Update on eDental payment and prior approval modernisation project - December 2017

Our monthly update on the project to modernise payment and prior approvals as part of the eDental programme, covering:

  • No more paper claims for GP17-1 payment after 31 December cut-off date
  • eOrtho payment and approval
  • ePrior Approval
  • the rollout of our eDental web form
  • changes being made to the web form
  • what stage practice management system (PMS) suppliers are at on the path to accreditation and rollout
  • December 2017 eDental transition update

No more paper claims for GP17-1 payment after 31 December cut-off date

From 1 January 2018, we will only accept electronic GP17-1 payment submissions - paper GP17-1 payment claims received on or after 1 January 2018 will not be accepted.

If your practice currently only submits paper claims for payment, you are at high risk of negatively impacting your practice’s financial position at the start of 2018 and you must take action now. You need to arrange a date to move, to eDental either with your Practice Management System supplier or the web form. You can do this by contacting the transition team on nss.edental-transition@nhs.net or 0131 275 6866.

eOrtho payment and approval

Please remember that paper submissions for Orthodontic Prior Approval requests and payments will no longer be accepted after 1 January 2019.

We issued a letter to all practices in November 2017, outlining our position on this project. If you submit orthodontic claims, please read the letter carefully and take action if required.

Our internal suppliers are continuing to develop orthodontic payments and prior approvals. The orthodontic system specification has been issued to Practice Management System suppliers who are now reviewing it. We’re arranging a meeting with all suppliers towards the end of January 2018 to discuss upcoming changes, which will include Orthodontic payment and approvals. We’ll arrange a separate meeting with orthodontist specialist suppliers.

ePrior Approval

The new ePrior Approval system is being implemented in January 2018. It will then be available for practice management suppliers to move through the accreditation process. We are finalising the details to run a pilot at the end of January 2018, initially with web form users. All GP17-1 prior approval requests must be submitted electronically from 1 October 2018 and paper requests will no longer be accepted beyond that date.

eDental web form rollout

Out of 42 practices planning to use the web form, 36 have now moved across. If you intend to use the web form and need access, contact the transition team on nss.edental-transition@nhs.net or 0131 275 6866.

We have contacted a further 7 practices currently submitting paper claims, where their PMS supplier is not ready to move the practice over to eDental.  As an interim measure, we are setting these practices up to use the web form, so they can submit claims after the New Year. 

Changes to the web form

We received feedback from the early adopters when we first rolled out the web form and we also identified changes to the rules and other improvements to be made. We’ve been sourcing funding to make some of the changes and will share dates for when the changes will be made once dates are available. The changes will include:

  • Extending date of birth validation to ensure a date of birth in the future cannot be entered.
  • Extending validation on Patient Forename, Surname and Previous Surname to ensure that the name cannot begin with either a hyphen or a space.
  • Amending the wording when cancelling a claim, as the pop-up message has the options ‘OK’ or ‘Cancel’ which was causing confusion.
  • If a user accidentally selects either Yes or No against ‘Radiographs Available’, it cannot then be removed. An ‘N/A’ option will now be added and can be used if an entry has been made in error by the user.
  • On the Value Summary tab, users are shown two calculated amounts; 'Total Value’ and 'Total Patient Charge'. These amounts are for the user’s information only and are not sent as part of the payment claim. The ‘Total Patient Charge’ amount will always show, even if the patient does is not liable to pay a charge. To avoid confusion, this will now be amended to read 'Total Patient Charge if patient pays'.
  • Allowing multiple materials to be entered on tooth specific items i.e. items 1470 and 1471

New rules and changes

  • Error E000670 is returned if a claim is submitted with a patient charge of zero and an exemption code of HC3. Unfortunately, this meant the rule was also applied in cases where no treatments had been claimed or the total of the treatments expected a zero patient contribution, for example a basic examination. This is being amended to accept a zero patient charge, with an exemption of HC3.
  • Error E000635 is returned where item 4600 has been claimed but where claim type 5, ‘I wish to be treated by this dentist as a referred patient’, has not been selected. This rule is being extended to cover Item 4405.
  • Error E000705 is returned if item 18(a)-(f)(2) is included on a claim, but item 2b is not included and the models available box has not been selected. This rule is being extended to cover item 29(D).
  • New rule: ensure that no fee shall be payable under item 48, in connection with any treatment other than item 57 (domiciliary visits and recalled attendance).

We’re anticipating that these changes will be made before the end of the financial year.

Practice management system (PMS) supplier update

As at 15 December 2017, four PMS suppliers are accredited and have either completed or are in the process of transitioning their practices to eDental - these are Carestream (R4+), Goodteith, Software of Excellence (SoE) and Systems for Dentists (SFD). If you use a PMS, or intend to start using one to claim for payments in future, visit our practice management systems page for more information on where each supplier is on their path to accreditation and rollout.

Feedback from suppliers suggests that they are still continuing to come across practices with issues at the point of transition, primarily because:

  • PCs need replaced – if you have very old PCs, or are using Microsoft XP, it would be prudent to upgrade.
  • firewall issues – this usually suggests a practice would be having an issue with Electronic Data Interchange (EDI) submissions. In some instances, we’ve found that something as simple as plugs have been moved in practice, so please be mindful of this. For firewall issues contact the dental helpdesk on 0131 275 6300.
  • not updating to latest version of software – when the latest release is made available, practices have not downloaded and installed the version required in the timeframe specified. If you require a third party to install this for you, please arrange for this to happen when required to do so.

eDental transition update for all Electronic Data Interchange (EDI) practices

With practices at different stages of transition with their chosen supplier, we want to make that practices have the information they need to effectively manage their transition. As well as communicating directly with each transitioning practice, we also have some general eDental transition updates practices for:

  • Carestream (R4+) practices
  • Software of Excellence (SoE) practices – using Exact or SOEL Health systems
  • Systems for Dentists (SFD) practices

Read the December 2017 eDental transition update article for more information.

We’ve also created some eDental advice and tips for practices. Our eDental advice article covers top tips for a smooth transition to eDental as well as ways to improve your claim turnaround when submitting eDental claims.

Read more

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