FOI 25-0249 LD – MBS Items Excess

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This document describes the Practitioner Data Library, an internal Department of Health and Aged Care resource used by the Benefits Integrity Division's compliance staff to conduct practitioner reviews under the Practitioner Review Program. The Library provides automated access to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) billing data extracted nightly from the department's Enterprise Data Warehouse, eliminating the need for staff to access Services Australia directly for compliance investigations. Available reports include MBS/PBS billing summaries, 80/20 breach verification reports, age profiles for specific item numbers, daily service breakdowns, derived major specialty identifications, line-by-line billing data, and provider payment summaries. The document notes that Library reports use verified methodologies and updated business rules that may differ from historical Services Australia reports, with technical documentation available for reference. Custom data requests beyond available reports can be submitted through senior analysts.