Our monthly update on the project to modernise payment and prior approvals as part of the eDental programme, covering:
- eDental payment update – July 2019
- ePrior Approval – Mandated from 1 October 2018
- eOrthodontic payment and approval – Mandated from 1 January 2020
eDental payment update – July 2019
Our operational team have identified key areas where some practices are not following eDental processes. Not following the correct process can cause delay to claims being processed and paid. The main reasons appear to be:
- Including unnecessary observations in cases. For example, patient failed to return but no fee is being requested (PFTR), referrals and continuation cases. New functionality is available in your practice management system (PMS) and the web form to provide the relevant information, without the need to add observations. These are all explained in the ‘Summary of changes to observations’ section in the PMS guide available on our website.
- MIDAS reply letter. If we have rejected a claim and returned it to you on paper (this is known as a MIDAS reply letter. MIDAS is our payment system), the claim must be adjusted in either your PMS or the web form, and returned via eDental. Please do not send the paper MIDAS reply letter back. If you believe two patients have been linked incorrectly, for example, in the case of twins, then a 287 registration adjustment form should be downloaded from our website and sent to the customer administration team.
- When sending any completed administration forms, for example numbers 283, 286 or 287 electronically, it must be sent from the personal NHS email address of the dentist who is querying the claim. If it is sent from anyone else in the practice, the paper copy must be signed by the dentist, saved as a PDF and submitted from an NHS email address to NSS.firstname.lastname@example.org.
- Some paper correspondence is being sent to our offices in Bain Square, Livingston. This will cause delays in processing. All paper correspondence relating to Dental claims, payments or queries should be sent to:
D&O Operations Team
1 South Gyle Crescent
In addition to the above, when claiming an incomplete 10(C), we ask that you include the following information:
- the number of active treatment visits
- if the active treatment is complete
- the number of teeth that have been treated
- the number of sextants that are involved
We currently need to adopt a workaround for submission of incomplete fees requested for patient failed to return (PFTR), in order to prevent payment adjustment scenarios.
When you have marked a claim as requesting a PFTR incomplete treatment fee, please add information to both the PFTR observation section and general observations.
If you are having issues with the payments aspect, please take a look at the eDental guidance in the first instance.
ePrior Approval – Mandated from 1 October 2018
The majority of PMS suppliers are now running electronic prior approvals. Dentally, Software of Excellence (SOE EXACT), Systems for Dentists (SFD) and WYSdom practices all have the ability to submit prior approval claims electronically. Dentists using other PMS suppliers not listed, have access to the web form if access was requested.
Carestream Dental R4+ has been granted temporary accreditation until 31 December 2019 and is ready to move into the beta stage. They have identified a number of practices with which they intend to go to beta. Carestream will rollout to their practices upon completion of the beta phase.
Please see the PMS supplier page on our website for up to date information on each supplier’s position.
Note for Software of Excellence (SoE) users:
Our customer services team recently received a number of calls from practices using SoE. Practices indicated that they were experiencing intermittent issues with the submission of their prior approval requests. SoE reported intermittent traffic issues to our systems from their SWAN IPSec tunnel. We have had no reports of other traffic issues from SWAN to our systems from other customer groups. Initial investigations did not pinpoint the source of the issue before it resolved itself. We understand from SoE that the service is currently running as they would expect.
To ensure we get to the source of the problem and to avoid a repeat incident, discussions and tests are continuing to take place between the appropriate parties within the NHS, our technical providers and SoE to understand more about the problem, and determine what actions need to be taken.
SoE latest version
We have been asked to remind SoE practices that they should update to the latest version of their software - V13.2. We understand this release will be mainly around SoE connect and enhancements relating to prior approval.
Our prior approval guidance remains available on our website, including online videos and frequently asked questions. If you are receiving 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, please contact our Customer Services team on email at email@example.com.
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 (PMS). Paper submissions received beyond this date will not be accepted and will be returned. Please note that there is no web form solution available for Orthodontics, therefore if you undertake orthodontic work, you must ensure you have a PMS which has been accredited for electronic orthodontic payment and approvals in order to be able to submit from 1 January 2020.
A letter entitled, ‘eDental Programme – moving forward with eOrtho’ has been issued out to all practices week beginning 1 July to advise them of the current status of the project and what, if any action they need to undertake. An email with a copy of the same letter was also issued out to those individuals we held an email address for.
To check the current and up to date position of each PMS supplier, please check our eOrthodontic PMS supplier page on our website.
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.
We advise PMS suppliers to allow one month for Ffp and one month for Accreditation as part of their planning.
Work is ongoing regarding an electronic signature specification to coincide with a new GP17-O PR form. The purpose of the GP17-O PR form is to capture patient signatures. Once the specification is complete, it will then be made available for PMS suppliers who wish to offer that service to their customers.
As agreed at the last Orthodontic specialist event on 15 April, another event has been arranged for 8 August at the Scottish Health Service Centre.
Existing GP17-O form processing update
Our operational team have highlighted that some paper GP17-Os are being sent to our offices in Bain Square, Livingston. This will cause delays in processing.
All paper correspondence relating to Orthodontic claims, including GP17-O forms, payments or queries should be sent to:
D&O Prior Approval Team
1 South Gyle Crescent