PCRS CLAIMS Flashcards

Question

SUBMISSION OF CLAIMS FOR **EARLY PAY**

Answer 1

To qualify for **early payment**, electronic claims must be received by PCERS no later than **midnight on the 3rd** working day of the month **To avoid technical issues, advisable to submit initial claim file on 1st day of the month** **Supporting paperwork** must be received by close of business **5th of the month** which moves to the next working day if this falls on a weekend or bank holiday. If not, processed eventually but payment will be late Working days are defined as **Monday to Friday** and **exclude** Bank Holidays Software immediately confirms submission file received by PCERS CAN REVIEW **TRANSMISSION HISTORY** FILE ON PHARMACY APPLICATION SUITE UNDER THE **CLAIMING TAB**

Answer 2

Claims submitted electronically and received at PCERS **after the 3rd working day and by midnight of the 7th** will be paid in the **normal pay cycle**. If this falls on a weekend or bank holiday deadline moves to the next working day. Schedule of deadline claim submission dates is circulated annually

Answer 3

Available to download **within 4 working days from receipt** (Most cases 24hrs) Rejected claims should be examined, corrected and resubmitted **No limit** on number of download and resubmission cycles **FINAL SUBMISSION MUST BE RECEIVED NO LATER THAN MIDNIGHT 8TH WORKING DAY**

Answer 4

**Summary of Claims Certificate** at the top of the appropriate bundle **Bundle 1** GMS Regular (fully coded) GMS exception (HE and not fully coded) GMS from previous month (due to emergency dispensing) Stock Orders Dental (DTSS) **Bundle 2** DPS, LTI, HIGH TECH, EU (EEA) HAA and EC CLAIMS Do not secure yellow bags with staples Secure bundles using treasury tags & elastic bands

Answer 5

**Pharmacy Application Suite > Supplies** www.pcrs.ie * unified claim forms * treasury tags **Summary Forms** * GMS * DPS * LTI/EEA/HAA * Methadone * High Tech **Yellow Bags** ordered via email to PCRS.Supplies@hse.ie

Answer 6

P76 Details of claims paid are reported on **Detailed Payment Listing** Available online within a week of payment **Early Payment = 15th (submitted by 4th)**

Answer 7

**Reason for rejection** of payment sent **24hrs** after electronic submission to PCRS Reclaims should be submitted no later than **8th working day** All final exception files should be download (not available after 8th?) Queries can be submitted using the **Pharmacy Query Form** on Pharmacy Application Suite Online Services > Services for Pharmacists Only > Query Form for Pharmacists (reclaims **not** to be sent via this method)

Answer 8

Under Finance Act, PCRS must deduct withholding tax (20%) from all payments for professional services by pharmacists under all schemes.

Answer 9

**AT RISK GROUPS FREE TO ALL** (6-23mths and 13-64yrs because 65+ and 2-12 free anyway) from GP or Pharmacy **ALL 65+ FREE** regardless of risk or scheme All healthy children **2-12yrs FREE** regardless of at risk/scheme by GP/Pharmacy (**nasal LAIV** unless contraindicated) At risk groups may need a **second vaccination** which is also covered free Intramuscular vaccine is QIV Intranasal is LAIV

Answer 10

**Respiratory Disease** - COPD, mod/severe Asthma, Cystic Fibrosis, bronchopulmonary dysplasia **Pregnancy** any stage **Heart Disease** (Inc history of heart attack and angina) **Renal Failure** **Liver Disease** **Neurological Disease** eg MS, CNS Disorders **Immunocompromised** due to disease or treatment (inc chemo) **Carers & Household of at risk patients** **Diabetes Mellitus** **Morbidly Obese** BMI 40 **Haemoglobinopathies** **Nursing home residents** **Healthcare Workers & Carers** **Down Syndrome** **65yrs + and 2-12** People on close contact with **pigs, poultry and water fowl**

