Loading Claim Reply Files

How do I check that claim reply files have all been loaded?

In Toniq Dispensary, from main menu

4. Electronic Claiming, 

1. Edit Claim, to see the list of recent claims.

STATUS - Meaning

ACCEPTED - Claim file sent to Te Whatu Ora Sector Services AND reply file received, loaded and saved.

SENT - Claim file sent to Te Whatu Ora Sector Services. This claim has NOT had its reply file loaded so it may not have been processed, some or all items may not have been paid. All historical SENT claims should have replies loaded (back to the start of online claiming)

NEW - Claim(s) that have not been sent to Te Whatu Ora for payment. These should be dated in the current claim period (at the top of the list).

There may be more than one if pharmacy process requires daily claims. There should normally be No NEW claims pre-dating the last claim period. If there are, contact Toniq for advice, you may be missing out on Rx payments.

Page down through your claim files – all historical files should have an ACCEPTED status (to start of OLC)

How to load a Te Whatu Ora Line by Line claim reply file into a SENT claim

Select the SENT claim to load the claim item details onto screen.

Press F3 Load Reply and wait for the reply to load.

Remember to press F12 Save Claim (not Escape)to save the claim with its reply

When should the Claim reply file be loaded routinely?

It should be loaded at least BEFORE you prepare and send your next batch. 

Ideally, it should be loaded soon after the claim is sent. The errors (if any) can be fixed immediately, usually from the claim itself, ready for the next batch. The reply file is usually available by the next day and is often ready within a few hours.

Most pharmacies are setup to automatically remind users to load the reply file 3 days after a claim is sent. The number of days (3) can be changed (in claim options) if required by the pharmacy.