Claim Errors: How to Resend or Resubmit

• From the main go to 4. Electronic claiming > 1. Edit claim.
• Select the most recent claim with the Status of Sent or Accepted:
  
  
  • If Sent, press F3 Load reply to see which items have been paid or need to be fixed.
    
    
• The items with errors are usually found at the top of the claim but F8 Find then Error Unpaid or Rx number can be used.
  • Sort functionality, using F10 Other then 6 Medicine generic name, 7 Medicine brand name, or G Error code, can be used if there are patterns to the errors to group them.
    
    
• Use F2 View / Edit to edit the script within the claim.
  • See Claim Error Investigations for tips to find the causes of errors.
    
    
• Once the error has been fixed, press F4 Status and mark the item 1 Resend - For rejected Rx, not processed by MOH or 3 Resubmit - For paid Rx, MOH to re-calculate:
  
  
  
• Items in a sent claim marked as Resend or Resubmit will automatically be brought forward into the next new claim when it is created:
  • Resend = a request for payment of an item not on Health NZ/Te Whatu Ora records (i.e. the item has not been paid before).
  • Resubmit = a request to re-process an item in the Health NZ/Te Whatu Ora system (i.e. it has been paid previously).

Notes

• A deleted script is treated as a payment and then an immediate reversal by the claiming system, therefore a repeat that has been credited in a claim should be resubmitted if re-dispensed.
• Items can also be marked Resend or Resubmit from a patient's history using F2 View/Edit.
  • Press F5 Claim History to access the F6 Resubmit and F7 Resend function keys.
• Grammatical case matters:
  • Sent, Resent, and Resubmitted are statuses of what has happened to items in a processed batch.
  • Resend or Resubmit are marked on items to go automatically into the next batch.
  • Resending or Resubmitting are the statuses of items in a new claim waiting to be sent.

See also Claiming Process.

Reviewed: 10/12/2024