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About pharmacy claims

The Services are defined in the Agreement. Pharmacy payments are determined by the Agreement and variations to the Agreement.

Different transaction types generally have different processing requirements.

For example:

  • supply orders and Controlled Drug items have no patient contribution (known as abatement)
  • the patient contribution for Special Food items are calculated differently when different flavours are claimed on the same prescription form
  • Owe and Wastage items have no abatement or dispensing fees.

PHARMAC supplies a monthly Pharmaceutical Schedule, containing pharmaceutical pricing and dispensing regulations, which are used to determine the subsidies.

Dispensing costs are defined in the Agreement, and are funded by the district health boards.

Order more pharmacy stationery

Call 0800 855 066 to obtain copies or email customerservice@health.govt.nz.

  • High Use Health Card applications
  • Bulk Supply Order forms
  • Practitioner’s Supply Order forms
  • Batch Record Sheet (these are also available from within the Pharmacy Software; please contact your software vendor if you have any questions)

We will request your claimant details.

How to get a Pharmacy Agreement

If you have any questions or wish to arrange an agreement call the Sector Operations Contact Centre to find out more:


0800 855 066 – option 2 – Claims

Mon, Tue, Thu, Fri: 8am – 5pm
Wed: 9.30am – 5pm

Submitting hard copy prescriptions

Even if your pharmacy claims electronically, you must retain prescription batches for 5 months. After the 5-month period, prescription batches must be submitted to Sector Operations once or twice each month.

Send all completed claims to:

Ministry of Health Archives Warehouse
137 London Street
Whanganui 4500

Remittance Advice Codes

The following table lists codes  that are the standard approach to referencing/coding payments on the pharmacy's remittance advice.

Remittance Advice Codes
Remittance Code Description of Remittance Advice Codes
Casemix ADV (month/year)     Advance Case mix for that month
Casemix REV (month/year)     Reversal of Case  mix that month
Casemix ACT (month/year) Actual Case mix for that month
APASM (month/year) APASR (month/year) Both APAS payments for that month
LTCYYYYMM LTC for that month
LTCYYYYMM-2-OOC LTC Out of cycle payment - separate payment calculated if the pharmacy has changes ownership and has missed the LTC monthly payment or pharmacy has technology problems and missed LTC payments
A3/J3   Paid quarterly based on the agreement calculation and number of prescriptions within each pharmacy's claim that were claimed as A3/J3
Qtr Case Mix 3 monthly wash up - calculated as per the pharmacy agreement
S26/S29 Paid quarterly based on the number of prescriptions within the last quarter the pharmacy had dispensed under these two services.
COO” Anything with the above references but also has the additional code of COO Change Of Ownership payments - usually moved from old owner to new owner

Forms

Find the Pharmaceutical Review Services Claim form on the Pharmecutical society of New Zealand website.

Publications

Claiming Guidelines

Claiming Dates

Procedures Manual

Contact Sector Operations

Call the Sector Operations Contact Centre to find out more:
0800 855 066 – option 2 – Claims

Mon, Tue, Thu, Fri: 8am – 5pm
Wed: 9.30am – 5pm