Claims and payment processing

The Program was announced by the Prime Minister, Scott Morrison on 5 January 2022. Later that same week, AHA’s Pharmacy Programs Administrator (PPA) was approached to administer payments for the Program to participating pharmacies. 

The PPA worked with the Australian Government in an extremely compressed timeframe to develop Program Rules, website content, FAQs, Support Centre training documentation and communications to pharmacies regarding the Program. These were all finalised and published prior to the Program commencement date of 24 January 2022. 

For claiming and payment purposes a new system was required to be built to hold and validate data provided by GuildLink (the software that pharmacies used to enter RAT transaction data). The new system then integrated with the existing PPA Portal to upload the validated data as claims for payment. A reporting dashboard showing payment amounts broken down by payment date, pharmacy, RAT quantities etc was also created for PPA Support Centre operators to answer queries from pharmacies.

The first dataset was received from GuildLink on 14 February, with PPA making the initial payment to pharmacies on Tuesday 15 February 2022. All payments were made according to the payment schedule agreed to between the Commonwealth, the PPA, the Pharmacy Guild of Australia and GuildLink. 

Over the lifetime of the Program (just over six months) the PPA made payments to 5,769 pharmacies for 69,577,528 RATs, with payments totalling $828,673,369.
  
The PPA also undertook monitoring and compliance activities during this time on behalf of the Commonwealth to ensure the veracity of claims and payments made to pharmacies, which included:

• Educative emails to all participating pharmacies
  
  
• Data analysis on RAT claiming patterns which led to 150 pharmacies being contacted regarding their claims
  
  
• Follow up with over 100 pharmacies regarding tip offs received from pharmacists/general public.