Claiming EPS scripts in time

Claiming EPS scripts in time

When to Send dispense and claim messages?

There are two key EPS notifications which can be sent to the central NHS Spine using your local PMR system:

(1) dispense notification; and

(2) claim notification – includes endorsement information and information on the charge status of the prescription

Delay prior to claiming: At present, pharmacy staff have the option of putting a prescription to one side on the dispensing bench, for example if pharmacy staff are waiting for an invoice to endorse the price paid for a product on the prescription or if a product is in short supply but the NCSO Concession has not yet been granted. In the same way, pharmacy staff will be able to choose to delay submission of the ‘claim’ message until the required additional information is available.

Checking exemption status and endorsement prior to claim: Some pharmacy contractors may prefer that staff, for example locums, do not submit the ‘claim’ message at the same time as the ‘dispensed notification’ message to allow the contractor time to check that a prescription has been endorsed fully and appropriately before submission.

Sorting by dispensed prescriptions to be claimed: Pharmacy systems will provide pharmacy staff with a list of electronic prescriptions which have not been submitted for reimbursement so that these can be completed and submitted when appropriate.

Amending after a claim: From August 2014, suppliers can introduce functionality so that prescriptions can be amended before the pricing agency ‘locks’ them for pricing. If your supplier has not added this feature you may wish to discuss this matter with them.

Submitting paper: Pharmacies will have to continue submitting paper prescriptions (and tokens where required) to the pricing agency on a monthly basis.

Payment Window

For paper prescriptions, the pricing agency process all prescriptions included in the physical bundle for each given month.

For electronic prescriptions, for each given month, the pricing agency consider all electronic prescriptions with a dispensing notification during that month where the claim message was then received by them by the end of the 5th day of the following month.* For example:

A form and item sent to the Pricing Authority on the 5th November but dispensed in October (e.g. dispensing notification date = 30th October) would be included with October prescriptions. See examples below:

*Drug Tariff Part II Clause 5A explains pharmacies should submit prescriptions by the 5th day of the month following that in which the supply was made.

5daypaymentwindow

First ‘dispense’, then ‘claim’: A claim message cannot be sent to the pricing agency until a dispense notification message has been sent for every item on the form. If the product is not going to be dispensed or is only going to be part dispensed, the dispense notification message can be sent carrying this information.

EPS 6 month (180 day) script expiry

You will need to ensure that prescriptions are submitted in a timely way to prevent them reaching the six month expiry date. This takes place six months after the most recent ‘dispense notification’ is applied to a prescription, or after 6 months where the prescription is neither marked as dispensed nor claimed.
 
The HSCIC dispensing system specification explains EPS prescription expiry takes place to ensure that the size of the prescription database on the Spine remains manageable.

 

PSNC EPS expiry2

Further information. Examples of what might occur if all or part of an EPS prescription remains unclaimed:

Scenario 1 – Fully dispensed. No claim for 6 months

Prescription fully dispensed, but no ‘claim’ made within 180 days (six months) after the final dispense notification for an item. The prescription will expire, but should remain visible on the local pharmacy system. Payment will not be made at the Pricing Authority (see Reimbursement for expired prescriptions below).

Scenario 2 – Partially dispensed. No claim for 6 months

Some items are marked as dispensed, but one item is left as partially dispensed and no claim is made within six months:
A prescription which has been left marked as partially-dispensed or owing will have its status changed to ‘expired’ 6 months after the last dispensing event (see Reimbursement for expired prescriptions below).

It is recommended you claim for what was dispensed rather than allowing a prescription to reach its expiry because part of it was not dispensed. Where needed mark an item or part of an item with “not dispensed” and submit your prescription

Scenario 3 – No items dispensed (and therefore no claim made) for 6 months

A prescription which is held on the Spine with no items dispensed will be changed to ‘expired’ after the expiry date of the prescription and the prescription will not be available to be dispensed. If dispensing is required, the patient should be referred back to the prescriber for a new prescription.

Patient requires further dispensing episodes against an expired script

The patient should be referred to the prescriber so that a new prescription can be issued. (NB: The RPS issued guidance on the legal validity period for owing slips which depends on whether the prescription is for a Controlled Drug or not. Guidance on the legal validity period for owings differs from the automatic expiry caused by the Spine’s housekeeping rules to keep data on the spine manageable.)

Expired prescriptions will be held on the Spine for three months after expiry with no processing allowed on these items. If an attempt is made to ‘pull down’ the item for dispensing, the pharmacy will be sent a rejection message informing the pharmacy staff that the prescription has expired.

Reimbursement for an expired prescription

After expiry an electronic reimbursement claim to the NHSBSA could not be processed. A manual request (which may be based on an average) must be made to the local NHS England team who may speak with the Pricing Authority on the issue. PSNC is in discussion with NHS England on arrangements for the manual submission of reimbursement claim requests in these circumstances. Your Local Pharmaceutical Committee may be able to assist with making a claim to the local NHS England team, and the LPC itself may seek assistance from PSNC on this.

Ensuring your system prevents prescriptions expiring before claims have been made: Does your system do this adequately yet?

System suppliers have flexibility to introduce or improve the warnings and reports to alert pharmacies that prescriptions have gone unclaimed

This is a key area for contractors to discuss with their pharmacy system suppliers to ensure that systems meet the needs of pharmacy staff.

Example discussion points:
  • What reports and alerts will be in place in the system to alert pharmacy staff of the need to claim these outstanding prescriptions when these accidentally go unclaimed?
  • Will there be a regular warning when logging in, advising that there are x number of prescriptions which were marked as dispensed more than three months ago but have not yet been claimed?
For further advice on making your pharmacy system work for you see here.
 

Factsheet summarises “Claiming EPS scripts in time”

The information on this page is summarised in a factsheet here (pdf):

Frequently asked questions

Q: I have dispensed two items on the prescription but have only partially dispensed the third item, how can I claim for the whole prescription?

A: Where a prescription has gone unclaimed for some time, you may choose to claim for what was dispensed rather than allowing a prescription to reach its expiry because part of the prescription was not dispensed. Where needed mark an item or part of an item with “not dispensed” and submit your prescription. Some contractors may choose to collect or use patient’s telephone numbers to inform patients about uncollected medicines.

Q. What happens if a price concession is announced after the date that I have sent my claim message to the Pricing Authority for an EPSR2 prescription?

A. Price concessions, once granted, apply for the whole ‘dispensing month’. For example a price concession announced on August 30th applies to the entirety of your August ‘prescription bundle’.

Your August prescription bundle is made up of all your paper prescriptions which are sent to the Pricing Authority by the 5th September and all the EPS prescriptions which fall into the August dispensing month (see below). Prescriptions for any one dispensing month are not priced until the Pricing Authority receives both the electronic and paper prescriptions as the FP34C submission document is needed from the paper bundle to calculate the advance payment for the contractor.

How a dispensing month is determined for electronic prescriptions is outlined below:

eps timing mini table

Related resources

eps arrow green-previous eps box green- home eps box green- Endorsing, submission& reconciliation eps arrow green-next

 

 



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