Pharmacy Services Agreement 2010 Guide for Guild members

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confidential – for guild members onlyH7.2: Prescriber informationYou must provide NZMC numbers for more than 90% of the items in a claim. If a pharmacyfails to meet this target, the claim can be rejected.If a pharmacy is not receiving an NZMC number from a doctor, the numbercan be requested from the doctor, or obtained from the Medical Council(phone 04 384 7635). If these options fail the pharmacy should contact their DHB.Where the doctor supplies a PAN number on a prescription to identify the practice, this mustalso be provided.In instances where the doctor has separate PAN numbers for different practices(or a practice with a PAN number and a practice without a PAN) pharmacies mustprovide the appropriate number for the prescription. This is easily achieved bysetting up separate doctor records for each of the PAN numbers in the dispensarysystem and selecting the appropriate doctor record for the prescription.DHBs have indicated they will be happy for the proportion of PAN numberssupplied to grow over time as pharmacies receive prescriptions carrying them andrecord them in their dispensary systems.H7.3 Service User’sinformationYou must provide patient NHI numbers where they are provided on the prescription bythe prescriber.Pharmacies are not required to validate NHI numbers are correct or obtain themwhen the prescriber does not supply them. Pharmacies simply have to supplythose NHI numbers they receive. Prescriptions not carrying an NHI number willstill be subsidised.However, the requirement to provide NHI numbers will be auditable.Pharmacies only need to record the NHI number once in the dispensary systempatient record. It will then be supplied to Sector Services each time a prescriptionfor the patient is claimed. However, if the pharmacy receives a prescription for thepatient from a hospital or the patient moves to a new doctor, the pharmacy shouldcheck the NHI number provided against the patient record. If the NHI number isdifferent to the one in the record, the new number must be recorded in place ofthe existing number.H9: Late claim items Claims for an item must be submitted within six months of dispensing (nine months in thecase of an oral contraceptive). Claims not made within this time, may be submitted up to12 months after dispensing provided the claim is worth more than $20 and an explanationfor the delay accompanies the claim.H10: Verification of claimitemThe DHB may ask a pharmacy to substantiate any claim item. Sending a copy of theprescription to the DHB will satisfy this requirement. When requested, the pharmacy has15 days to provide the prescription.Notwithstanding the above, all original prescriptions associated with a claim must besubmitted to Sector Services. If you submit claims electronically you may retain prescriptionbatches for up to five months before submitting them.Batches should be filed in order of the date of processing.PAGE 24
confidential – for – for guild guild members only onlyH12: Payment time frames Where four-times-a-month claiming is allowed (ie online claiming):• claims received by the 7th will be paid on the 28th• claims received by the 15th will be paid on the 5th of the following month• claims received by the 23rd will be paid on the 12th of the following month• claims received by the last day of the month will be paid on the 20th of thefollowing month.Where only twice-monthly claiming is allowed:• claims received by the 15th will be paid on the 5th of the following month• claims received by the last day of the month will be paid on the 20th of thefollowing month.If the payment date is not a business day, then payment shall be made on the first businessday after the above dates.H18: Payment agent Sector Services (a business unit of the Ministry of Health) is the payment agent for all DHBs.H19: Access to records Pharmacies retain the right to audit payments made to them for services.PAGE 25
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Pharmacy Services Agreement 2010 Guide for Guild members

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