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

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

  • ePrior Approval – mandated from 1 October 2018
  • ePrior Approval supplier progress
  • eOrthodontic payment and approval – mandated from 1 January 2020
  • eOrthodontic payment and approval supplier progress

eDental payment update – February 2019

If your Practice Management System (PMS) supplier has made a new version of software available, we recommend updating to this. This will ensure you have the latest fixes in place.

If you have any queries specifically in relation to other error codes or payments, refer to our eDental guidance.

You are also reminded not to complete observations for payment claims when they are not required.  Between 13 Dec 2018 and 9 Jan 2019, we carried out some analysis on what had been received.  A significant number of the observations received a total of 81% were not required.  Supplying unnecessary observations can result in rejections or delays in payment.

The Top 5 supplied unnecessary observations.

Observations

Guidance

 

Patient failed to return (PFTR)

Do not provide observations for PFTR.  Tick the PFTR box only.


 

Continuation

Observations are not required for Continuation cases.  Follow new eDental process.

 

General observations that are not required for payment

Various comments being provided unnecessarily, however details are on form, or appropriate box ticked.  Also includes more information on why a crown, filling is being claimed.  This level of information is not required.

 

Resubmissions

If you received a Midas claim rejection letter and are resubmitting the claim, there is no need to add observations.

 

Referrals

Observations for referral are not required.  In your PMS or on the webform, select one of the three options:

  1. facilities
  2. experience
  3. expertise
 

 

Please refer to the eDental guidance for further information.

ePrior Approval – mandated from 1 October 2018

All new prior approval requests must be submitted electronically, either from your practice management system or through the web form.  Paper submissions will not be accepted, and will be returned to you, unless the following exceptions are met:

  • if the case was submitted and approved on paper prior to 1 October 2018, then requires re-approval, we will accept this re-submission on the existing paper GP17 form
  • a prior approval request submitted on paper prior to 1 October 2018, but was not approved and was returned to the dentist for clarification

These will only be permitted until 31 March 2019.

ePrior Approval supplier progress

We have provided an update on the current position of each PMS supplier below, but please check the PMS supplier page for the most up to date information.

Dentally, Software of Excellence (SOE EXACT), Systems for Dentists (SFD) and WYSdom practices all have the ability to submit prior approval claims electronically.  Goodteith and Software of Excellence (SOEL Health) are not offering a fully integrated system to system solution for prior approval.  These practices will be required to use the web form, in addition to Computer Surgery and Carestream practices.   

Carestream R4+ provided us with an update on their dates regarding their development and subsequent testing phases.  Please see the PMS supplier page for up to date information on each supplier’s position.

eOrthodontic payment and approval – mandated from 1 January 2020

From 1 January 2020, all new orthodontic prior approval requests and payments must be submitted electronically from your practice management system.  Paper submissions received beyond this date will not be accepted, and will be returned to you.

The main release of eOrthodontic payment and approvals is now in the live environment.  

The Scottish Government issued a PCA in February providing an update and highlighting to practitioners who undertake orthodontic treatment, that there will be no web form option.  More information on this can be found on the Scottish Dental website

The intention is to organise a follow up meeting with the orthodontic specialist group in April.  This is in the process of being arranged.

eOrthodontic payment and approval supplier progress

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.  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.

As at 28 February 2019, two PMS suppliers have confirmed they will not be offering a fully integrated system to system solution and have no plans to further develop their software; Goodteith and SOEL Health (SoE Exact is still committed to delivering eOrtho).  A third PMS supplier, Dentally has confirmed that due to a lack of customer demand, they won’t be undertaking development at this stage.  They have, however, stated that they are committed to future work.  We are awaiting responses from some suppliers to understand their development and testing timescales with regards to meeting the legislative date of 1 January 2020.

The summary position as at 28 February is shown below.  

To understand the up to date position of each PMS supplier and detail around dates provided, view the eOrthodontic PMS supplier page.

 

PMS supplier

Current position

 

AssisOrtho

Committed and currently in development.  A few pre fit for purpose testing show and tell meetings were held, and a follow up has been scheduled for March 2019.


 

Carestream

Committed and confirmed changes will be delivered in accordance with 1 January 2020 date.

 

Computer Surgery

No confirmation received.

 

Dentally

Due to lack of customer demand, won’t be undertaking development at this stage.  Committed to other future work.

 

Systems for Dentists (SFD)

Committed and in accreditation stage.

 

Software of Excellence (SoE) -Exact

Committed and currently in development.

 

Orthotrac

Verbally committed to deliver in time with legislative date, but no confirmation of dates received.

 

WYSdom

Committed to delivering eOrtho but unable to commit to deliver by 1 January 2020 at this stage.

 

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