Update on eDental payment and prior approval modernisation project – January 2019

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

  • eDental payment update – January 2019
  • 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 – January 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. 

There are still a number of errors in submissions, with the most common being shown below.

Error message

Reason

Additional information

E000852

For a claim type 2, the patient must be registered with a different list number at the same practice on the acceptance date.

A PMS may hold their own registration list however this may not always match what we hold in our payment system, Midas. As patients are free to move between dentists and practices, we will always hold the most up to date record. We have highlighted this to a couple of PMS suppliers. 

The other reason, you may receive this error, is if our system cannot find a record for your patient, usually caused by the patient details on your system being slightly different to those held by Midas.

To resolve this, carry out a patient detail check, select the correct patient from the results and carry out a secondary search, then re-submit the claim. If the claim fails for this error again after you have carried out the patient detail check, it is likely the patient is not registered with the dentist you think they are.   

If you select "none of the above" at the point of the search, you will be unable to use Claim Type 2 "I am registered with another dentist at this practice" because you have indicated the patient is new to the practice. 

E000511

A previous valid submission for the claim is being progressed by the payment system.

An amended claim cannot be submitted if we have already processed it through to our payment system. You should follow the claim adjustment process once payment has been made and complete a Dental 283 form, if required.

E000631

An adult registration only claim is not allowed.

Treatment must be included on this claim, as only claims for children can be accepted without treatment. It is possible you may have missed entering a fee code and/or completion date.

E000626

Your claim was not received within three months of the completion date.

We will only approve a case to override this rule under exceptional circumstances. This must be agreed in advance, by emailing NSS.psd-customer-admin@nhs.net, detailing the number of claims you have and the reason they were not submitted within three months of completion. If we are satisfied that these claims should be paid, we will issue a unique reference number to be added to observations, so that we can undertake verification when the claims are submitted. References that were agreed for a finite period of time will not be accepted beyond the date agreed.

E000614

Check the patient's Community Health Index (CHI) number as the first six digits must match the patient's date of birth.

The first six characters of the CHI number must match the patient’s date of birth, in ddmmyy format. Confirm the patient's date of birth you hold is correct and if it does not match the CHI number in your PMS, remove the CHI number and carry out a patient details check.

E000509

The claim reference number has already been used for this list number and a case is either being processed or has already been paid.

You have already successfully submitted a claim with this reference number and the number cannot be re-used on a different claim.

Contact your PMS supplier and ask them to investigate why this has happened.

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.

If you are claiming a tooth specific item code you must indicate the tooth/teeth you are carrying out that treatment on. Tooth specific items are indicated in the Statement of Dental Remuneration (SDR) with [TS] beside the item code.

Some item codes can only be used for deciduous teeth and others only permanent teeth refer to the SDR for details.

Note:  For claiming purposes, retained deciduous teeth in adults should be coded as permanent teeth.

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 appear on the claim. If you appear to have a fee code and completion date included, please contact your PMS supplier for further investigation.

E000603

The patient details response code has been used for a previous claim reference.

Carry out a new patient details check, using the list number of the dentist who is making the payment claim. If you still have issues, please contact your PMS supplier for further investigation.

E000623

Claim dates are not in the correct sequence. These dates must also be in sequence against the start and end dates of the list number.

The various claim dates (if supplied) must be in ascending order, as follows:

  • patient's date of birth
  • acceptance date
  • approval date
  • completion date
  • current date

For example, check that the completion date is after the acceptance date.

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

You may also experience rejected claims, or delays in payment as a result of completing observations when they are not required.  Between 13 December 2018 and 9 January 2019, we carried out some analysis on what had been received. Over 80% of observations received  were not required.

The top five supplied unnecessary observations were:

Observations and 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.

Referral

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

  1. Facilities or
  2. Experience or
  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.

Two exceptions for paper submissions will be allowed until 31 March 2019:

  1. 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.
  2. A prior approval request submitted on paper prior to 1 October 2018, but was not approved and was returned to you for clarification.

Prior approval guidance is available on the web site, in addition to online videos and a frequently asked questions (FAQs) guide.  

Below are some of the top reasons for rejections with regards to ePrior Approvals.  We have provided the responses to each. The images included are from the web form.  If you are a PMS user, your system design will look different.  If you do not know where to find specific aspects within your system, please contact your supplier.

 

Error MSG

Reason

Comment

E001117

Where no examination fee codes are being claimed, the “no examination” reason field must be completed.

Some requests, for patients under 18 years of age where no exam should be claimed, are being incorrectly rejected with this error.

We have determined the cause and will fix the issue soon, but in the meantime in the “Examination Details” tab select ‘No’ for “I have examined the patient” and in the “Reason for no examination” field add ”Patient is under 18 years old”. View an image of the screen.

E001124

Supplementary information can only be provided in one of the following circumstances:  

  • When you have indicated that physical evidence has been sent 
  • When you have indicated electronic attachments have been uploaded 
  • When notes have been included if you have indicated Prior Approval is no longer required, you will be unable to add supplementary information

When we have returned a request to the dentist for additional information, only the following can be carried out:

On the ”Submission” tab, tick “lectronic Attachment Uploaded” and/or tick which form of “Physical Evidence” is being sent. View an image of the screen.

And/or write a message in the “Response Area” of the “Communications” tab. View an image of the screen.

You can have complete one, two or all three of the options above, but you must complete at least one.

