an authority 5 = deferred supply authorisation 6 = prescription written by a participating dental practitioner 7 = doctor's bag order form 8 = DVA authority original form 9 = DVA authority repeat form Valid values include: 1-9 |
Payment Category | 3 | 3 | 1 | N | One byte numeric, batch category: 1 = general benefit 2 = PBS Safety net (free) 3 = concessional benefit 4 = repatriation 5 = doctor's bag order form Valid values include: 1-5 |
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. Valid values include: 0-9, A – Z, a-z |
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. Valid values include: 00001-99999 |
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. Valid values include: 0000000-9999999, A – Z |
Prescriber Id | 37 | 43 | 7 | A/N | Seven bytes numeric, right justified, space filled being the prescriber number of the prescribing medical or dental practitioner or authorised optometrist. Valid values include: 0000000-9999999 |
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. EG: 01012007 |
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. EG: 01012007 |
Date of Supply | 60 | 67 | 8 | N | In the case of owing prescriptions, this field should be protected. This field is mandatory. EG: 01012007 |
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. ‘1’* = hospital patient (not identified by any of the above) Blank/space is an invalid value. Valid values include: 0-9, A – Z |
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. Valid values include: 00000-99999, A – Z Alpha character must be in upper case. |
Brand | 75 | 76 | 2 | A | In the case of extemporaneously prepared items two spaces are to be left as no brand information is available. Valid values include: AA – ZZ |
Quantity | 77 | 81 | 5 | N | A value must be present for all items. Valid values include: 00001-99999 |
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. Valid values include: 0000000-9999999 |
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. Valid values include: 00-99 |
*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 filled. Valid values include: 000000-999999, A – Z Alpha character must be in upper case. |
* 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 space filled. Valid values include: 0-9, A – Z, a-z |
*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 filled. EG: 01012007 |
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. Valid values include: 00-99 |
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'. Valid values include: Y or 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'. Valid values include: Y or 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. Valid values include: 00000000 - 99999999 |
Authority Approval Number | 137 | 144 | 8 | A/N | To be sent to Medicare Australia CEO space filled until required. Associated check digit routines/formats will be provided in the future. |
Immediate Supply Necessary | 145 | 145 | 1 | A | One byte alphabetic field. Where immediate supply was necessary the value will be 'Y' or ‘S’ otherwise 'N' or blank. ‘S’ indicates that the prescription falls under the Safety Net 20 Day Rule and immediate supply was necessary. 'Y' or ‘S’ indications do 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. Valid values include: Y, N or S |
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. Valid values include: 00000000000-99999999999. |
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 (Where Immediate Supply Necessary is not ‘S’) or doctors’ bag order forms, this field is space filled. Valid values include: 0-9, A – Z Alpha characters must be in upper case. |
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. -. ( ) These are alpha characters |
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. -. ( ) These are alpha characters |
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. Valid values include: Y or N |
Pharmacy Processing Code | 249 | 250 | 2 | A/N | Numeric field, right justified; being a field which indicates that the Pharmacy has reason to contest the response from the Medicare Australia CEO. These will be in the form of a processing code (supplied to pharmacy by Medicare Australia ). The following are acceptable values: 00 – Processing code not required (default) 01 – New Centrelink Customer Indicator*** 02 – ISP not available Valid values include: 00-99 |
PBS Reference Number | 251 | 262 | 12 | N | Numeric field, right justified; being a number created by Medicare Australia 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. Valid values include: 0-9 |
return and line feed | N/a | N/a | N/a | N/a | End of record |
* New or enhanced fields.
**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.
*** 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.
PART 3 – CLAIM TRAILER RECORD
This details the end of the claim reiterating the claim number for the year and listing the number of prescription records in the claim.
Column 1 | 2 | 3 | 4 | 5 | Column 6 |
Field | Start | End | CH | Type | Description |
Record type | 1 | 1 | 1 | A | One byte alphabetic, value 'Z', to identify this record as being a claim trailer record. |
Number of scripts | 2 | 6 | 5 | N | Five bytes numeric, values 01 to 99999, being the total number of scripts in the claim. Valid values include: 00001-99999 |
Carriage return and line feed | N/a | N/a | N/a | N/a | End of record |
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