Universal Claim Framework

The Universal Claim Framework supports electronic claiming for pharmacy-led services.

The Universal Claim Framework allows community pharmacy to manage and deliver pharmacy-led services from their Patient Medication Record (PMR) system. Claims for re-imbursement are sent as part of the dispensing process and included in the payment and reporting for that dispensing month.

Some services require a form to be printed as part of the service description. Information is printed on the form on who needs to see what service was provided to the patient. The pharmacy may also choose to print forms to support the dispensing and checking process in the pharmacy.

For some services supported by the Universal Claims Framework, the patient’s Community Health Index (CHI) number is needed to send the electronic claim. This number may already be known through previous contact with the patient but where the patient’s CHI number is not known the lookup facility in PCR allows the CHI number to be obtained using the patient’s details. Use of this facility has been approved for the following services.

  • Unscheduled Care
  • Public Health Services including Emergency Hormonal Contraception and Smoking Cessation
  • Healthy start vitamins
  • Gluten-free Food Service
  • Meningitis B Prophylaxis
  • Urinary Tract Infection (Pharmacy First)
  • Impetigo (Pharmacy First)

 The claim for the service should be submitted using the CPUS form if the patient’s CHI is not known and can't be looked up or it is not possible to submit the claim electronically.

Find out more about the Universal Claim Framework