Preparing your Claims

Throughout the month, and at any point before you send off your End of Month claims, you can review and prepare the scripts you wish to claim for. There are two major steps in the Preparation stage:

  • Validation: tell the system which scripts you want to claim for
  • Verification: run some key checks to ensure there are no major errors with the scripts that would prevent payment

Below you will find more information on each of these steps.

Validation

How to Validate Scripts for Claiming

Before you can send your claim, you first need to tell the system which of the scripts you have dispensed throughout the month you wish to transmit to HSE PCRS for reimbursement.

For a quick video on the Validation process please follow this link: https://vimeo.com/312093820

To begin validating scripts:

  • Select the Claims option under Modules

claims02

  • The main summary screen will be displayed
  • Select the Claim Period that you wish to claim for

claims02

  • A total of all scripts that have been dispensed under each scheme will be displayed under Not Validated
  • Press the Not Validated tab to begin validating the scripts
  • Select the scheme you would like to validate first
  • On this screen you will see a listing of all scripts for the currently selected scheme

Note - A script on loan will not go through claims, the script must first be repeated then claimed.

claims02

  • Check each script to ensure all items have the correct patient reference, date, scheme, doctor and product gms number
  • Tick Validated for each script that you have reviewed and want to Validate as a script you wish to claim.
  • If you need to follow up on a script/item or you're unsure if you can claim for it and want to return to it a later point, tick the Query box, this will hold the script in this section for later review

Quick Tip: Use the spacebar to mark scripts as validated and use the arrow keys to move between scripts for quick navigation

  • Tick each script that has been validated
  • If you have bulk validated them, tick Validate All button
  • Press Apply
  • All scripts under the selected scheme will move to the Validated tab

Verification

How to Verify Scripts After Validation

  • Press the Validated tab and ensure you are still on the expected scheme
  • All scripts should be ticked
  • Press Verify for Claiming

claims02

  • Once you press Verify for Claiming all scripts will be verified by the system for the selected scheme(s)
  • If there are identifiable errors in azny scripts that have been verified the system will show a dialog once verification is complete showing you a summary of the errors
    • Please see the next section for details on handling Verification Errors
  • Once all scripts are fixed they can be verified again by ticking the scripts and pressing Verify for Claiming
  • All successfully verified scripts will now move to Ready To Claim status and can be see in the Send Claim tab

IMPORTANT: please note that when you validate Drugs Payment (DPS) scripts, the system will automatically "hide" scripts for DPS families that have not yet met the threshold for claiming - see our Additional Tasks (LINK GOES HERE) section for more info!

Verification Errors

If there are errors in any scripts that have been verified then the system will display the following dialog detailing the errors:

claims02

  • If the following column is ticked:
    • Prescriber No: the GMS Number is missing or invalid for the Prescriber
    • Open the Patient maintenance screen, double click on the Prescriber's dropdown list and find the doctor in question. Enter the GMS code for the prescriber.
    • Alternatively, if an incorrect Doctor has been selected for the script, Edit the dispense and change the GMS Doctor assigned to the script.
    • Product No: the GMS Number is missing or invalid for the Product
    • Edit the script highlighted and either select a different product that has a GMS code or enter a GMS code for the product.
    • Patient Ref: the Scheme Reference Number for the affected patient is missing or incorrect
    • The Patient reference (their scheme card number) is entered on the Patient maintenance screen.
    • The PCRS online Card checker can be used to verify the patient reference or contacting the PCRS directly.
    • Dupl. Scheme: the affected patient has more than one of the same Scheme on their Edit (F3) screen
    • Open the Patient’s file and open the Patient maintenance screen, Select the duplicate scheme and click the ‘Deleted Scheme’ button
    • Form Number: the Form Number is missing or invalid
    • Not Disp Reason: the Not Dispensed reason is missing or invalid
    • Qty: the Dispensed Quantity is missing or invalid. Quantity needs to be non-zero unless the item is Not Dispensed and must be greater than zero
    • Repeat Part Error: the Repeats Made or the Maximum Repeats information is missing or invalid
    • Amount Error: the Total Cost is missing or incorrect. If the Total Cost of an item is 0.00 you will see this error.
    • Edit the script and correct the Cost Price or select another product with an amount assigned.
    • Extemp Item: the item is marked as an Extemp Item but does not have the correct GMS Number. GMS Numbers for Extemp items must begin with 99 e.g. 99189.