Journey of Presciptions

• The electronic message is sent by the prescriber and the prescription is then presented by the patient to a pharmacy of their choice
• When the barcode is scanned it brings down the electronic prescribed message allowing for you to generate a dispensed message in the PMR containing all the relevant electronic messages and endorsements for payment
• When you submit the paper prescription for payment it is scanned, bringing down the electronic message, and linking the two together
• The electronic message passes through ePay and where there is information that could not be extracted, they are entered manually (e.g. barcodes) and put back into automation
• The business rules are applied via ePay, if the ePay check fails for reasons such as the prescribed message does not match the dispensed, the claim is passed to an operator where they will use the electronic message as the primary source of payment
• No image is presented unless it is a non-barcoded prescription, or has no electronic message

You will all have different ways of counting your prescriptions in the pharmacy, but it is important to remember what should be counted for your GP34 Declaration Form. All of your prescription forms and items should be counted except from eMAS & UCF which we will guide you through below.

eMAS, UCF and MCR will be counted differently from your other prescriptions.

eMAS

• For CP2 registration and consultation forms where only a referral or advice was supplied, these should be counted as 1 form, 0 items
• For CP2 consultation forms where treatment was supplied should also be counted as 1 form, 0 items, regardless of the number of items on the form. The form must be supplied for registration purposes, but the items will be paid electronically via eMAS

UCF

Universal Claims Framework (UCF) supports electronic claiming for pharmacy-led services. As these are sent electronically, regardless of whether a prescription is generated by your PMR, a paper form is not required, out with those that are required to be sent to the GP practice. No UCF form or item should be recorded on your GP34.

The only instance for pharmacy-led services where a form and item should be counted, is when a CPUS form is used where the CHI is not available.

For more information on UCF form requirements, please see the matrix table.

MCR

CMS CP3 registration forms should be counted as 1 form, 0 items. For MCR serial prescriptions, once the last instalment has been dispensed it should be submitted and counted as 1 form, 0 items. MCR items and instalments are paid electronically but the prescription is needed for auditing purposes.

For any items that have not been collected or not dispensed, ensure that the electronic message is amended before you submit the prescription.

• The prescription form has been signed by the prescriber
• The correct form has been used by the prescribers for their prescription. Always check that the prescriber code matches the form type. (e.g. Nurse prescribers may not use doctors’ GP10s and vice versa)
• Please take note that a red pen should not be used on any part of the prescription form
• All endorsements should be clear and in the correct place and that the corresponding electronic endorsement(s) has been applied to the relevant item
• Ensure all computer printed endorsements are clear. If the endorsement is faint it may not be seen on the visual image produced by the scanners
• Make sure the pharmacy stamp or any other markings do not cover the CHI number, prescriber code, serial number, barcode or endorsements
• Prescriptions for schedule 2 and 3 controlled drugs, ensure the person who collects the prescription has signed the appropriate area on the back of the form
• You have completed your GP34 fully

With the increase of automation and use of electronic messages for payment, we have developed our checking database to accommodate looking at these electronic messages to support you with accurate reimbursement and remuneration. We continue to report to pharmacy owners our observations on what we find and where applicable arrange for adjustments to be made via P&CFS.

Our prescription price monitoring includes:

• Random price checks on submissions
• Checks requested by contractors where there is evidence that a pricing problem has occurred or there is a concern that endorsements are not being applied
• Investigation of electronic claim information to verify allocated standard dispensing and instalment allocations relating to the dispensing pool payment

From our checks we give members feedback on the quality of their submissions detailing our findings of anomalies of endorsing (paper and electronic), claiming of handling charges, out of pocket expenses, ePay discrepancies on pack size and quantities, whole packs, Methadone fees and missed opportunities for instalment claiming and broken bulk and any adjustments that may be made.