Top tips for completing eDental claims - March 2018

Tips for a smooth transition to eDental - general tips

To make the process of completing your claims as quick and easy as possible for your practice, read the guidance for PMS, web form or the new error messages and:

  • ensure 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's our understanding that each system supplier has a facility available advising practices of claim rejections
  • ensure you check through your claims before you submit, to check 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
  • ensure you pull back your last payment reconciliation file on EDI before you transition across.  Currently, the latest file is 31 December 2017.  The 31 January 2018 file will be available around 14/15 February 2018.
  • when you’re clearing out your claims, don’t send claims older than three months from the completion date
  • ensure you only provide observations where necessary.  Details of when observations are required is included on guidance.  Your claims are at risk of delay for payment if you provide information that's not relevant
  • if your PMS supplier has provided guidance, make sure you review and become familiar with any of the changes.

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:

The following are commonly returned errors. Our additional guidance can help resolve your issues.

E000673

As there is a completion date entered, enter the appropriate fee code(s), for the work carried out and being claimed.

If a date of completion is included on the claim, at least one treatment should exist on the claim.

If the claim is for a child only examination, please remove the date of completion and resubmit.

E000852

For a claim type 2, the patient must be registered with a different list number at the same practice on the acceptance date.

For the claim type "I am registered with another dentist at this practice", the patient must be registered with a different list number at the same practice on the acceptance date.

There are a number of reasons why you might have received this error:

  1. The patient does not have an active registration
  2. The patient is registered in a different practice
  3. The patient is registered with the same list number submitting the claim

We are aware that some PMS software hold their own registration list, and this does not always reflect the current position held by Practitioner Services.  Patients are transitory and therefore the registration moves with them when they attend for treatment elsewhere; the lists held within the PMS may not be up to date.

Carry out a patient detail check, select the correct patient from the results and carry out a secondary search, then re-submit the claim.  Please note that some details may differ slightly, for example if you are provided with a list and patient surname Johnston is returned, yet you have Johnstone, it could still be the same patient.

If claim fails for this error again after you have carried out the patient detail check, above, it is likely the patient is not registered with the dentist you think.

E000631

An adult registration only claim is not allowed.

Check the patient date of birth. 

If the claim is for an adult, there must be an acceptance date, completion date and treatment on the claim, as Scottish Government policy advises that adult only registration is not allowed.

A registration only claim for a child can be accepted without treatment by including the acceptance date and no treatment.  No completion date should be entered.

E000626

Your claim was not received within 3 months of the completion date.

The regulations highlight that claims cannot be submitted more than 3 month after the completion date.

If you have a genuine reason for us to override this rule, please add sufficient observations onto the claim and resubmit.  Successful receipt of the claim does not necessarily indicate that the claim will be processed for payment.  The team will review on a claim by claim basis. 

E000602

The patient details response code is not valid for this list number.

We have temporarily switched off this rule to streamline the process, and will advise you in future if there are any changes. 

If you have any pre-existing claims which have rejected for this error, please resubmit the claims.

E000681

Provide details of the tooth notation for all tooth specific items or if you are claiming for a capitation/ continuing care code make sure the tooth notation is correct for that code. Retained deciduous teeth in adults should be coded as permanent teeth.

Ensure the tooth notation is correct for the tooth specific items specified on the claim.  Specific items can only be applied to specific teeth.  Please check the relevant Statement of Dental Remuneration (SDR) for details. 

The two digit notation system used is the Federation Dentaire Internationale (FDI)

E000851

An exact duplicate of the claim being validated must not previously have been submitted by the list number.

This claim is a duplicate of a previously submitted claim.

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.

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