Top tips for completing eDental claims - May 2018

To make the process of completing your claims as quick and easy as possible for your practice, we've put together some top tips to help you avoid common errors and to help improve your eDental claim turnaround.

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.

We’ve prepared guidance detailing when observations are and are not required.

Read our guidance for PMS, web form or the new error messages

The following items do not require observations:

  • Special needs
  • Domiciliary visits
  • Emergency treatment
  • Advising that the claim was returned via EDI and re-sent
  • Previously paid claim - where you are requesting a claim be deleted, a 283 adjustment form (PDF, 491kb) should be submitted
  • Continuation cases - you should have a new area to complete in your software, follow the process outlined in the guidance and refer to specific PMS software guidance, web form users should complete the area designated on the ‘Claim Details’ screen
  • X-rays available - you should have an area within your PMS software to mark x-rays as being available, follow the process outlined in the guidance and refer to specific PMS software guidance, within the web form, you should use the ‘Radiographs Available’ box found on the ‘Claim Details’ screen
  • Prior approval date – you should have an area within your PMS software to enter the prior approval date, web form users should complete the area designated on the ‘Claim Details’ screen.
  • Advising that the patient is pregnant - the exemption section within your PMS will highlight to us that the patient is pregnant, you should complete the relevant area outlined on the ‘Patient Acceptance’ screen.
  • Patient Failed To Return (PFTR) – you should select the PFTR box in your PMS to declare PFTR, if you require a fee for treatment not covered by a code in the Statement of Dental Remuneration or the Discretionary Fee Guide, mark PFTR fee request as ‘Yes’ and provide the observations in the box that relates specifically to PFTR, web form users should complete the relevant boxes on the ‘Dentist Completion’ screen.

Commonly returned errors

We’ve compiled a list of commonly returned errors with additional guidance on how to 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 an examination only for a child, 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. 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 registration only claims are 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. 

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 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.

 

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