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Request Reference: 7784 Request Date: 21 Jun 2018
Request: I would like to request 5-day window EPS analysis for the last financial year (April 2017 – latest data available for May 2018) showing dispense claims received in the leeway period where the dispense notification was sent prior to the start of the leeway period. [Name Redacted] kindly shared some earlier analysis he undertook in 2017 on the EPS claim messages received between 1st – 5th of the following month for items with a DN claim sent in the preceding month. This analysis covered the period April 2016 – January 2017 (see attached a summary document along with explanation below) Tab Claims recd 1-5: This shows for each month the number of ETP claims (forms) and the percentage of all ETP claims this represents. - So for April 2016 11% of claims were received 1st – 5th of May. Tab Perc of total claims 1-5: This shows the percentage of a contractors batch that was received 1st – 5th with the number of contractors and the percentage of those contractors that submitted late. - So for April 2016 67 contractors (0.9% of contractors who submitted a late claim) submitted between 71% and 80% of their entire batch between 1st and 5th May. Also on this tab is the number of ETP contractors who submitted 0 claims late and those that submitted at least 1 claim between 1st – 5th. - So, for April 2016 2920 contractors (24%) submitted all their claims in the dispensing month, whereas 8942 (75%) submitted at least 1 claim between 1st and 5th of May. Tab Size late subs: This shows the size of a contractor’s batch that is sent between 1st and 5th of the following month. - So, again for April 2016, 6 contractors sent in between 4,001 and 5,000 claims between 1st May and 5th May. - This will help us examine any changes to submission practices since the last analysis period and understand the impact of increased EPS volume on the 5-day window. Given that EPS Phase 4 will result in significant spike in EPS items, we are looking to explore the impact of the 5-day rule to ensure contractors are claiming correctly and on time. Additionally, one of our Committee members [Name Redacted] has requested if BSA can provide EPS data for his pharmacy from April 2017 to latest available data for 2018. [Name Redacted] is an example of a contractor who regularly submits and claims – so it would be good to see how this affects his reconciliation The figures required are for [Pharmacy and code Redacted] showing EPS claims per month and number of claims made during the 5-day window to include: • Number of claims where CN was received in the leeway period and DN was sent prior to start of the leeway period • Separate report showing number of claims where both DN and CN were received in the leeway period

Status: Complete
Response Date: 19 Jul 2018
Response: Please see attached response