Update on eDental payment and prior approval modernisation project - May 2018

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

  • eDental payment transition update – May 2018
  • ePrior Approval
  • eOrtho payment and approval

eDental payment transition update

All practices are now enabled for eDental submission of claims. 

As the eDental transition team has now been disbanded, if you have any queries about eDental, contact customer services:

While the volume of eDental rejections in our payment system, MIDAS, is less than with EDI and paper, there are a number of claims that are being unnecessarily rejected. 

Our team need to review these rejections which can lead to a delay in the processing of these claims through to payment. 

These rejections primarily occur when practices are providing observations that are not required. 

Find out more about common reasons for rejection in our eDental top tips

All existing practice management system (PMS) suppliers are now accredited for eDental payments. 

Find out more about PMS suppliers

ePrior Approval

The live early adopter pilot phase continues with web form users, and we have received 56 prior approval requests to date.

We have approved 33 of these requests, with others at varying stages of the process with a number awaiting evidence such as x-rays or models. 

Remember that once evidence has been submitted, you must go back into the web form and complete the ‘Submission’ tab of the request, where a new area called ‘Supplementary Information’ will now be visible. 

You must select if either attachments have been uploaded, and/or any physical evidence has been submitted.

Once complete, you should resubmit the request electronically from the webform to us, within 28 days. If you don’t, you will receive a reminder to do so, you'll then have 14 days before the case is closed.

Read our guidance on prior approval (PDF, 1.6MB)

In addition, some early changes identified to PARS (our internal prior approval review system) have already been developed and passed user acceptance testing. These changes have now been implemented.

Supplier progress on ePrior Approval

It is important to note that 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 now have responses from the vast majority of PMS suppliers in relation to their anticipated development and delivery dates for electronic Prior Approval.

Find out more about supplier progress on ePrior Approval

Systems for Dentists (SFD) users

One PMS supplier, SFD, is nearing the end of the accreditation phase. SFD have undertaken a minor change which we are looking to test. We have also identified a change that is required at our side, which we are looking to progress, and have asked our own IT suppliers for timescales.

We hope beta testing with SFD will start prior to the end of May. Beta testing is a short period of time when a few early adopter practices move ahead with the changes and provide feedback for PMS suppliers.

As a result of the feedback, a PMS supplier might make improvements and then roll this out the all other sites.

Carestream users

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 action the web portal from within R4+.

Full design and implementation is planned to be complete for the first week of June, after which Carestream intend to make a statement to their customers on the final design.

Regular updates will be carried out through the Exchange.

Prior approval from 1 October 2018

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 2 weeks. In this event, you will be required to complete some paperwork before we can turnaround your user account. 

eOrtho payment and approval

We are continuing our development and testing for Orthodontic payment and prior approval. The changes are being developed and released in three phases for our user acceptance testing environment.

The first phase has been released for us to start testing. The second phase is due for release in early June and the third at the end of June, so all of the changes will be in our environment in early July.

PMS supplier testing is due to start around September 2018. One of the orthodontic specialist PMS suppliers, AssisOrtho has now provided timescales, and two of the general PMS suppliers (SFD and SOE) have committed to the development.

We are still waiting confirmation from other PMS suppliers, as we need to understand their intention. 

Get the latest information on eOrtho payment and approval

An orthodontic specialist day was held in Apri, at our offices in Gyle Square, Edinburgh with Andy Kernan and Martin Morrison providing an update to the group. 

Remember that paper submissions for Orthodontic Prior Approval requests and payments will no longer be accepted after 1 January 2019.

Our top tips for eDental

Read more