Our monthly update on the project to modernise payment and prior approvals as part of the eDental programme, covering:
- ePrior Approval – 1 October 2018 mandated date approaches
- practice management system (PMS) supplier update
- eDental payment update – August 2018
- eOrtho payment and approval
ePrior Approval – be ready for 1 October 2018
The live early adopter pilot phase is now drawing to a close. ePrior Approval has been available since the end of January 2018 for both web form and PMS. All prior approval requests must be submitted electronically from 1 October 2018 and paper requests will no longer be accepted beyond that date.
Find out how to avoid prior approval delays.
There is a concern that some PMS suppliers may not be ready in time for 1 October as we have approximately two months to go and few PMS suppliers have provided us with their anticipated testing dates.
If your PMS supplier is not ready in time for 1 October 2018, you will need a web form account in order to submit your Prior Approval requests.
One supplier, Systems for Dentists (SFD), is now rolling out the prior approval changes to their remaining practices. Each supplier must undertake fit for purpose testing and e-prior approval accreditation testing before they can roll the changes out to their customers.
Following this, a supplier will move to beta phase, which forms part of early rollout. At this stage, a PMS supplier may make improvements and then roll this out to all other sites. We are continually updating our PMS supplier page as and when PMS suppliers update us with information in relation to their anticipated development and delivery dates for electronic Prior Approval.
Practitioner Services are disappointed with the lack of communication from some PMS suppliers at such a late stage. The fact that a number of PMS suppliers will not be ready in time, or have chosen not to develop is a significant disruption to practices and has the potential to adversely impact your patients.
This is particularly disappointing as we had been assured by the Dental System Suppliers Association (DSSA) which represent the majority of PMS suppliers that 1 October was a date they could achieve.
After discussion with the eDental Project Board, we have decided that we must step in and therefore we will issue all dentists with usernames and passwords for the webform. User accounts will only be created for dentists, and will not be extended to include practice staff.
We appreciate this may be a limitation for dentists, however, we only hold and have access to dentist details, and not practice staff information. The timescales, costs, substantial increase in users and the associated maintenance cannot be justified when the volume of prior approval requests are so small.
We remain hopeful that PMS suppliers will develop the prior approval integrated system soon, and would encourage you as one of their customers to communicate your views to them on this matter.
We have provided an update on the current position of each PMS supplier but please check the PMS supplier page for the latest information. As a guide, we allow one month for fit for purpose testing, a further month for accreditation and thereafter a few weeks’ for beta testing before commencing full rollout.
While things can be turned around quickly, any issue identified at any stage that requires further development will have a knock on effect to meeting the 1 October 2018 dates.
Carestream have confirmed they will not be offering a fully integrated system to system solution for prior approval for 1 October 2018. If you are a Carestream user, we will be writing to you this week to advise you on the steps to follow next regarding the use of the dental webform.
Dentally is in development and have arranged a date with us for fit for purpose (Ffp) testing in early September. Following successful Ffp, Dentally will be required to undertake accreditation testing. On successfully passing this, they will then roll out to beta and thereafter, all users.
We are currently awaiting dates from Goodteith.
Systems for Dentists (SFD)
SFD are rolling out the changes to their live practices.
Software of Excellence (SoE)
EXACT - SoE are currently at the latter stages of fit for purpose testing, thereafter they will move on to accreditation testing and finally beta then roll out.
SOEL Health - We are currently awaiting dates from SoE.
We are currently awaiting dates from WYSdom.
eDental payment update
We expect data to be available shortly for July 2018 rejections. Once we have this information available, we will be able to compare month on month and determine if there are improvements as a result of guidance, or if we need to do something different. We are aware that some customers have raised changes directly to their PMS supplier as a result of specific errors that they are encountering.
There are still a number of claims being unnecessarily rejected within our payment system, Midas. This can lead to a delay in the processing of these claims through to payment. These rejections mainly occur where practices provide observations, when they are not required.
Patient Failed To Return (PFTR)
Practices should only select the PFTR box in their PMS, unless they are requesting a fee not specified in the SDR.
When a claim has been rejected for being a duplicate etc, and returned as a paper MIDAS reply, resubmit only one claim electronically (the claim you wish to progress for payment). In the case of duplicates, both will have been returned.
Do not add comments in observations.
Practices are still entering referring dentist details in observations. This is not required. They must instead complete Claim Type 4 “on referral”, and reason for referral on their system/web form.
There is no requirement to advise us through observations that no CHI has been found during the CHI search.
Domiciliary Visit details
Practices are still entering domiciliary visit details in observations. This is not required.
Prior Approval date
Enter PA date in a specifically marked box on your PMS. Do not add PA date into observations.
One example where observations are not required is when the correct category for registration has been selected but additional observations have been added to indicate where the patient is registered.
Special Needs (item 45c) detail
Practices are still entering special need details in observations. This is not required.
Follow your PMS supplier guidance – continuation details should be recorded in a separate area of your system.
Incomplete 10b and other items
Where an incomplete 10b is being claimed, you should add the appropriate code to the claim without observations.
If any item you are claiming is in the SDR or discretionary fee guide, you should be able to select it from within your PMS. If you are unable to do this, please contact your PMS supplier.
If you do not know where to record something in your PMS, contact your supplier, or check your PMS guidance to find out how.
Use our eDental guidance published on our web site, for more information on observations.
If you receive a Midas claim rejection letter, do not return the letter to us with written instructions, as we cannot process the claim this way.
The claim the letter relates to must be resubmitted electronically via eDental with the necessary amendment, if payment is still being requested. You can refer to our guidance on the error codes.
eOrtho payment and approval
We now have all three initial planned phases released to us for testing. A further release will be arranged in the near future, including some aspects that could not be completed in the timescales and defect fixes identified during our testing phase. This phase of testing will continue until early-mid September 2018.
PMS Supplier testing will be undertaken in two parts. Part one is fit for purpose (Ffp) testing, which tests the technical connections and communication channels between the PMS and ourselves. This can be undertaken by suppliers when it becomes available, from around mid August.
The second part of supplier testing is accreditation and this takes place following a successful Ffp. The accreditation process is a verification process that allows us to test a set of valid business scenarios, which the PMS supplier must create as a dentist would, thus ensuring a level of satisfaction that their software will perform as expected. Any supplier who has passed Ffp can undertake accreditation testing from September 2018.
One of the orthodontic specialist PMS suppliers, Assisortho, has now provided timescales and has indicated that they will be ready to carry out initial testing at the end of August. There are still ongoing discussions with the other specialist PMS supplier, Orthotrac, and we expect their plans to be finalised and communicated to us in the near future.
Two of the general practice management system (PMS) suppliers, Systems for Dentists (SFD) and Software of Excellence (SOE), have already committed to the development. SFD have confirmed their testing will begin in September. We are still awaiting confirmation from other PMS suppliers, as to what their intentions are in relation to this development.
You can get the latest information on our PMS supplier pages.
Paper submissions for Orthodontic Prior Approval requests and payments will no longer be accepted after 1 January 2019.