The guide for edental payments and prior approval web service. Version 1.7 March 2018

Transcription

1 The guide for edental payments and prior approval web service. 1 Version 1.7 March 2018

2 edental web form Our edental web form service delivers two main objectives for dentists who do not operate a practice management system; to allow electronic submission of prior approval requests and claims for payment of treatment carried out. Use this guide to help you complete the web form. While online you will see hints on screen and the system will highlight where your claim is not quite complete. If you have not already applied for your web form login details, visit our web site at: to complete the relevant paperwork. We will send your login details to your NHS mail address. 2

3 Contents Logging on 4 Homepage 5 Changing your password 6 Patient search.. 7 Tabs for claim types 13 Patient details tab and button options.. 14 Patient acceptance and Payment claims tabs 15 List claims screen and claim status.. 27 Failure tab.. 31 Prior approval tabs 32 Attachment upload 41 Changes to observations, New validation messages and General changes Tooth notation

4 1. Logging on Open the web form by clicking on the web address below or copy & paste the link into your browser*: This will take you to the login page, where you will be asked to enter your username and password, which we will have issued to you. You will be asked to change your password the first time you log in. When you have successfully logged in, you will be taken to the homepage (see next page). We suggest you save this to your favourites in your browser or create a shortcut on your desktop to speed up opening the web form in future. *Note The operating system on your computer must be Windows 7 or above. This application was built to run on two browsers, Internet Explorer (IE) 11 and the latest version of Chrome. The web form should still work on other browsers, but the look and functionality cannot be guaranteed. 4

5 2. Homepage After entering a username and password in the login screen, the name of the person logged in, and the practice name, will be displayed in the bar at the top of the home page. It also details the time and date of your last login. If a dentist has logged in, their name and list number are displayed. Where admin staff have logged in, only their name will show. Admin staff must select, from the drop-down list, the dentist they are creating a new prior approval or payment claim for. If a dentist is logged in, they only need to make a selection if they have more than one list number at that location. You must inform us of staff changes that result in someone no longer requiring access, by ing NSS.psd-customer-admin@nhs.net inserting WEB form access leaver into the subject field of the . Clicking Create Claim or Create Prior Approval presents the Patient Search screen, which is always the first step to completing the form. Clicking on View Claims, View Claims Ready for 5

6 Submission or View Prior Approvals will display the List Claims screen, where you can view and manage all claims for the practice. 3. Changing your password Selecting Change Password on the home page will present the Change Password screen. If your password has expired as you attempt to log in, you will be taken to this screen to change it. The box on the left hand side of the screen provides details of the format passwords must adhere to. Passwords are valid for 90 days and cannot be one of the 5 previously used passwords. If you have forgotten or locked your account please contact Customer Services on or NSS.psddental@nhs.net 6

7 4. Patient search Selecting Create Claim or Create Prior Approval on the home page presents this page. You must carry out a patient search for every claim you enter. * denotes a mandatory field Format for date of birth is dd/mm/yyyy All fields throughout the web form marked with * are mandatory, so must be completed before the form is submitted. Enter mandatory details - surname, forename, date of birth, sex and first line of the address. If you know other details enter them as well, as this will make the search more accurate, particularly the postcode. Previous surname should only be entered if the patient s name has changed since their last visit. 7

8 Being able to search and select your patient from the patient records we hold will improve the accuracy and validity of claimed treatment. It will also prevent patients being incorrectly linked; cutting down on the number of patient detail amendments you need to request. Transgender patients If a patient has changed their gender, you must send us a Patient Detail Amendment form, Dental 287, before submitting a claim with the patient s new details. Once we have changed our records, the details you enter when carrying out a patient search should match to the amended record in our system. If you submitted a prior approval request with the patient s original details, but submit the payment claim with the patient s new details, you will need to add observations to the claim as well as the prior approval reference number and date. The observations should include the patient s date of birth, previous names, sex and CHI number. The patient search will present with one of three outcomes: 8

9 Exact match: When the details you entered match with only one record in our system, an exact match is displayed. The Date of Last Examination returned may be a 1a, 1b or 1c examination. If you are happy that the details returned are for your patient, select Create Claim or Create Prior Approval and these patient details will be used for the claim. If not, select Back and check the patient details entered and search again. Note: Only the Create button that corresponds with the selection you made in the home page will be active. 9