Answer 11

The Primary Care Reimbursement Service (PCRS) will receive, process, and integrate electronic COVID-19 and influenza vaccination payment claims from **HSE PharmaVax** Payment is via electronic claims submitted by the vaccinations recorded in HSE PharmaVax (**record specific batch, injection site, PSI number, at risk/eligibility**) Payment claims will be validated, loaded, reimbursed, and included on the pharmacies monthly statement

Answer 12

An Individual Health Identifier (IHI) is a number that identifies each person who has used or may use a health or social care service in Ireland. Each individual will be assigned their own personal number which is unique to them. The main benefit of having an IHI is to uniquely identify each service user and therefore, improve patient safety by reducing errors that might happen, such as ensuring patients receive the correct medication, vaccinations, and treatment.

Answer 13

**Adverse Reaction Reporting** The Health Products Regulatory Authority (HPRA) is responsible for managing the **national pharmacovigilance system** The HPRA reports nationally occurring adverse reactions to the EMA. This enables the EMA to continue to safeguard public health safety. The HPRA must be informed using the Adverse Reaction Report (Yellow Card System).

Answer 14

**Reporting of Incidents during a Vaccination Session** In the case of medication errors that directly involve the vaccine recipient, i.e., **wrong medication/dose/route being administered** or another medication error the incident must be recorded in your pharmacy incident records and a full investigation should be undertaken to identify the root cause of the incident. The **vaccine recipient and/or significant others should be informed of the incident** The **NIO** (National Immunisation Office) will be able to advise on required follow up. contact using immunisation@hse.ie **do not use patient identifiers in this communication** Any suspected adverse reactions associated with medication errors should be reported to the HPRA.

Answer 15

**HSE PharmaVax** allows pharmacies to record details of and claim reimbursement for COVID-19 and influenza vaccinations administered. The portal is used to record vaccination events. **It is not a tool to be used to support clinical decision making and it does not have scheduling functionality** **Note**: Please do not enter any “test” vaccinations on the system as these will be treated as bona fide records. Refer to the **most recent version of the HSE PharmaVax User Guide** via Healthmail after each update. The **Vaccination History Lookup portal** should be checked by the pharmacist prior to vaccination to identify a patient’s current eligibility. This portal is available through the PharmaVax system. **Google Chrome** Firefox and MS Edge (latest version) are the recommended browsers. • Internet Explorer is not recommended. Chrome is preferred.

Answer 16

Pharmacists must enter records of vaccination asap onto HSE PharmaVax to ensure **update of the patient vaccination history which may be accessed by other vaccine providers** This will **reduce the risk of inadvertent duplicate vaccination by different providers** accessed by the same patient Additionally, there is a **requirement for pharmacists to forward to the HSE within 7 days** by electronic means, specific details relating to a vaccine administration. The following details are recorded on HSE PharmaVax and transferred to the HSE automatically and satisfy that requirement: a) the **date of administration** b) the **name, address, contact number(s), email address(es), ethnicity, pregnancy status, date of birth and sex** of the person to whom the product was administered c) **Consent** d) the patient’s **PPSN** number; the **name and batch number** of the product (**not serial number**) **expiry date** e) the **name, business address, email and telephone number of the person who administered the vaccine and the number of his/her professional registration** h) the **name, address and telephone number of the GP** if any) of the person to whom the product was administered For a full list of vaccine record requirements in Community Pharmacy please refer to the PSI website. A record of the vaccination with **batch level detail** must be provided to the patient.

Answer 17

*Removal of COVID-19 Sharps from Community Pharmacy Sites* **Stericycle Services** will be providing a COVID-19 sharps disposal service on behalf of the HSE. Pharmacies should contact **serviceireland@stericycle.com** or 1800 937 628 for removal of sharps containers, quoting account number **9607596** Stericycle will only accept those sharps bins supplied by the HSE for this service.

