Here you will find information about Payment Verification.
Payment verification is carried out on the claims made by ophthalmic practitioners in order to provide assurance to NHS Boards that payments are valid.
The programme of payment verification operates at the pre and post payment stages, and takes place on 4 levels:
Level 1 – these checks are carried out by payments staff and/or automated payment systems at the pre-payment stage
Level 2 – these post payment checks involve trend analysis and random sample testing where:
- The results of level 1 checks indicate that this would be beneficial
- The results of statistical trend analysis indicate a need for further investigation
- The formal assessment of the level of risk associated with a particular claim type indicates a need for further testing
Level 3 – these post payment checks involve the undertaking of extended sample testing, the sending of patient letters, or the undertaking of a targeted practice visit in order to pursue the outcome of claims identified at level 1 and/or 2 as requiring further investigation
Level 4 – these post payment checks involve the random assessment of claims as part of a practice visit
Inspection of clinical records may or may not necessitate Practice Visits.