Resources

If you feel there were exceptional circumstances that were outside your control with regard to the handling of your claim, you can request a review of your claim under an Exceptional Circumstances process.

To begin this process, you must comprehensively outline your situation in an Exceptional Circumstances Request Form, attach any additional information to substantiate your claim, and email your request to the Support Centre at support@ppaonline.com.au. We will refer all requests to the Department of Health and Aged Care (the Department) for their consideration.

The Exceptional Circumstances process can take up to 30 days to be completed and you may be required to provide further evidence to substantiate your position. Please note that this process is for exceptional circumstances only.

Exceptional Circumstances means circumstances that are out of the ordinary, unavoidable or unexpected, and may have affected your ability to make a claim for payment that meets the requirements of this Agreement and the relevant Program Rules.

For example, exceptional circumstances could include but are not limited to:

• Property damage due to flood, fire or theft that resulted in a disruption to normal operation
• Power outages that last the remainder of the claiming period
• Software or IT concerns that last the remainder of the claiming period.

Circumstances that would not be considered ‘exceptional’ for example could include but are not limited to:

• Staffing difficulties including leave, resignations, handovers, locums etc.
• Forgotten submissions.

Ultimately, it is the Service Providers responsibility to ensure appropriate processes and procedures are in place, to ensure claims are submitted correctly and within appropriate timeframes.

Please note that services performed during the Seventh Community Pharmacy Agreement will no longer be able to be submitted as Exceptional Circumstance requests from 30 September 2024. Following this date, requests will only be sent to the Department for services completed on or after 1 July 2024.

The Pharmacy Programs Administrator (PPA) is aware that many pharmacies and other registered service providers use a range of software packages to manage their operations and record information in relation to the services they provide.  Due to the real-time validation functionality that has been built into the PPA Registration and Claiming Portal (Portal) to enable ‘fast track’ payments, claiming data cannot be uploaded in a spreadsheet format.

In order to enhance the claiming experience for pharmacies and other service providers, the PPA has developed an API for some programs to enable interested software vendors to integrate their software with the PPA Portal for claiming purposes.  

This approach will potentially reduce:

• Time associated with data entry
• Risk of error when transferring or entering data.

We currently offer an API for following programs:

• MedsCheck and Diabetes MedsCheck
• Home Medicines Reviews (HMRs) – initial service claims (not follow-up claims)
• COVID-19 Vaccination in Community Pharmacy (CVCP)
• Residential Medication Management Reviews (RMMRs) – initial service claims (not follow-up claims)
• Opioid Dependence Treatment (ODT) Community Pharmacy Program – ODT Staged Supply and Injection claims
• National Immunisation Program Vaccinations in Pharmacy (NIPVIP).

At this stage we do not have set dates on when APIs may be offered for other programs however, interested vendors can be added to our contact list if they wish to be kept up to date with any new developments.

If you would like to be included on the list of software vendors that we contact, please email sv.support@ppaonline.com.au and provide:

• Software company name
• Contact name
• Email
• Phone number
• A brief overview of:
  • Your software. For example, is it professional services software, booking software, dispensing software, something else entirely?
  • The relevant program/s you are interested in potentially integrating with
  • Whether your software is currently being used by any pharmacies/businesses and if so how many?

Please ensure you complete the details listed above in your enquiry. 

The Integration Process

Once we have your details, we can provide you with:

• Public API specification documents, data dictionaries and a a guide to setting up your API Vendor Profiles
• Details for our Sandbox Testing Environment so you can test your solution
• API Licence Services Agreement.

Please note before being provided with access to the Live Production environment software vendors must:

• Have an executed API Licence Services Agreement
• Provide the PPA with a demonstration of their software solution
• Have rectified any issues identified by the PPA during the demonstration. 

Archived Program Rules can be found on the Archived Program Resources Page.

From 1 February 2019, all claims and applications must be submitted to the Pharmacy Programs Administrator. The Pharmacy Guild were responsible for processing and paying claims it received up to and including 31 January 2019, including subsequent resubmissions in relation to those claims.