Answer 18

**HSE NATIONAL COLD CHAIN SERVICE VACCINE RETURN FORM** Complete form and place in box with vaccines for destruction **Only unused/unopened vaccines** in their original packaging received from NCCS should be included. **SHARPS MUST NOT BE INCLUDED** NCCS Account Number: 300_ _ _ _ Name of Site: Phone: Customer Name: Customer Signature: Date: Customer email: PLEASE COMPLETE IN FULL Product Name Quantity Batch / Lot Number Expiry Date: Bexsero Boostrix DiteBooster Engerix B Fendrix Fluenz Tetra (LAIV) FLU (QIV) Gardasil 9 Havrix Junior Havrix Monodose HBVAXPRO 5 HBVAXPRO 40 Hiberix Infanrix Hexa Menitorix Menjugate M-M-RVaxPro Nimenrix Pneumovax Prevenar 13 Priorix Revaxis Rotarix Tetravac COVID -19 Note: COVID19 vaccine expiry date is superseded by “Use Before Date”.

Answer 19

**Sequencing of vaccination in PharmaVax** For **COVID-19 vaccinations**, dose sequence should follow **Primary Course Dose 1, Primary Course Dose 2** (where clinically indicated), and **additional dose** (where clinically indicated). **Booster doses** should only be recorded after a primary course/additional dose record. It is important that the dose sequence is correct on entry to ensure that clinical records are up to date and that payment is issued from PCRS For **Influenza vaccines** if an individual is clinically eligible for a single dose of Influenza vaccine, the *course complete* box in PharmaVax should indicate *yes* For individuals that clinically **require a second dose of Influenza vaccine** during the season, the *course complete* box should indicate *no* on the first dose.

Answer 20

*Vaccine Stock and Consumables* The vaccine supply chain is managed by the **NIO** (National Immunisation Office) and the **HSE National Cold Chain Service** (NCCS). Pharmacies order online through **www.ordervaccines.ie** (See National Immunisations Office for comprehensive information on Vaccine Ordering and Storage) *Ordering Vaccines* The **HSE NCCS will deliver COVID-19 and Influenza vaccines** Appointments should be scheduled based on the expected vaccine delivery as per NCCS delivery calendar *Vaccine Consumables for COVID-19 in Community Pharmacy* A national distribution service (JMC Logistics) will deliver consumables to pharmacies participating in the COVID-19 programme. **When ordering COVID-19 vaccine stock on NCCS, the system will ask you if you require COVID-19 clinical consumables** Tick the “YES” box to receive packs in line with your order volume. If sufficient packs are available in your site tick the “NO” box and none will be delivered. For further information, please refer to VPCC Guidance Note 1 on COVID-19 vaccine consumables

Answer 21

**Free to GMS females without Rx** No prescription charge but pharmacist paid a **consultation fee** **79996** if EHC supplied 79997 if **no product supplied** Service recorded on PMR under normal GMS claims procedure **selecting correct drug code for EHC** as above **Pharmacy Contract Number** inserted as **Prescriber** **Patient must sign a Unified Claim Form** (UCF) to confirm they have received the service Pharmacist confirms on UCF stating: *I confirm that I have counselled the patient and provided the service and/or product listed in compliance with the relevant protocol* **Pharmacist signature and PSI Reg No** Top copy of UCF submitted with GMS Claims using form number **valid medical card holders only**

Answer 22

HIV Pre-Exposure Prophylaxis (PrEP) is the **preemptive use of oral anti-retro viral therapy (ART)** in HIV negative people to reduce risk of HIV infection In 2019, HSE approved reimbursement for **fixed dose combination of oral emtricitabine/tenofovir** On GMS/DPS for **HSE APPROVED PERSONS ONLY** No prescription charge to patient and free on eligible GMS and DPS if approval **Pharmacy can apply for *DPS Express* if not registered** Patient **must complete eligibility process for their *patient specific* approval** info to become visible on Secure Checker Pharmacy Application Suite > Eligibility > **Patient Specific Arrangements**

