Claim Errors for Incorrect Pack Sizes

Background

Due to recent Pack Size / UOM Pharmacode Changes, the quantities on repeats and new prescriptions (if you use the Copy function) must be adjusted. If this is not done, incorrect quantities will be dispensed and claimed.

For example, Ensure Plus Vanilla 200mL is now Ensure Plus Vanilla 1 Op. To dispense 1 bottle, the quantity needs to be 1 instead of 200. If 200 is entered on the repeat or copied script, i.e. without changing the quantity, many times the amount given to the patient will be claimed.

HealthNZ are in the process of identifying pharmacies affected, however, you can follow the steps below to identify and fix scripts that may be affected.

Process

If a list of script numbers has been provided, skip to 2. Fix Prescription Quantities and Reclaim.

1. Find Scripts with Incorrect Quantities

The Prescription Details Report can be used to find any items that may have incorrect quantities. It should be run for each product dispensed that had a pack size description change on 1 April.

Note: HeathNZ will contact pharmacies where a quantity error results in a claim for a significant value, but may not do so for smaller value claim items. This report may therefore still be a useful check.

1. From the main menu, go to 3. Reports, 2. Prescriptions reports, then 2. Prescription Details.
2. Set the Start date to 01/04/25 00:00 and the End date to the current date (to cover the period from when the pack size descriptions were changed).
3. Enter Food as the Medicine class (as many changes made were special foods):
   
4. Press F12 Accept Details.
5. View or print the list of medicines to be checked for errors in pack size using the function keys. 

A separate report should be generated for each pharmacode with a change in pack size description dispensed. See Pharmac's Changes to pack size descriptions for a list of affected products, which includes both the new and previous pharmacodes.

2. Fix Prescription Quantities and Reclaim

Note: For scripts identified by HealthNZ, the scripts must be resent/resubmitted in a claim with the same end date as the items were originally claimed. (Scripts found using the steps in 1. Find Scripts with Incorrect Quantities above, and not from HealthNZ, may be resent/resubmitted in the next batch following the usual process.)

For each affected script:

1. Find the prescription number in the claim:
   • From the main menu, go to 4. Electronic claiming, then 1. Edit claim.
   • Select the claim with the errors, e.g. 1 - 7 April.
   • Press F8 Find, then Rx number to find a script number from a list provided or generated via Find Scripts with Incorrect Quantities above:
     
   • Press F2 View/Edit and adjust the quantity to the correct amount based on the new pack size by:
     • Pressing F2 Edit Rx, edit the Quantity field, and Enter to the end of the entry fields.
     • Press F12 Accept Details and F11 End Edit.
   • Press F4 Status and select 1 Resend if the item hasn't been paid or 3 Resubmit if it is marked Paid in the claim.
   • Continue this process until all items with a pack size change has been edited to the correct quantities.
   • Press F12 Save Claim.
     
     
2. Create a new claim for the same period that will generate all resent/resubmitted items from the original claim:
   • Press 1. Edit claim then press F3 New Claim.
   • Enter the same Start Date and End Date as the claim just edited to ensure the payment dates match those at HealthNZ, and press F12 Accept Details.
     • Items that were resent/resubmitted per the steps above should come up in this new claim.
   • Do the regular claim checks then press F11 Send Claim.
     
     
3. Load reply for duplicate claim.
   • Load the reply using F3 Load Reply before the next claim is created to ensure that all items have been accepted.
     • Fix any errors per Claim Error Investigations if straight forward, else call the claiming extension at Sector Operations (0800 855 066) or contact Toniq.
       
       
4. If there are more claims with these errors, follow the above steps but with different claim dates.