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.

Privately prescribed items outside the PBS

Useful resources

TAC & WorkSafe: www.tac.vic.gov.au/providers/for-health-professionals/other-medical-professions/pharmacists/how-to-invoice-the-tac

Pharmaceutical Benefits Scheme

www.pbs.gov.au

Medicare – compensable patients

www.medicareaustralia.gov.au/public/services/scripts/pbs-compensation.jsp

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 1300 654 329

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 8630 1000QBE 9246 2226Gallagher Bassett 9297 9000Allianz 9234 3800XChanging 9947 3000

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 WorkSafeTo make a formal complaint to the TAC or WorkSafeInterpretation of TAC or WorkSafe policies, guidelines or item codes

Pharmacy calls

1300 654 329

Can the TAC representative

answer the query?

TAC representative

emails Provider Support

Can HDSG Provider Support answer?Escalate to

Clinical Panel

Provider SupportContacts Pharmacist by

phone / email

Case studies:

No

No

Clinical Panel may speak directly to Pharmacist

Yes

Yes

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

HDSGCommercial

Agent answers the enquiry

Communicates IMA’s feedback to Pharmacist

Agent contacts

Pharmacist

WorkSafe emails answer to Agent rep.

Agent writes to Pharmacy

17

Questions?