As practices transition over to eDental with their chosen supplier, we want to ensure your practice has all the advice and guidance you need to make the move to eDental as smooth as possible.
This article pulls together advice and guidance covering:
- top tips for a smooth transition to eDental
- ways to improve your claim turnaround when submitting eDental claims
Tips for a smooth transition to eDental
You can make the process of completing your claims as quick and easy as possible for your practice by reading the guidance for PMS, webform or the new error messages and following our top tips.
We’ve compiled some general tips and also specific points on observations and rejections.
eDental top tips
- make sure you submit claims regularly on the lead up to your transition date
- ensure you keep up to date with your claim rejections. Where practices have not been regularly handling their rejections, this has resulted in some additional effort for practices post implementation of eDental. It is our understanding that each system supplier has a facility available advising practices of claim rejections
- make sure you check through your claims before you submit, to ensure there are no missed treatments or duplicates for an individual patient. Once you receive a response stating successful submission of a claim, any missed treatment will need to be submitted on a DPD283 form
- when clearing out your claims, do not send claims older than three months from the completion date
- ensure you only provide observations where necessary. Details of when observations are required are included on guidance. Your claims are at risk of delay for payment if you provide information that is not relevant
- if your PMS supplier has provided guidance, please review and become familiar with any of the changes
- ensure you retrieve the latest payment schedule reconciliation file back on EDI and before you move across to eDental. We will advise your supplier of when the forthcoming payment schedule dates are, so that they can advise you accordingly if your switchover is around the same time
Improve your claim turnaround
Practice Management Systems (PMS) submitting eDental claims
The majority of PMS claims process directly through our payment system, MIDAS, and onward for payment. However, a number are being stopped unnecessarily, mostly due to observations. To help practices ensure continuous flow of claims for payment, please note the following:
What to do when you cannot find CHI number
If the CHI number is not in the system already, search for one by carrying out a patient detail search. You will either be presented with an exact match (where only one record in our system matches the patient details you entered) or, if there is not an exact match with a record in our system, a list of patient’s will be presented. Choose the correct patient from the list presented and carry out a ‘secondary search’. This will bring back the CHI number if the patient has one.
If the patient matched or selected by you does not have a CHI number, the claim will not be rejected for this, as long as you have carried out a patient detail search.
There are two main reasons why these are being stopped for processing:
- Entering 'Part 1 continuation' in observations – this is not needed
- Entering 'Part 2 continuation' in observations, where part 1 was eDental. Where part 1 was eDental, the reference number from that claim should be entered on the part 2 submission and the acceptance dates of both claims should be the same
More detail around the continuation process is available in our guide to eDental payment and approval modernisation changes and improvements (PDF, 645kb)
Domiciliary visit – observations being provided when not required
With eDental, you are no longer required to provide details within observations.
We have seen a few exact duplicate claims being submitted which are auto rejected by our system and others have treatment or other details with overlapping dates. In each of these examples, we return both claims for confirmation from the practice as to what should be processed. This will be returned on paper. Once you have confirmed which is correct, you can submit a new claim to be processed for payment.
Patient failed to return (PFTR) and fee request being marked as yes when not required
In a simple PFTR case, where there is no incomplete treatment being claimed, click the box next to ‘The patient failed to complete the treatment (PFTR) and answer 'No' to the question 'Are you making a fee request?' Any item of treatment in the Statement of Dental Remuneration (SDR) completed and claimed by the dentist will be processed for payment, so fee requests would only be in the case for items not listed in the SDR or Discretionary Fee Guide.
Prior Approval date entered in Prior Approval field but also in observations
Prior Approval date only needs to be entered in the Prior Approval Date box and does not need to be repeated in observations.
Observations entered to say radiographs available
Your PMS will have a box to allow you to select “Radiographs Available”. You should select this box or claim for radiographs, rather than entering observations to indicate there are radiographs available.
Observations are no longer required for Referral claims within eDental. Additional validation has been built in to the system and you will now be required to specify whether the referral is on the basis of facilities, expertise or experience. No other information is required in observations around the referral.
Sending a claim requesting to delete paid claim
Where a claim is being requested to be deleted, a 283 adjustment form should be submitted to us.
Download the 283 adjustment form (PDF, 490kb)
Find out more
Read our January 2018 update to find out more about the project to modernise payment and prior approvals as part of the eDental programme.
You can also learn more about the eDental transition in our January 2018 update.