At a recent meeting with the PCRS we raised the issue of withheld payments on all items on a prescription where one item has been rejected. We advised that pharmacies are experiencing serious financial losses due to this practice by the PCRS. Furthermore, the PCRS were advised that the number of claims being rejected is increasing due to the larger volume of items with reimbursement restrictions now applied. We have insisted that it is an area that must be addressed urgently by the PCRS and will be engaging with them further to have this issue addressed once and for all.
We would advise members that a way to reduce these rejections is to revise and submit exception claims as soon as possible. If you are unsure of how to process exception claims, contact your vendor for support.
