Update on eDental payment and prior approval modernisation project - November 2019

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


• spotlight on eOrthodontic payment and approvals – mandated from 1 January 2020
    • eOrtho transition
    • GP17PR(O) forms and electronic signatures
• eDental payment update
• ePrior approval update


Spotlight on eOrthodontic payment and approvals – Mandated from 1 January 2020


As you will be aware, the submission of orthodontic prior approval requests and payments must be submitted electronically from an accredited practice management system (PMS) from 1 January 2020.


It remains the responsibility of each practice who undertake Orthodontic treatment to ensure they are in a position to submit electronic orthodontic payment and approvals from 1 January 2020. Paper will only be accepted for a short transition period to 31 March 2020 for treatment commenced before 1 January 2020 – all courses of treatment commenced on or after 1 January 2020 will not be accepted on paper.


Practices are reminded that there is no web form solution available for Orthodontics.


Two PMS suppliers, Software of Excellence (SoE) and Systems for Dentists (SfD) are currently accredited for eOrtho and we are accepting orthodontic claims and prior approval submissions from practices using these systems. Carestream Dental R4+, Dentally and Wysdom are committed to delivering the required changes by 1 January 2020.


As we make changes to the eOrthodontic PMS supplier page, and expect to update this more frequently due to the proximity of the upcoming legislative date, we advise that you regularly check this page.


PMS supplier testing is 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 generally allow around a month for Ffp and a further month for Accreditation, and ask that PMS suppliers take this into account when they plan their timescales.


eOrtho Transition


We are now over half way through the transition of Orthodontic specialist practices, with numbers having ramped up in recent weeks. There are now only four full working weeks prior to Christmas, so time is swiftly moving on.  We are liaising closely with PMS suppliers and the Orthodontic specialist practices around roll out, and will continue to do so until all specialist practices are across the line.


For general practices who undertake Orthodontic treatment, we also need your help. For Software of Excellence customers, the update is now available for you to download. Generalist practices in particular have been slow to adopt the software since it was first made available in October. We would urge you to do this promptly, and begin submitting as soon as possible in order to allow yourself maximum time to become familiar with the new software. Leaving it until the festive period or beyond only increases the risk of experiencing problems encountered by unfamiliarity of the software, and cover will inevitably be limited over the holiday period by all parties with whom you might interact with.


From the practices who have transitioned across already for eOrtho, we have some learnings and top tips we can share that will help you avoid any delays in processing:


• when submitting physical evidence, mark on the box submitted, “eOrtho”
• remember to send us the updated electronic submission request once you have sent the physical evidence
• 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 on paper, 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 included on prior approval requests

 

When you submit a prior approval, the case is immediately returned to you with a message asking you to submit evidence. This message used to read ‘Please submit all relevant evidence relating to the case’. With the introduction of eOrtho, this message has been changed to the following:


"Where the request relates to general dental treatment please submit all relevant evidence relating to the case.
 
Where the request relates to orthodontic treatment, please submit relevant radiographs, photographs and study models.

NB for cases with an IOTN DHC score of 5 please submit only radiographs and photographs at this stage."


In addition, the team are aware that some GP17-O’s are being sent to our offices in Bain Square, Livingston. This will cause delays in processing. All paper correspondence relating to GP17-Os should be sent to:


Dental Prior Approval Team
South Gyle
1 South Gyle Crescent
Edinburgh
EH12 9EB


GP17PR(O) PR forms and electronic signatures


Given the festive period is coming up and mail may be affected, we urge any practice providing Orthodontic treatment and not yet submitting payment claims and prior approval requests electronically, to request supplies of the GP17PR(O) form from their NHS Board store. This captures the patient declarations, and is required as part of the electronic claim and approval submission process, unless an accredited electronic signature solution for the GP17PR(O) is being used.  Practices should retain these forms (either as electronic copy or paper format) for a period of two years, and ensure that they are made available when requested.


In terms of progress on GP17PR(O) electronic signatures, we have one PMS supplier nearing completion of accreditation. Please refer to the table at the bottom of the Orthodontic PMS supplier web page which details the status of PMS suppliers with respect to electronic signatures.

 

eDental payment update:


Please review the October 2019 update  for the latest information and advice.

 

ePrior Approval  


The majority of practice management system (PMS) suppliers are accredited to submit electronically. Please see the PMS supplier page for up to date information on each supplier’s position.


We are continuing to notice that where a practice has moved from using the web form to electronic submission with a PMS, some dentists have not gone back into the web form to pick up any updates on their outstanding prior approval cases.  If you started a prior approval in the web form before moving to your electronic system, please log back in to the web form to check update responses on your outstanding web form cases. You may be required to take further action.


Our clinical team has advised that there are some common issues being experienced in ePrior Approval:


• practitioners are updating observations and advising of changes in treatment, but not updating the charting section. The charting section must be updated, or the request will be returned
• there appears to be a number of practitioners claiming fillings and crowns on the same tooth within the same course of treatment. This is not allowable under the Statement of Dental Remuneration, where only one can be claimed
• physical evidence is being sent in, but the electronic request has not been updated to indicate physical evidence has been sent, and thereafter, resubmitted


Our prior approval guidance remains available online, in addition to online videos and frequently asked questions. If you are receiving error messages you do not understand, please review the guidance on the web site in the first instance before contacting our Customer Services team, as many calls can be answered by looking at the guidance.

If there are areas you feel would benefit from further guidance or require changes/further clarification, contact our Customer Services team via email at nss.psddental@nhs.net 

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