Summary of Covid related claims as of 1st October 2023

Tosupportrecentupdatesto GuidanceforPrimary Care Model of Care for Covid-19,seethebelowsummaryof claim types.

Halcyon claims should be made as activity occurs; payments are made on a monthly cycle.

Swab-based Activity Claims

If a RAT is required to be carried out by a clinician for an in-person consult, it will only be funded if positive and the patient meets the antiviral criteria.

NOTE: this is allocated under one funding stream, claims cannot be made separately for testing and proactive clinical assessment.

If a PCR is required as per testing guidance AND the patient meets the antiviral criteria this will be funded even if the PCR is negative. See COVID-19 Testing Operational Guidance: General Practice and Urgent Care here.

Those who meet

View this link for COVID-19 antivirals: Access Criteria and flowchart.

(further advance prescription when initial prescription has expired)

Primary

(pharmacist initiated supply of antivirals. Provision of advice OR additional information when a pharmacist needs support for a complex patient)

Those that meet anti-viral criteria OR, eligibility review that doesn’t meet criteria.

View this link for COVID-19 antivirals: Access Criteria and flowchart.

Information Effective 1 October 2023 Approved by PHO Clinical Director 1 | P a g e

Claim Type Amount (inc. GST) Eligibility Claim Via PCR & RAT Testing Consultationandtesting (PCR/RAT) $103.50 (Standard) $155.25 (Afterhours / Weekends)

Halcyon Covid-19 Community Care Assessment (2023) Community Management Claims Claim Type Amount (inc. GST) Eligibility Claim Via Standard Afterhours/Weekends Proactive Initial Clinical Assessment $103.50 $155.25 Those who meet antiviral access criteria View this link for COVID-19 antivirals: Access Criteria and flowchart. Halcyon Other Claim Types Claim Type Amount (inc. GST) Eligibility Claim Via Advanceprescriptionfor COVID-19 anti-viral medication $103.50 (initial prescription

$69.00

$51.75

consult)

(Initial prescription consult - No Prescription)

antiviral access criteria

Halcyon

Care Prescriber Support

$43.13

Halcyon

ADDITIONAL NOTES:

• After-hours on weekday is between 8pm-8am Monday – Thursday. Weekend rate covers Friday 5pm - Monday 8am and any public holiday. Most standard COVID-19 care is intended to be undertaken during business working hours (weekdays) with after hours and weekend reviews based on clinical need.

• A claim can be submitted for each person in a household who is COVID-19 positive, including probable cases.

• Claiming is limited to one type of claim per person, per day, per practice.

• Claims can be made for consultations undertaken by any means including in-person/telephone/video/text/patient portal.

• Pharmacy-initiated antiviral assessment and supply is supported by a funded consultation between the pharmacist and a primary care prescriber, where required for complex patients. This enables safe pharmacy-initiated supply in situations where there is limited access to patient information and can help avoid the need to re-direct the patient to a prescriber.

• No co-payments can be charged for the services funded within this guidance.

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