 If Prior Approval is no longer required, only select that option, and indicate whether patient or dentist initiated and add the reason. View an image of the screen.

Note: After you have completed one (or more) of the three options above, you must re-submit the request.

E001128

It is not possible to submit a request for an existing case unless a request for additional information has been received or you are seeking re-approval of an approved case.

The request you are trying to submit has already been successfully submitted.

 

You cannot re-submit a request that has been successfully submitted unless you are changing the treatment plan and seeking re-approval.

 

E000693

A treatment has been specified without a matching dental charting record.

A treatment has been specified without a matching dental charting record:

  • Treatment record = item code and tooth number
  • Charting record = annotation code, surface(s) and material

E000693 occurs when snnotation code, surface(s) and material have not been included for an item of treatment. 

You must provide annotation code, surface and material for the item codes. View the list of item codes.

E000694

A charting record has been supplied without a matching treatment record.

A treatment has been specified without a matching dental charting record:

  • Treatment record = item code and tooth number
  • Charting record = annotation code, surface(s) and material

E000694 occurs when annotation code, surface(s) and material have been included for an item of treatment, but the item of treatment does not require these to be included.

View details of the item codes that require an annotation code. If the item is not on this list, do not provide an annotation code.

E001116

Where the patient is over the age of 18 on the acceptance date, a full Basic Periodontal Examination (BPE) score should be provided. Where the BPE is not available, remarks should be completed providing a reason.

Where the BPE score is not available for a patient over the age of 18, you must indicate that BPE is unavailable. In the web form, tick the box for “BPE unavailable” and add the reason why in the “Reason for no BPE” field. View an image of the screen.

E001113

Baseline charting must be provided in the prior approval submission from Practice Management Systems (PMSs).

For baseline charting, every tooth must have one of the following annotation codes marked against it:

  • M – missing
  • P – present
  • U – unerupted
  • Z – missing and space closed

There can be other annotation codes marked against each tooth, but each tooth must also have one of the four annotation codes above.

E001107

Where the number of intra-oral (periapical) radiographs is one or more then the teeth covered by the radiograph should be included in the submission.

This means the teeth covered by the radiographs have not been indicated. This is how it’s done in the web form, but PMS should be along the same kind of lines. When a number is entered for the first question, the teeth shown in the radiographs should be indicated in the chart to the right. View an image of the screen.

 

E000677

Treatment code and quantity are not valid on the date of acceptance.

The combination of the four digit SDR treatment code and quantity is not valid on the date of acceptance.

Either the treatment code does not exist or the quantity claimed is not allowed. Refer to the SDR and amend appropriately.

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.

If you are claiming a tooth specific item code you must indicate the tooth/teeth you are carrying out that treatment on. Tooth specific items are indicated in the SDR with [TS] beside the item code.

Some item codes can only be used for deciduous teeth and others only permanent teeth - refer to the SDR for details.

Note:  For claiming purposes, retained deciduous teeth in adults should be coded as permanent teeth.

E000509

The claim reference number has already been used for this list number and a case is either being processed or has already been paid.

You have already successfully submitted a claim with this reference number and the number cannot be re-used on a different claim.

Contact your PMS supplier and ask them to investigate why this has happened.

E001127

Where the same prior approval reference has been submitted and had been previously approved, the case should be marked as a re-approval.

The request you are trying to submit has already been successfully submitted.

You cannot re-submit a request that has been successfully submitted unless you are changing the treatment plan and seeking re-approval. You must submit the request as a “Re-approval”.

 

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, Systems for Dentists (SFD) and WYSdom have all completed full rollout. 

The latest statuses on the remaining PMS suppliers are noted below. We have been in touch with those practices who have not as yet requested access to the web form. The responsibility remains with the practices to get in touch to arrange access if they require to undertake prior approvals.

Carestream

Carestream have confirmed they intend to provide an integrated system to system solution for electronic prior approval and have supplied us with dates.  At the time of writing, these are fit for purpose testing, 6 March, accreditation, 18 March, beta pilot during April, and a go live date of 3 July 2019.  Please see the PMS supplier page for up to date information.

As an interim solution, Carestream practices must use the web form to submit their prior approvals electronically - approximately 5% of Carestream practices have yet to request a username and password.

Goodteith

Goodteith have confirmed they will not be offering a fully integrated system to system solution for prior approval. 

To submit prior approval requests, users must request a username and password for the dental web form. Approximately 7% of practices are still to do this.

Software of Excellence (SoE) - Exact

SoE have made their software available (SOE connect) for practices and are rolling out. The majority of practices are now set up to submit electronic prior approvals. Approximately 14% are still to register for SoE Connect in order to be able to submit electronic prior approvals.  

Software of Excellence - SOEL Health

We have received confirmation that there will be no fully integrated SOEL Health system to system solution for prior approval. All practices with SOEL Health have access to the web form.

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.

At the December 2018 eDental payment and approval project board, the board agreed to delay the live release to around the end of January 2019.

While the release could have gone ahead as planned, the team’s main focus is to ensure the delivered system is robust and reliable. The delay in the legislative timescales to 1 January 2020 has given the team an opportunity to further refine performance. 

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 24 January 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.

The position as at 24 January is shown below. To understand the up to date position of each PMS supplier, view the eOrthodontic PMS supplier page.

PMS supplier and current position

AssisOrtho

Committed and currently in development.  A pre fit for purpose testing show and tell was held in December 2018.  Follow up session due February 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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