Additional Claims Tasks

Claiming for High Tech Not Dispensed Fee (Patient Care Fee)

As part of providing the service of dispensing High Tech drugs to the patient, pharmacies are eligible to claim a High Tech Care fee, also known as a Patient Care Fee for handling these products for patients.

Pharmacies can claim a Patient Care Fee in the following circumstances:

• The same month a High Tech Drug is dispensed.
  • This is claimed normally by dispensing the item and sending it in the Claim.
  • This will give you the full Patient Care Fee (approx €63.52)
• In the 1st month after a High Tech drug has last been dispensed and is not being dispensed this month.
  • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
  • This will give you the full Patient Care Fee (approx €63.52)
• In the 2nd month after a High Tech drug has last been dispensed and is not being dispensed this month.
  • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
  • This will give you HALF of the Patient Care Fee (approx €31.76)
• In the 3rd month after a High Tech drug has last been dispensed and is not being dispensed this month.
  • This is claimed by dispensing the drug and marking it as Not Dispensed and giving it the relevant Not Dispensed Reason.
  • This will give you HALF of the Patient Care Fee (approx €31.76)

It may also be necessary for you to amend the GMS Number against your dispense to a GMS Number beginning with 88xxx. please check with the HSE/PCRS on this if you are unsure what GMS Number should be placed against the dispense in order to correctly claim the Patient Care Fee for the item in question.

To Claim a Continuing Care Fee for Hi-Tec Patients:

In the claims section there is an option to create all at once, the claimable HT scripts ( patient care fee scripts) for the month that you are claiming for.

Go to the Claims Module and select HT Care Fee

Press Select All at the bottom right hand side of the page

Once the selected tick box beside all the scripts are ticked then press request

A pop up box will now appear. Put in your pin number and the reason for the not dispensed scripts

Once you press okay a message will appear to say how many scripts are now in the Not validated tab for the HT Scheme

Go back to the Status Tab and in the HT Scheme Not Validated section those scripts are now ready to be verified/validated for claiming.

You can also manually create HT Patient care fee not dispensed scripts on a Patients PMR

• Select the patient's record as normal
• Select the last Hi-Tec dispense for the patient
• Repeat the Dispense
• Click 'Not Dispensed', or Hit Alt & T
• Enter a Not Dispensed reason
• Edit the GMS No., replace with "88999"
• If there is more than one item dispensed, replace the GMS No. for each item
• Complete the dispense as normal.

• In the Claims module:

• Validate and Verify the dispense as normal