Tips for completing eDental claims

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 complied 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

Improve your eDental claim turnaround

The majority of Practice Management Systems (PMS) claims are processed directly through our payment system, MIDAS, and then onwards for payment. However, a number are being stopped unnecessarily, mostly due to observations.

We’ve created the following advice and guidance to help practices ensure continuous flow of claims for payment.

Continuation Cases

There are two main reasons why continuation cases are being stopped for processing:

  1. Entering ‘Part 1 continuation’ in observations – this is not needed.
  2. Entering ‘Part 2 continuation’ in observations, where part 1 was e-Dental. Where part 1 was eDental, the reference number from that claim should be entered in the relevant field 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 the eDental guidance.

Domiciliary visit observations

With eDental, you are no longer required to provide details within observations for domiciliary visits.

Duplicates

We’ve 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. These will be returned on paper. Once you’ve confirmed which is correct, you can submit a new claim to be processed for payment.

Patient failed to return (PFTR) and fee requests

In a simple PFTR case, click the box next to ‘The patient failed to complete the treatment (PFTR)’ and there is no need to answer the question ‘Are you making a fee request?’

Any item of treatment listed in the Statement of Dental Remuneration (SDR) or Discretionary Fee Guide and claimed by the dentist will be processed for payment. You only need to answer ‘Yes’ to the question where you are requesting a fee for a treatment that is not listed in the SDR or Discretionary Fee Guide.

Entering Prior Approval date

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.

Referral observations

Observations are no longer needed for referral claims within eDental. Additional validation is built in to the system and you’ll now be asked 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 dental claim adjustment form should be submitted to us.

Find out more

Read our December 2017 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 December 2017 update.

Read more

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