10 Multiple matches: If more than one record is matched to the patient details you entered, you will be presented with a list of those matches. Select the details that match your patient and hit Search, these details will be used for your claim. Where a patient search comes back with a selection of patients, but the details of the patient you know is yours had slightly different details, select that patient to create the claim even although the details differ slightly. You should then submit a Patient Detail Amendment form, Dental 287, asking us to update that patient s record with the correct details. If none of the records on the list correspond with your patient, select None of the above and hit Search. A further search on the original details you entered will be carried out. 10

11 No match: If you have selected None of the above from the list of patients presented and hit Search, you will receive the message above. If any of the details you entered are incorrect, you can go back and change them. If they are correct, select Create Claim or Create Prior Approval to use the original patient details. If you know the patient is definitely registered at your practice, go back and check the details entered and search again. When you have confirmed the patient details you wish to use for the claim, those details will be added to the bar at the top of the screen. 11

12 This bar will remain at the top of every screen as you navigate through the web form, so you always know who is logged in and which patient the claim refers to. The results from a patient search will return some clinical data, as well as the patient details. Where you accept an exact match as being correct or select a patient from the list provided for a multiple match you are confirming that this is the correct patient and you are taking responsibility for providing care and treatment to that patient. Note: If a claim is started as a payment claim and you realise it requires prior approval, it cannot be converted to a prior approval claim. You must cancel it and begin a prior approval claim from the start. The same applies in reverse. 12

13 5. Tabs on view for each claim type The payment claim form has the following tabs, with the Treatment tab having further sub tabs. The sub tabs only appear when you have clicked on the Treatment tab. The prior approval claim form has the following tabs, with the Prior Approval Details and Treatment tabs having further sub tabs. The sub tabs will only appear when you have clicked on these tabs. 13

14 6. Patient Details tab Now you have created a claim or prior approval request, the patient details tab will show the details of the patient you selected. You do not need to do anything further on this tab. You can create claims prior to the patient attending and use the Save button to save them for when you are ready to complete them. This tab is identical for both payment claims and prior approval requests. 7. Button options Until you reach the submit stage, each tab will have the following button options at the bottom: - Cancels claim, removes all information entered and returns to home page. - Navigates to the previous tab. - Saves information entered to this point and places claim on the List of Claims table. - Navigates to the next tab. 14

15 8. Patient Acceptance tab Your patient must sign part 1 of the GP17(PR) form before treatment starts and these details should be reflected here. This tab is identical for payment claims and prior approval requests. We will shortly be in a position to publish details of accredited versions and/or specifications for electronic signature pads to record the details currently captured on the GP17(PR). 9. Payment claims 9.1 Claim Details tab If claiming for Special Needs or External Trauma to the mouth, just select the box beside that entry, observations are no longer required. Similarly, if the claim is a referral, you only need select the reason for referral, Facilities, Experience or Expertise - no observations are necessary. You need to answer the Radiographs Available question only when one or more of the treatment codes you have claimed has a proviso in the Statement of Dental Remuneration (SDR) stating 15

16 that no fee shall be payable except where appropriate radiographs are available, for example, for the provision of a bridge (item 18). If you have radiographs available, select Yes. Where it is not appropriate to take radiographs, for example, pregnancy, select No and you must enter a Reason for no radiographs in the box provided. If none of the items claimed require radiographs, as stated in the SDR, do not select anything for this question. Do not enter anything in observations. A continuation case is where one dentist starts treatment and a different dentist within the same practice completes the treatment. In these cases, the Previous Claim ID and Continuation Part No. are required. The previous claim ID can be located on the List of Claims table, under the column named Reference. Do not enter any of this information in observations, only in the specific fields on this tab. The same date of acceptance must be used on all parts, to reflect that it is one course of treatment. If the case was granted Approval, the Prior Approval Reference Number and Approval Date must be entered. These can be found on the Submission tab of your Prior Approval request. Do not enter the Prior Approval Reference Number or Approval date in observations. 16

17 9.2 Treatment tab Other Treatment When you click on the treatment tab, you will see an additional four tabs below it. The first tab is Other treatment, which allows the selection of some common non tooth specific items, for example, examinations. To claim these items, simply click on the square beside each one you are claiming. There is no need to use the button for these items. If you are claiming for radiographs, simply enter the number being claimed in the box beside No of Small Radiographs. There is no need to use the button for radiographs. Select other non-tooth specific items by entering the four digit Treatment Code from the Statement of Dental Remuneration (SDR) and the Quantity being claimed. Click the button to move the treatment onto the table and repeat as necessary. There is no maximum number of rows on the table, a scroll bar will appear when you reach the bottom. If you have added a treatment to the table in error, it can be removed by clicking delete. Free Replacement can only be selected with the usual trauma proviso. 17

