Resend(ing) = a request for payment of an item which is not on MOH records, meaning the item has not been paid before.

Resubmit(ting) = a request to re-process an item which is in the MOH system, usually meaning it has been paid previously.


An item marked Resend or Resubmit will automatically go into the next claim created. If the item is marked Resending or Resubmitting it is already in a new claim waiting to be sent.


Note: Credits item can break these guidelines, if in doubt call Toniq.


Tools:

  • In the claim, use Claim History F5 to check previous payment/non-payment
  • Check the script itself for any anomalies, e.g. whether the /1 is marked NS and the repeats A4
  • Check for edits:
    • Go to 3. Reports > 8.Audit reports > 1. Audit prescriptions
    • Select the Rx number, tick Show all edited items, enter the appropriate dates
    • Run the report by pressing F12 Accept Details
  • Use external sources, such as Special Authority Lookup – taking careful note of the start/expiry dates


*** Call Toniq if a script item has been rejected multiple times and you would like further advice. ***