Presentation on theme: "PHARMACY: Working with the TAC and WorkSafe The Pharmacy Guild Member Forum February 2015."— Presentation transcript:
PHARMACY: Working with the TAC and WorkSafe The Pharmacy Guild Member Forum February 2015
Objectives To better understand the Transport Accident Commission (TAC) and WorkSafe Victoria (WorkSafe) invoicing processes and requirements for pharmacists to allow prompt processing and payment of your accounts. Become familiar with the TAC and WorkSafe resources available to pharmacists. Understanding of when and how to escalate any unresolved issues.
Agenda Who is HDSG? Overview of pharmacy invoicing requirements for TAC & WorkSafe Requirements for submitting an account Case studies TAC & WorkSafe pharmacy contacts Questions
Health & Disability Strategy Group Who is HDSG? What is our role? HDSG Provider Support HDSG working with the Pharmacy Guild
Pharmacy Invoicing: What’s required? The TAC & WorkSafe can only pay for pharmacy items to treat a transport accident or work related injury or illness, that have been prescribed or requested by a medical practitioner. Over the Counter (OTC) items must be requested by a medical practitioner but a copy of the script is not required to be sent to TAC or the WorkSafe Agent. The request may be in the form of a prescription or message on letterhead requesting the use of the OTC item at the initiation of treatment. Requests should be kept on file at the pharmacy.
Before submitting an account: Ensure your patient has an accepted TAC or WorkSafe claim and has met the medical excess. Only one patient appears on each account. Ensure you do not issue the TAC or WorkSafe Agent with receipts or patient history reports. Ensure that your account is in the form of a dispensary computer-generated tax invoice. Include the status of an item, which may be handwritten on the tax invoice (e.g. OTC).
Invoicing requirements: Your patient can also choose to pay for their pharmacy items themselves and seek reimbursement from the TAC or WorkSafe Agent; therefore the patient may ask you for a dispensary generated tax receipt.
Privately prescribed items All TAC clients and injured workers with a Medicare card are entitled to medications under the Pharmaceutical Benefits Scheme (PBS). TAC & WorkSafe can pay the reasonable costs of medications that are provided in accordance with the PBS.
Over the Counter TAC & WorkSafe can pay the reasonable costs of OTC items in accordance with the following:
Contact information If you have a TAC query about a specific item for payment on your pharmacy invoice, you can contact the TAC on Freecall If you have a query regarding other matters related to a particular client (e.g. to check if TAC/WorkSafe is still liable to pay for a particular medicine) contact the client’s Claims Manager, have the claim number on hand if possible.
Contact information If you have a WorkSafe query about a specific item for payment on your pharmacy invoice you can contact the WorkSafe Agent: CGU QBE Gallagher Bassett Allianz XChanging
Escalating unresolved issues For escalation of unresolved issues you can contact The Pharmacy Guild, who will work with HDSG Provider Support to have the matter resolved. You can also contact The Pharmacy Guild for: Enquiries as a result of formal communication from the TAC or WorkSafe To make a formal complaint to the TAC or WorkSafe Interpretation of TAC or WorkSafe policies, guidelines or item codes
Pharmacy calls Can the TAC representative answer the query? TAC representative s Provider Support Can HDSG Provider Support answer? Escalate to Clinical Panel Provider Support Contacts Pharmacist by phone / Case studies: No Clinical Panel may speak directly to Pharmacist Yes YesYes Pharmacy contacted
Case studies: Pharmacist has a WorkSafe enquiry Contacts the Agent Agent cannot answer and communicates with their IMA IMA communicates with WorkSafe WorkSafe consults: Clinical Panel HDSG Commercial Agent answers the enquiry Communicates IMA’s feedback to Pharmacist Agent contacts Pharmacist WorkSafe s answer to Agent rep. Agent writes to Pharmacy