18 9.3 Treatment tab Tooth Specific Treatment Enter the four digit Treatment Code from the Statement of Dental Remuneration (SDR) and the tooth number, using FDI tooth notation (see diagrams at the end of this guidance). For all fillings you must select the Annotation Code (F - Filling), Surface(s) and Material. For all gold inlays you must select the Annotation Code (IN - Gold inlay) and Surface(s). Do not select an Annotation Code for any other type of treatment, only the treatment codes listed below: 18

19 If your Treatment Code is not listed on the previous page, you only need enter the four digit Treatment Code and Tooth Number, then click the button. Clicking the button moves the treatment onto the table on the right hand side of the tab. Repeat as necessary for all tooth specific items. Select Supernumerary and Free Replacement, as necessary. Free Replacement can only be selected with the usual trauma proviso. There is no maximum number of rows on the table, a scroll bar will appear when you reach the bottom. If you have added a treatment to the table in error, it can be removed by clicking delete. 9.4 Treatment tab Value Summary You must always go to this tab and click the Get SDR Values and Refresh Table button, which will populate the table with the information from the Other Treatment and Tooth Specific Treatment tabs. If you go back to previous tabs and amend any treatment, you must return to this tab and click the button again to refresh the table and monetary values. 19

20 Where the fee code is a Discretionary item with no fee and a fee has been awarded by a Dental Adviser, enter the value and patient charge in the boxes under Specified Fee Value and Specified Patient Charge. Always click on the Get SDR values and refresh table button to update the total value field after any addition or change. Note: The Total Patient Charge shown is for your information only. This indicates the amount the patient would have to pay if they pay for their treatment. The actual patient contribution must be entered on the Patient Completion tab, either zero or the amount the patient is paying. 20

21 9.5 Treatment tab BPE The BPE is not mandatory for a payment claim. Acceptable entries are: single number 0-4 a single number 0-4 followed by asterisk (*) a dash (-) with no number an X with no number 9.6 Observations tab Observations should only be used for clear requests and/or instructions pertinent to the claim and not already covered elsewhere on the claim. Observations are no longer required for Special Needs, Referrals, Domiciliary Visits or Free Replacement. 21

22 9.7 Patient Completion tab Your patient must sign Part 2 of the GP17(PR) form on completion of the treatment and these details should be reflected here. This will not be completed in cases of PFTR, where PFTR is ticked on the Dentist Completion tab (see next page). If the patient was liable to pay for treatment at the start of treatment, but on completion of treatment they now receive a benefit, you must tick the first box on the tab Patient circumstances have changed from fee paying to receiving a benefit and select the benefit they are now on from the drop-down list. This should only be used when the patient moves from fee paying to receiving a benefit, not if they fall pregnant. As far as whether the patient is then liable for any charges is wholly dependant at what point in the course of treatment you charge the patient. If you charge at the end of treatment, then the patient would not pay. If you charge as you go, the patient will only be exempt from charges at the point they moved onto the benefit. You must enter the patient contribution on this tab, in the field Patient has paid or will pay the dentist. If the patient does not pay for their treatment, you must enter in this field. 22

23 9.8 Dentist Completion tab This tab is used to record details of treatment that was not completed as planned: - Patient refused treatment If the patient has refused treatment, you must tick the box for The patient refused the treatment and I have provided the care and treatment the patient was willing to undergo and enter the reason for refusal of treatment in the box provided; - Patient failed to return (PFTR) - If the patient fails to return, tick the box for The patient has failed to complete the treatment (PFTR). For the question Are you making a fee request, only select Yes where you are claiming for an item of treatment that is not covered by a code in the Statement of Dental Remuneration (SDR) or the Discretionary Fee Guide. You must also enter details of the treatment carried out in the box provided. Where you can enter a code for all individual items of treatment, there is no need to answer the question Are you making a fee request and no remarks are required. The Prepare to Submit button triggers in-form validation, which checks you have completed all mandatory fields and that dates, etc, are in the correct format. If errors are detected, the tab with 23

24 the error is highlighted in red, the field is also highlighted in red and the relevant error message(s) are displayed at the bottom (see next page). If the in-form validation does not find any errors, the claim is closed and placed on the List of Claims table. The List of Claims table is then displayed and the status of the claim is set to Ready. You can then submit this claim on its own or as part of a bulk submission. The Submit button does the same validation as the Prepare to Submit button, with errors highlighted in the same way. However, if no errors are detected the Personal Identification Number (PIN) declaration pop-up is displayed. When you enter your PIN and tick the declaration, the claim will be submitted. The Submit button will only be active when a dentist is logged in. 10. Errors highlighted following in-form validation When errors are found during in-form validation, the tab with the error is highlighted in red. The field with the error will also be highlighted. The error message(s) explaining the reason for the failure will appear at the bottom of the tab. When you correct the errors and select the Prepare to Submit or Submit button again, the inform validation will run again. Note: The red highlight(s) will not disappear when you have corrected the error(s). 24

