Additional Claims Tasks

To Claim a Continuing Care Fee for Hi-Tec Patients:

  • Select the patient's record as normal
  • Select the last Hi-Tec dispense for the patient
  • Repeat the Dispense
  • Click 'Not Dispensed', or Hit Alt & T
  • Enter a Not Dispensed reason
  • Edit the GMS No., replace with "88999"
  • If there is more than one item dispensed, replace the GMS No. for each item

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  • Complete the dispense as normal.

  • In the Claims module:

    • Validate and Verify the dispense as normal

FAQ's - How Do I Process my DPS Claims with FEMPI

Special Note: 
In your first month with the FEMPI enabled the version of TouchStore Rx, ALL DP Scripts dispensed prior to the upgrade WILL be marked as Can Claim.

Why? Prior to your upgrade, DP scripts are calculated as normal using the IPU Trade price and pre-FEMPI pricing schedule. As such, TouchStore Rx does not have the PCRS reimbursement value to calculate the FEMPI value of the script. Therefore, we must set ALL DP Script as Can Claim – for the first month. Any DP dispenses completed after your upgrade - to the FEMPI enabled version - will have the Can Claim flag determined using the PCRS reimbursement price (see questions below for more info).

N.B. Be aware: Please be careful of DP families who have scripts dispensed both before the upgrade and after the upgrade for the same claim period. As dispenses completed prior to the FEMPI upgrade, will not have a FEMPI Total available on the script record, TouchStore Rx may determine the Can Claim flag incorrectly. These forms may need to be manually marked for claiming.

What Do I Need to Do to Separate my DPS Scripts Under the Co-Payment Threshold Before Clicking Verify for Claiming?

Nothing. TouchStore Rx automatically separates DPS scripts per family, for claiming at the time of dispense. As you complete each DPS Script, TouchStore Rx calculates the FEMPI family total. If the FEMPI Family total is under the co-payment threshold, the Can Claim flag is set to FALSE for all script records for that family, for the current month.

If the FEMPI Family total is over the co-payment threshold, the Can Claim flag is set to TRUE for all script records for that family, for the current month. After you have validated all DPS Scripts for the current month, you can simply click 'Verify for Claiming' as before.

Note: As always, please check that all script records have been entered and validated correctly. An incorrect entry can result in the Can Claim flag being set incorrectly.

How Do I Get a List of Forms That Are Under the Co-Payment Threshold to Remove Those Forms from my Claim Bundle?

How Do I Remove the Below Threshold Paperwork (DPS Forms / Unified Claim Form Receipts) From Claims Bundle Before Posting to the PCRS?

How can I view forms that are under the co-payment threshold?

  • Open the claims module
  • Select the month being claimed for
  • Open the Validate tab for the DPS Scheme
  • Click the "Under Co-pay" button

TouchStore Rx will now display all forms that are calculated as being under the co-payment threshold. These forms can be removed from the DPS form bundle before posting to be PCRS.

How Can I View Forms That Are Over the Co-Payment Threshold?

By default, TouchStore Rx will always display DPS Scripts that are over the co-payment threshold.

If you have previously clicked the "Under Co-Pay" button, and TouchStore Rx is displaying forms under the co-payment threshold;

  • Open the claims module
  • Select the month being claimed for
  • Open the Validate tab for the DPS Scheme
  • Click the "Over Copay" button

TouchStore Rx will now display all forms that are calculated as being over the co-payment threshold.

Do I Need to Calculate FEMPI Values?

Do I Need to Click the Calculate FEMPI Button at the Top of the Claims Module Before Claiming / Separating DPS Scripts?

Short answer, no. TouchStore Rx automatically calculates the FEMPI value of ALL scripts at the time of dispense, and for DPS scripts, determines if the family is above or below the threshold. The Calculate FEMPI button allows users to re-calculate the default Dispensing fee allocated at the time of dispense. As the FEMPI regulations have introduced a sliding scale dispensing fee, based on the number of items dispensed during the month, TouchStore Rx must use a default dispensing fee value for calculating FEMPI script values during the month, as the total number of items dispensed for the month, is not known until the end of the month.

