Update on eDental payment and prior approval modernisation project – November 2018

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

  • eDental payment update
  • ePrior Approval – 1 October 2018 mandated date in place
  • Practice management system (PMS) supplier update
  • eOrtho payment and approval

eDental payment update

If you’ve got any queries in relation to error codes or payments, take a look at our eDental guidance for more information.

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 electronically via eDental with the necessary amendment, if payment is still being requested. 

ePrior Approval – Mandated 1 October 2018       

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. 

Exceptions allowed until 31 March 2019 are:

  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.

In October, we hosted roadshows in Aberdeen, Edinburgh, Glasgow and Stirling. 

These were well attended and included a presentation on how to use the web form, for the purposes of electronic Prior Approval submission. 

Thanks to all who attended - we hope you found this training useful in helping to navigate the web form successfully. 

In addition, you can find out more with our Prior Approval web guidance

You can also read our latest tips on how to avoid prior approval delays.

Guidance on the use of the Prior Approval Reference field

When a prior approval request is submitted and approved electronically, you will be provided with a prior approval reference that you must enter on the claim when you are submitting it for payment.  

The reference is between 1 and 30 characters long, for example: BGDLCT222BZIUNWMWJX2RKNBKJLTIM

If you submit your prior approvals and payment claims using the web form, copy and paste the reference, being careful not to include any spaces before or after the reference, into the prior approval reference field.  You will also need to enter the date the prior approval was authorised in the prior approval date field. 

If you submit your prior approvals and payment claims using the web form, but submit payment claims from your practice management system (PMS), copy and paste the reference, being careful not to include any spaces before or after the reference, into the prior approval reference field within your PMS when submitting the claim for payment. 

You will also need to enter the date the prior approval was authorised in the prior approval date field. 

We are aware that some PMS software prompts users to enter both the reference number and prior approval date for the purposes of payments.  We have provided clarity to these PMS suppliers, based on:

  • Where approval was granted on paper, you should only enter the approval date.
  • Where approval was granted electronically, either using the web form or your PMS, you should enter both the approval date and the prior approval reference in the appropriate fields.

You should only enter the reference and prior approval date in the appropriate fields.  We have received a number of claims with different information populated in the prior approval reference field, such as a date or the name of the dental adviser spoken to around the case. 

Both pieces of information (prior approval reference and approval date) are used to verify the approved treatment versus the treatment submitted for payment.  If the information does not match, it may delay the processing of your payment claim. 

Supplier progress

We are continue to update our PMS supplier page as and when PMS suppliers update us with information in relation to their delivery dates for electronic Prior Approval.  

For those who require to use the web form, we are up to date with all requests for usernames and passwords from those who have submitted their online form, however, as at 6 November, there are 14 individuals who need to provide us with an updated and valid email address in order that the password can be issued.  The total number of usernames and passwords issued to date (including Public Dental Services) is around 1500.

Carestream

Carestream have confirmed they intend to provide an integrated system to system solution for electronic prior approval.  We are awaiting timescales as to when this will be developed, tested and available for fit for purpose testing and ultimately, accreditation and rollout.

As an interim solution, Carestream practices must use the web form to submit their Prior Approvals electronically from 1 October 2018, until such time as their development has been successfully accredited and rolled out to customers. 

We have set up requests for all practices who have submitted the online form to us.  These account for the majority of Carestream practices, but there is approximately 10% who have yet to request a username and password.

Practices must complete the online form in order to submit Prior Approvals electronically using the web form.  Please ensure you provide valid NHS.net email addresses as part of this process, and confirm they have not expired.  If you do not have usernames and passwords for accessing the web form, please ensure you action this now.

Once we have sent your username and password to you, Carestream will issue your practice with a new software release, which you will need to install.  There is a dependency on your practice completing the online form, and allowing sufficient time for these subsequent actions to take place. 

Dentally

Dentally have completed the live rollout to their practices.

Goodteith

Goodteith have confirmed they will not be offering a fully integrated system to system solution for prior approval for 1 October 2018. 

On 20 September 2018, it was formally announced that Goodteith would be joining Dentally.  The intention is to continue to run the Goodteith software platform until the end of 2019, to ensure a smooth transition period for existing Goodteith customers.  As an interim solution, Goodteith practices must use the web form to submit their Prior Approvals electronically from 1 October 2018, until such time as the practice transitions.

We have set up requests for all practices who have submitted the online form to us.  These account for the majority of Goodteith practices, but there is approximately 15% who have yet to request a username and password.

Practices must complete the online form in order to submit Prior Approvals electronically using the web form.  Please ensure you provide valid NHS.net email addresses as part of this process, and confirm they have not expired.  If you do not have usernames and passwords for accessing the web form, please ensure you action this now.

Systems for Dentists (SFD)

SFD have completed the live rollout to their practices.

Software of Excellence (SoE)

EXACT 

SoE have completed ePrior Approval accreditation testing and are rolling out the changes to their practices. 

SOEL Health

We have received confirmation that there will be no fully integrated SOEL Health system to system solution for prior approval for 1 October 2018.  SOE’s commitment to the delivery of ePrior Approval and eOrthodontic payment and approval features in EXACT is not impacted and remains unchanged. 

100% of all practices with SOEL Health have now been issued with web form usernames and passwords.

WYSdom

WYSdom have completed the live rollout to their practices.

eOrtho payment and approval

Following an announcement from the Scottish Government, the date from which paper submissions for Orthodontic Prior Approval requests and payments are no longer accepted is moving from 1 January 2019 to 1 January 2020. 

You can read the Scottish Government announcement on the Scottish Government Health and Social Care Directorates website.

Our testing team are completing their final tests and are planning the live install of changes shortly.

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.  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.  

We are awaiting firmed up timescales from both orthodontic specialist PMS suppliers, Assisortho and Orthotrac.  Two of the general PMS suppliers have already committed to the development: Systems for Dentists (SFD) and Software of Excellence (SoE) for their EXACT software.  SFD are looking to undertake Ffp with us shortly, and SoE are currently undertaking development.  We are still awaiting confirmation from other PMS suppliers to understand their intentions in relation to this development. 

You can get the latest information on our PMS supplier pages.

 

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