North Yorkshire Council Claims Procedure


Public Health Services: Pharmacy Claims Procedure

This information is also available as a download:

General Information

spreadsheet claim form template will be emailed to each provider. This will include worksheets showing

  • provider information and which services will be provided
  • activity in the claim month for each service
  • space for the commissioner to highlight any disputed payments
  • an invoice that is automatically generated from the service activity entered

As much of the data is formula driven many cells are locked and providers cannot alter them, only cells highlighted in yellow can be updated by providers.

The claim form needs to be completed each month with activity data for the preceding month. Extra lines can be added to each worksheet using the “add line” button at the top of each page (this works when you’ve clicked in a cell in the bottom/lowest yellow row).

Completed claim forms need to be emailed to publichealth.claims@northyorks.gov.uk by the 5th working day of the month. This deadline ensures enough time for the information to be checked, authorised and paid by the commissioner within the calendar month. If you have a problem with a particular deadline due to illness or holidays, please get in touch and we will do our best to help.

The commissioner expects that all claim data will be provided electronically. If a supplier has a specific issue then they need to contact the commissioner well in advance to discuss. Claim forms will not be accepted in any other format or hard copy without the prior agreement of the commissioner.

Detailed guidance for completing the claim form for each service is given below.  Failure to provide the data requested may result in delays processing and paying claims. Providers who have specific issues need to contact the commissioner in advance of the claims deadline to discuss.

  • Claims that are received after the 5th working day of the month will be processed as and when received but with no guarantee of payment by a certain date.
  • Providers cannot claim for activity before the date they have signed up to provide a service.
  • Activity undertaken prior to the start of this contract on 1st April 2013 needs to be claimed from the PCT as per their instructions.
  • Detailed information about the requirements for each service is in the service specifications.

If you have queries about the claims process please email publichealth.claims@northyorks.gov.uk

Pharmacy Services Detailed Guidance

Pharmacy Information

The pharmacy information is currently blank as we are using a generic template whilst we work with individual pharmacies to overcome problems with the template and sign up. Once these are resolved, we will issue templates populated using provider information received during the provider registration process, including information on what services a pharmacy is contracted to provide.

In the meantime, please fill in the pharmacy information in the yellow sections.

If there are any changes to pharmacy information please email publichealth.claims@northyorks.gov.uk

For each claim please update the month and year as required.  The month should refer to the month that the activity was carried out in not when the form is completed, e.g.  If filling out a form in May with data from April then the claim month should read April.

Month and year information will pre populate the other worksheets.

A separate template should be completed for each month’s claim. However, because of the delays in issuing the template, April and May can be claimed on one claim form – pick the April/May option on the drop down box.

Smoking Cessation

This worksheet records all NRT provision associated with smoking quits. (The NRT access voucher scheme needs to be shown separately on the NRT Access Scheme worksheet).

The pharmacy needs to record the client initials and first 4 or 5 digits of the client postcode (i.e. not the last 2 digits: DL1 1xx or DL7 5xx).

Please use the drop down boxes to show the products supplied, the quantity and whether any payment was received for products. The prices for these products are automatically calculated within the claim form.

If a product is not shown, please chose the “Item not listed” option from the drop down box and let us know what the item was and the trade price when you email your claim to us. This information will be checked to the current drug tariffs at http://www.ppa.org.uk/ppa/edt_intro.htm and will then be added to the invoice and you will be notified of the amended invoice total.

All payments received from patients need to be recorded.

Please note that we cannot pay for NRT issued prior to 1 April 2013 – this needs to be claimed using the PCT Q4 payment process.

Quit info

This worksheet shows 4-week quitters. Please enter the client’s initials; the first 4 or 5 digits of their postcode; the agreed quit date; and the 4 week follow up date(25 – 42 days).

Quits should be claimed in the month that they were validated – so for example if the quit date was in June and the 4-week follow up was in July, it should be claimed on the July form.

The client record data for all quit attempts must continue to be sent to the Stop Smoking Service (not us). Please note that we will not pay for quits unless the client record has been received by the Stop Smoking Service.

The £20 payment for mouthpieces to each pharmacy signed up to the service during April will be paid separately. This is not shown on the claim form.

Please note that we cannot pay for quits where the quit date was prior to 1 April – these need to be claimed using the PCT Q4 payment process and should not be included on this claim form.

NRT Access Scheme

The pharmacy needs to record details of the voucher number, the date the product was dispensed, the detail of the product(s) supplied and the number of each using the drop down boxes and whether any payment was received for the products.

The price for these items will be automatically calculated within the claim form.

If a product is not shown, please chose the “Item not listed” option from the drop down box and let us know what the item was when you email your claim to us. . This information will be checked to the current drug tariffs at http://www.ppa.org.uk/ppa/edt_intro.htm and will then be added to the invoice and you will be notified of the amended invoice total.

Please note that we cannot pay for NRT issued prior to 1 April 2013 – this needs to be claimed using the PCT Q4 payment process and should not be included on this claim form.

Supervised Consumption

The pharmacy needs to record the client initials, the first 4 or 5 digits of the client postcode and the name of the GP/Prescriber.

Please use the drop down box to show the products dispensed and detail:

  • Number not collected
  • Number taken home
  • Number supervised

Emergency Hormonal Contraception

The pharmacy needs to record for each activity the date the product was dispensed, the name and registration number of the pharmacist who dispensed the drug, the age of the patient and first four or five digits of their postcode, the reason for supply using the drop down box, whether the patient was offered the condom distribution scheme, how many times the patient has obtained EHC in the last 12 months and whether Levonorgestrel 1500 was supplied.

The price for these items will be automatically calculated based on the current drug tariff for the month being claimed which is available at http://www.ppa.org.uk/ppa/edt_intro.htm

  • Levonorgestrel 1500 is the only drug item which can be claimed
  • Consultation fees will be payable whether Levonorgestrel 1500 was supplied or not.

Pharmacies also need to provide as part of the claim:

  • total numbers of patients seen over the age of 24 who were unable to be treated under the scheme in the claim month
  • total number of patients eligible for the scheme who had to be signposted to other services for treatment due to services not being available at the pharmacy

Disputed Payments

If some element of the claim is being disputed, maybe due to an incorrectly completed claim form or gaps in the data then the commissioner will note it here and the payment related to the disputed element of the claim will not be paid automatically. Providers will be made aware of any disputed payments within 10 working days of their claim being received by the claims deadline.

When a disputed element has been followed up and a payment is due this will be added to the next month’s claim using section b of this worksheet.

Invoice

The invoice is automatically generated from the activity information entered onto each work sheet. Any disputed payments will be taken off and any disputed payments that have been settled will be added back in.

If there’s anything we can help with, please get in touch via publichealth.claims@northyorks.gov.uk