Our monthly update on the project to modernise payment and prior approvals as part of the eDental programme, covering:
- eDental payment update
- ePrior Approval
- eOrtho payment and approval
- practice management system (PMS) supplier update
eDental payment update
All practices can now submit payment claims via eDental and all existing practice management system (PMS) suppliers are accredited for eDental payments.
If you’ve got a query about eDental, contact our Customer Services team on 0131 275 6300 or email firstname.lastname@example.org
We carried out a review of the top reasons for rejection in June 2018 and are in the process of issuing information to PMS suppliers, to allow them to help practices address or avoid common errors. This may be through additional development or adding information to their guidance.
When we analysed the data we noticed that some practices have not yet updated their PMS software to the latest available release.
Rejection rates are significantly improved with the most recent releases, so we suggest that you make sure your version is the most up to date available.
If you receive a Midas claim rejection letter, do not return the letter to us with written instructions, as we cannot process the claim this way.
The claim the letter relates to must be resubmitted via eDental with the necessary amendment, if payment is still being requested.
The live early adopter pilot phase is drawing to a close, and as of 13 July 2018, we had received 105 prior approval requests.
70 of these requests have been approved, with others at varying stages of the process, including a number of awaiting evidence such as x-rays or models.
How to avoid Prior Approval delay
When evidence has been submitted using the attachment upload facility, or sent in as physical evidence, you must advise us of what has been sent, for example physical or electronic evidence.
This is done by updating the prior approval request, on your PMS or web form, to indicate the evidence has been submitted, and to re-submit the claim.
You must do this within 28 days. If you do not, you will receive one reminder to do so, after which you have 14 days before the case is closed.
One PMS supplier, Systems for Dentists (SFD), is now fully immersed in beta testing for ePrior Approval, and has extended the beta phase to include additional sites.
Live rollout is planned to take place with all other SFD practices, in the week beginning 23 July 2018. During a beta phase and early rollout, a PMS supplier may make improvements and then roll this out to all other sites.
Each supplier must undertake fit for purpose testing and e-prior approval accreditation testing before they can roll the changes out to their customers.
We update our PMS supplier page when PMS suppliers provide information about their anticipated development and delivery dates for electronic Prior Approval.
All prior approval requests must be submitted electronically from 1 October 2018 and paper requests will no longer be accepted beyond that date.
If your PMS supplier is not ready in time for 1 October 2018, you will need a web form account in order to submit Prior Approval requests.
The anticipated lead time is around two weeks to allow to ensure your user account is ready.
For Carestream users, where the limit is reached in treatment planning, the user will be prompted to send in a prior approval claim.
From this prompt, the user will be able to link to our web form portal from within R4+.
Practices should note that the two systems are independent of each other - the web form does not “talk” to R4+ or vice versa.
This means a dentist will need to log on to the webform and choose which list number the Prior Approval submission is for. The dentist will then have to replicate information from their PMS including patient details, patient status, medical questions, and all proposed treatments that are being requested before finally signing off the Prior Approval request to be submitted.
Any submission which fails validation or makes a request for additional information will need to be actioned through the webform, and not the PMS.
If approved, and once treatment has been carried out, details of the prior approval date and prior approval reference sent back to the webform should be entered into the relevant area within your system and the payment claim submitted electronically from your PMS.
Carestream will notify practices soon about upcoming system updates. We are liaising with Carestream to ensure communications from both them and us are consistent, to avoid confusion during the process of setting up Carestream dentists on the web form.
We will initiate contact with Carestream practices by writing to practices separately, advising of the steps to follow in order to get access to the web form.
eOrtho payment and approval
We now have all three initial planned phases released to us for testing. A further release will be arranged in the near future, including some aspects that could not be completed in the timescales and defect fixes identified during our testing phase.
This phase of testing will continue until early September 2018.
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. This can be undertaken by suppliers when it becomes available, from around mid August.
The second part of supplier testing is accreditation and this takes place following a successful Ffp. The accreditation process 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. Any supplier who has passed Ffp can undertake accreditation testing from September 2018.
One of the orthodontic specialist PMS suppliers, Assisortho, has now provided timescales and has indicated that they will be ready to carryout initial testing at the end of July. There are still ongoing discussions with the other specialist PMS supplier, Orthotrac, and we expect their plans to be finalised and communicated to us by the end of this month.
Two of the general practice management system (PMS) suppliers, Systems for Dentists (SFD) and Software of Excellence (SOE), have already committed to the development. We are still awaiting confirmation from other PMS suppliers, as to what their intentions are in relation to this development.
You can get the latest information on our PMS supplier pages.
Paper submissions for Orthodontic Prior Approval requests and payments will no longer be accepted after 1 January 2019.