Answer 23

You might benefit from PrEP if: 1: You are having sex without condoms with HIV-positive partners who: * are not on HIV treatment, or * are on treatment but not virally suppressed (do not have an undetectable viral load) 2: You are a man who has sex with men. This includes transgender men who have sex with men or a transgender woman who has sex with men, and 1 of the following: * had anal sex without condoms with more than 1 partner in the last 6 months * likely to have anal sex without a condom in the next 3 months * had an STI in the last year * used HIV post-exposure prophylaxis (PEP) in the last year * used recreational drugs for sex (also known as chemsex) in the last 6 months 3: You are considered to be at risk of contracting HIV through sex or sharing injecting drug equipment. **You are not eligible for free PrEP if** you are: * in a **mutually monogamous relationship** with a partner who is living with HIV who is on treatment and virally suppressed * in a mutually monogamous relationship with a partner who is known to be HIV negative

Answer 24

**MYLAN 77100** *Emtricitabine/Tenofovir disoproxil 200mg/245mg FC Tablets x 30* and **TEVA 77101** *Emtricitabine/Tenofovir disoproxil 200mg/245mg FC Tablets x 30* Type in HIV Pre-Exposure Prophylaxis and look for GMS coded products **Reimbursement Claims submitted for patients who are not HSE approved will not be paid**

Answer 25

**CLAIMING** - Vaccination Services - Phased Dispensing - Transmission History - Claim Enquiry

Answer 26

www.pcrs.ie Online Services **Pharmacy Application Suite** Eligibility > *Secure Scheme Checker* - Use **PPSN to retrieve all patient specific eligibility information** - **Family Grouping** option displays details of persons in family group **Patient Specific Arrangements** can be used to check if patient approved for: - Phased Dispensing - Special Drug Requests (eg additional diabetic test strips, Fampridine, Entresto, ONS, DOACs, Versatis, Freestyle Libre) Can also check patient’s **Prescription Charge Status** **LTI illness codes and Core Lists** available directly from Scheme Checker (inc approval of non-core list items for that patient) **APPLICATION FOR ADDITIONAL ITEMS TO BE ADDED TO PATIENTS LTI CARD** Pharmacists and GPs can see date of vaccinations under *Vaccination Services*

Answer 27

*Pharmacy Application Suite > Correspondence* All Pharmacy Circulars **only** available on Pharmacy Suite or HSE website Can search using Ctrl F

Answer 28

www.pcrs.ie > Online Services > Pharmacist - apply for **Phased Dispensing** - **High Tech Ordering** & management - **Express DPS/LTI** applications - **Ordering Supplies** - **Vaccination Services** - **Special Drug Requests LTI** Queries in relation to Special Drig/Phased Approval requests are managed by Pharmacy Function Unit on 01 864 7100

Answer 29

A **hospital emergency** claim (from public hospitals **61559**) is available to **EU** patients Pharmacist can give **maximum 7 days** supply against hospital prescription Claim submitted on *Unified Claim Form* and in **all cases a copy of the Irish hospital prescription should accompany the claim**

Answer 30

Up to date list of reimbursable drugs available at: www.pcrs.ie > List of Reimbursable Items (Or Google it!!) **Only licensed medicines show on list** **GMS and DPS** items on list **drug codes also listed on UD website when ordering products and in pharmacy software** *Withdrawn Drug* means drug code no longer valid and item will not be paid for

Answer 31

Under **no** circumstances should a duplicate claim be submitted to PCRS. Only one of same drug code should be listed as a line item on a claim form. **Items should not be split into separate items to facilitate multiple flavours**

Answer 32

*not participating in scheme on date of claim* ensure correct **GMS Panel** number *no paperwork received please provide original claim* **supporting documentation required** *no claim made on form* on **Dental/EU** prescription claim form had **no drug codes endorsed on it** *unable to claim service code with prescription* relates to **EHC** when patient’s GP number had been submitted instead of **Pharmacy Contract Number** in prescriber field *withdrawn drug* item no longer reimbursed

Answer 33

Must have **Pharmacy Authorisation by the HSE** to access stock (takes upto 48hrs) **Once off process** and pharmacy can obtain stock thereafter Continue to notify the HSE by forwarding blue stock order forms to *pharmacy.response@hse.ie* Circulars 040/18 and 003/19

Answer 34

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PCRS CLAIMS Flashcards

(58 cards)