Update on eDental payment and prior approval modernisation project - December 2019

This month, our update on the project will focus specifically on electronic submissions for eOrthodontic payment and approvals, as this is coming into effect 1 January 2020:

  • eOrthodontic payment and approval – Mandated from 1 January 2020
  • PMS supplier update for eOrtho
  • eOrtho transition update
  • eOrtho transition - top tips
  • GP17PR(O) forms and electronic signatures

eOrthodontic payment and approval – Mandated from 1 January 2020

Submission of orthodontic prior approval requests and payments must be submitted electronically from an accredited practice management system (PMS) from 1 January 2020. This effectively means, if a new patient comes into practice for Orthodontic treatment on or after 1 January 2020, any orthodontic examination, prior approval and subsequent payments must be carried out electronically. If you submit a case to us with an acceptance date on or after 1 January 2020, it will be returned to you.

It remains the responsibility of each practice that undertakes Orthodontic treatment to ensure they are in a position to submit electronic orthodontic payment and approvals from the mandated date. To assist practices in their transition to full electronic submission, a transition period from 1 January to 31 March 2020 will be in place for treatment commenced before 1 January 2020. Allowable scenarios will include:

  • A request for re-approval where the original form was dated prior to 1 January 2020 
  • A payment where the acceptance date was prior to 1 January 2020
  • An interim payment where the acceptance date was prior to 1 January 2020

Where active treatment has concluded, the following would need to be submitted electronically from 1 January 2020 as they are based on a different date of acceptance from the active treatment. Scenarios include retention, retainers and regulation 9 for example. Practices are reminded that there is no web form solution available for Orthodontics.

PMS supplier update for eOrtho

Two PMS suppliers are currently accredited with eOrtho and we are accepting orthodontic claims and prior approval submissions from these practices. These are Software of Excellence (SoE) and Systems for Dentists (SfD).  Carestream Dental R4+ and Dentally are both in the accreditation phase. Our test teams are working with both parties to help them move through their remaining accreditation tests as quickly as possible, and therefore ensure their practices have the software required for 1 January 2020.

Wysdom are committed to delivering the change, however as fit for purpose (Ffp) testing has not yet commenced formally, it is likely Wysdom won’t be in a position to move to accreditation before the New Year. Wysdom advised they are communicating with the affected customers, and are considering offering an option to practices so they can record any treatment carried out at the start of 2020. This will mean the relevant information will be captured, but activity undertaken (prior approvals and examinations for example) at the start of January cannot be transmitted until accreditation is complete.

We expect to update the eOrthodontic PMS supplier page more frequently due to the proximity of the upcoming legislative date and the current position of those PMS suppliers who are moving through the accreditation phase.
PMS supplier testing is 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.

The second part of supplier testing is accreditation and this takes place following a successful Ffp. Accreditation 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. We generally allow around a month for Ffp and a further month for Accreditation, and ask that PMS suppliers take this into account when they plan their timescales. Following this, PMS suppliers may choose to undertake an early adopter phase before commencing full roll out.

eOrtho transition update

As at 12 December, 92% of Orthodontic specialist practices have been set up to submit electronically. Some of those practices set up have not yet submitted. If you need to carry out any actions before you can submit, such as following up with your IT, please do so now. If you have the ability to submit but have not yet taken the plunge, we would encourage you to try submitting with something simple, such as an orthodontic examination to build up your confidence levels that everything is working as expected.

For those who have already transitioned with Systems for Dentists, we have been advised that a session is being arranged for practices at the end of January/early February. SfD will contact their practices directly around this. For Software of Excellence practices, the software update is now available for you to download. We would urge you to do this promptly and begin submitting as soon as possible, in order to allow yourself maximum time to become familiar with the new software. Leaving it until the festive period or beyond only increases the risk of experiencing problems encountered by unfamiliarity of the software, and cover will inevitably be limited over the holiday period by all parties with whom you might interact.

We have guidance available online, and suggest you familiarise yourself with it, as it will aid your transition. If you are receiving error messages you do not understand, please review the guidance on the web site in the first instance before contacting our Customer Services team, as many calls can be answered by the guidance. If there are areas you feel would benefit from further guidance or require changes/further clarification, contact our Customer Services team via email at nss.psddental@nhs.net

eOrtho transition - top tips

From the practices that have transitioned across already for eOrtho, we have some learnings and top tips we can share that will help you avoid any delays in processing. These are:

  • You must remember to re-submit your request after you have uploaded your digital images
    When submitting physical evidence, mark on the box submitted, “eOrtho”
  • If you have physical evidence to submit, make sure you tick to indicate what physical evidence is being sent before submitting the request. If we do not receive the physical evidence within 30 days of the submission request, a reminder will be sent and you will need to re-submit the request. If a further 14 days pass without the case being re-submitted and receiving models, the case will be closed and you will need to submit a brand new request. Please consider this if you may have delays submitting to and receiving from labs
  • If using discretionary code 3999 01, you must add a description of the treatment proposed in your observations
  • If you are submitting electronically, do not submit the paper GP17-O as duplicate
  • If you have previously received an interim payment on paper, you must enter the appropriate recovery code within your practice management system at the point of final payment
  • Referrals should only be claimed on final payment and supervision of retention claims. They should not be claimed on prior approval claims
  • If you receive the following error: ‘Electronic attachments could not be appended’, you must untick the box that indicates you have uploaded digital images before re-submitting

In addition, the team are aware that some GP17-O’s are being sent to our offices in Bain Square, Livingston. This will cause delays in processing. All paper correspondence relating to GP17-Os should be sent to:

Dental Prior Approval Team
Gyle Square
1 South Gyle Crescent
EH12 9EB

GP17PR(O) PR forms and electronic signatures

With the festive period looming, mail may be affected, so we urge any practice providing Orthodontic treatment to request supplies of the GP17PR(O) form from their NHS Board store. This captures the patient declarations, and is required as part of the electronic claim and approval submission process, unless an accredited electronic signature solution for the GP17PR(O) is being used. Practices should retain these forms (either as an electronic copy or in paper format) for a period of two years, and ensure that they are made available when requested to do so.

In terms of progress on GP17PR(O) electronic signatures, one PMS supplier is now accredited. Please refer to the table at the bottom of the Orthodontic PMS supplier web page which details the status of PMS suppliers with respect to electronic signatures.

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