The Calculate FEMPI button can be clicked at any time to re-determine the likely dispensing Fee to be allocated to a given dispense. Allows users to view the estimated claim value of scripts dispensed to date. The Calculate FEMPI function is automatically run when you click the “Send Claim” button, so there are no additional steps when submitting your claim.

How Can I View the FEMPI Family Total?

To view the FEMPI Family value of all scripts dispensed to a selected family;

  • Open the claims module on the Validate tab, or select one patient's file, from that family
  • From the PMR Console, or the Validate tab in the claims module, Hit F5
  • This opens the standard “F5 DPS Analysis screen”

A new “FEMPI Family Total” text box has been added to the top of this screen.

How Can I Set as Form as Claimable? How Can I Manually Set as Form to be Claimed?

To set a form that is currently flagged as Can Claim FALSE to Can Claim TRUE;

  • Highlight the script record on the validated tab of the claims module
  • Click the "Set Can Claim" button
  • TouchStore Rx will change the Can Claim flag to TRUE
  • The validated tab scripts grid will refresh and the script record will disappear

Click the "Over CoPay" button, to confirm that the record is now set to be claimed.

How Can I Set as Form as NOT Claimable? How Can I Manually Set as Form to NOT be Claimed?

To set a form that is currently flagged as Can Claim TRUE to Can Claim FALSE;

  • Highlight the script record on the validated tab of the claims module
  • Click the "Set Can Claim" button
  • TouchStore Rx will change the Can Claim flag to FALSE
  • The validated tab scripts grid will refresh and the script record will disappear

Click the "Under Co-Pay" button, to confirm that the record is now set NOT to be claimed.

Form Number Format

Example: GM1806/0056

  • GM: The scheme shortname, GM = General Medical Services, must always be two characters only
  • 18: The year the script is being claimed for, must always be two digits only
  • 06: The month the script is being claimed for must always be two digits only, includes leading zeroes where applicable e.g. 01-09
  • /: this separates the scheme and date information from the Sequence number
  • 0056: The Sequence number, this tells you this script was the 56th script for this scheme in this month and year. Must always be four digits only, includes leading zeroes where applicable e.g. 0001-0999

N.B. the FORM NUMBER only controls which Claim Period the items will be sent in and is not strictly tied to the Dispense Date. It is also not reviewed by the PCRS to check whether items are being dispensed at least 28 days apart either, this is handled by the PCRS looking at the Dispense Date, not the Form Number.

E.G. You can have a GM item dispensed on 23rd March 2019 and it may receive a Form Number such as GM1903/0045. If you do not transmit it in your MARCH Claim you can change the Form Number to any subsequent claim month, e.g. APRIL or MAY and then send it in that month. The Dispense Date will remain the same and the PCRS will reimburse you if the Claim is valid based on the Dispense Date.

Claiming for High Tech Not Dispensed Fee (Patient Care Fee)

As part of providing the service of dispensing High Tech drugs to the patient, pharmacies are eligible to claim a High Tech Care fee, also known as a Patient Care Fee for handling these products for patients.

Pharmacies can claim a Patient Care Fee in the following circumstances:

  • The same month a High Tech Drug is dispensed.
    • This is claimed normally by dispensing the item and sending it in the Claim.
    • This will give you the full Patient Care Fee (approx €63.52)
  • In the 1st month after a High Tech drug has last been dispensed and is not being dispensed this month.
    • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
    • This will give you the full Patient Care Fee (approx €63.52)
  • In the 2nd month after a High Tech drug has last been dispensed and is not being dispensed this month.
    • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
    • This will give you HALF of the Patient Care Fee (approx €31.76)
  • In the 3rd month after a High Tech drug has last been dispensed and is not being dispensed this month.
    • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
    • This will give you HALF of the Patient Care Fee (approx €31.76)

It may also be necessary for you to amend the GMS Number against your dispense to a GMS Number beginning with 88xxx. please check with the HSE/PCRS on this if you are unsure what GMS Number should be placed against the dispense in order to correctly claim the Patient Care Fee for the item in question.

No Send Claim Button

If you are in the Send Claim tab in the Claims module and there is no Send Claim button, please ensure you are on your Claiming PC. You will not be able to send your Claim on any other RX PC

How to see a list of all previously sent Claims

There are two places to find a listing of items previously sent in a Claim:

  • DataViewer
  • Claims Module -> Claimed Tab