Update on eDental payment and prior approval modernisation project - January 2020

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

  • eOrthodontic payment and approval
  • Practice Management System (PMS) supplier update for eOrtho
  • eOrtho top tips
  • GP17PR(O) forms and electronic signatures

As the project has now closed and is effectively part of our business as usual, these updates will no longer continue.  Any critical information to be shared with contractors will be included as part of ongoing scheduled communications.

eOrthodontic payment and approval – mandated from 1 January 2020

The submission of orthodontic prior approval requests and payments must now be submitted electronically from an accredited practice management system (PMS). In terms of transition activity, all Orthodontic specialist practices have been set up to submit electronically, with one practice yet to successfully submit. We are working closely with the practice and their PMS supplier to help them resolve their issues. 

With electronic submission being mandated from 1 January 2020, this means that if a new patient comes into a practice for Orthodontic treatment, any orthodontic examination, prior approval and subsequent payments must be carried out electronically. Any payment cases submitted to us on paper dated on or after 1 January 2020, are now being returned to practices. Numbers returned to date are very low (under 20), which is a positive sign. 

We appreciate that Orthodontic practices are still learning a new way of working and this is likely to involve adapting their processes. Until 31 March 2020, there are a few scenarios for which we will still accept paper:

  • 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, retention, retainers and regulation nine would need to be submitted electronically from 1 January 2020, as they are based on a different date of acceptance from the active treatment. 

PMS supplier update for eOrtho

Four PMS suppliers are currently accredited with eOrtho. These are Carestream R4+, Dentally, Software of Excellence (SoE) and Systems for Dentists (SfD). We are accepting orthodontic claims and prior approval submissions from practices using these systems.   

Systems for Dentists (SfD) have advised that a session is being arranged for their practices in early February. This will help practices understand more about their system’s functionality. SfD will contact their practices directly around this. 

Wysdom indicated they are committed to delivering the change, however as Fit for Purpose (FfP) testing has not yet commenced they are not in a position to move to accreditation. Prior to Christmas, Wysdom advised they were communicating with affected customers and were considering offering an option to practices to allow them to record any treatment carried out at the start of 2020. This will mean the relevant information will be captured, but activity undertaken (for example, prior approvals and examinations) cannot be transmitted until accreditation is complete. We are awaiting confirmation from Wysdom as to their revised timescales.

The latest position for all PMS suppliers can be found on our eOrthodontic PMS supplier page.

eOrtho top tips

We have gathered feedback from the clinical and prior approval teams regarding what they are noticing as approvals and claims are coming in. The following top tips will help you avoid any delays in processing:

  • when submitting physical evidence, mark on the box submitted, “eOrtho”
  • 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 for a course of treatment, 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 requests
  • some of the physical study models being sent in have no details attached, or have insufficient information to be able to match them up to the prior approval requests. In addition, they are not always bench marked. It would help expedite cases if practices can ensure they provide adequate information
  • there are a number of cases outstanding where practices have sent in or uploaded physical evidence, but have not resubmitted the prior approval request to indicate that physical evidence has been sent

We have guidance available online and if you receive error messages you do not understand, please review the guidance on the website in the first instance. If there are areas you feel would benefit from further guidance or require changes or further clarification, please contact our Customer Services team at nss.psddental@nhs.net

GP17PR(O) forms and electronic signatures

Patient declarations still require to be captured as part of the electronic claim and approval submission process. This is done using the GP17PR(O) form which can be requested from NHS health board stores unless an accredited electronic signature solution is being used. Practices must retain these forms (either as electronic copy or paper format) for a period of two years from the date the patient signed at completion of treatment, and ensure that they are made available when requested.

We have one PMS supplier accredited for eOrtho eSignatures. Please refer to the table at the bottom of the Orthodontic PMS supplier web page which details the status of all PMS suppliers with respect to electronic signatures.

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