25 If errors are still present, you will again be presented with the red highlights to indicate the errors. If you have corrected all the errors and select Prepare to Submit, the form will be displayed in the List of Claims table, with a status of Ready. If you select Submit after correcting all the errors, the PIN declaration pop-up will be displayed. 25

26 11. Personal Identification Number (PIN) declaration When the dentist has chosen to submit a claim or claims from the List of Claims table, the PIN declaration pop-up box will appear. Admin Staff do not have the ability to submit forms, so the dentist must be logged in to submit forms. The dentist must enter their PIN, tick the declaration and click the authorise button to submit claims. 26

27 12. List of Claims screen and claim status This table lets you view the details of all claims and prior approvals for the practice. Here you will find claims saved before completion, ready to be submitted, successfully submitted and those returned with errors. The list can be filtered on Acceptance Date, Type of Claim, Dentist and Status (an explanation of all statuses is shown on the next two pages). Click the Refresh button to update the view. Select individual claims by ticking the Select box at the end of the row. You can View, delete or Submit a selected claim. 27

28 Status for general claims Saved Claim has been created, but only part completed and saved. Claim cannot be submitted for payment until it has been completed in full and status is 'Ready'. Ready Claim has been created, completed and saved. It has passed all validation within the edental Web Forms application and is ready to be submitted for payment. If you choose to do a bulk submission, all claims with the 'Ready' status will be submitted. Submitted Claim has been submitted, but is assigned the temporary status of 'Submitted'. A status of 'Successful' or 'Failed' will be assigned to the claim once the initial validation has been carried out. Error Submission of claim could not be completed due to a technical issue. Claims with a status of 'Error' should be re-submitted. Failed Claim was rejected following initial validation. Refer to the reasons for error returned with the claim. Successful Claim passed initial validation and has been successfully submitted. 28

29 Status for Prior Approval requests Saved Prior approval request has been created, but only part completed and saved. Submitted Prior approval request has been submitted, but is assigned the temporary status of 'Submitted'. A status of 'Accepted' or 'Failed' will be assigned to the request once the initial validation has been carried out. Accepted Prior approval request has passed initial validation and is awaiting review. Error Submission of prior approval request could not be completed due to a technical issue. Requests with a status of 'Error' should be re-submitted. Failed Prior approval request was rejected following initial validation. Refer to the reasons for error returned with the request. Approved Prior approval request has been approved, you can commence treatment. Request We have requested additional information: 1. One or more attachments of radiographs, photographs and/or written reports; 2. An electronic response, providing the additional information to a question we have asked. Reminders will be sent if you have not responded and the prior approval request will return to this status. Declined Prior approval request has been declined. Closed Prior approval request has been 'Closed', usually due to a lack of response to a request for more information. Not required Prior approval request does not require approval for the identified treatment or total value. 29

30 Claims with a status of Ready can be selected for submission. Prior approvals must be submitted one at a time, with the PIN entered each time. Payment claims can be submitted in bulk, so you can select as many claims as you wish that are at the Ready status. The PIN declaration will appear only once to cover all claims selected. Once the PIN and declaration have been completed, you will be presented with a Progress screen. On successful submission, the Case ID number will be shown above the tabs. The Case ID is also shown on the List of Claims table, under the column Reference When all claims have been successfully submitted, you will be returned to the List of Claims table. Note: You cannot bulk submit claims from different list numbers, as each list number has its own unique PIN. To view the claims that have been successfully submitted, choose Successful from the dropdown list for Status and press the Refresh button. 30

31 13. Failure tab When your payment claims and prior approval requests are submitted, they undergo initial validation before reaching our payment or prior approval systems. If any submission fails that validation, it will be displayed on the List of Claims table with a status of Failure. A new Failure tab will be shown when you next view that claim. The tab will be highlighted in red and will display all reasons why the claim failed, in the form of error messages. You must correct all the errors before you resubmit the claim. If you fail to correct all the errors, the claim will fail again and be returned. Note: The red highlight(s) will not disappear when you have corrected the error(s). 31

32 14. Prior Approval requests 14.1 Prior Approval Details tab Examination Details If you answer No to the question I have examined the patient, you must enter a reason in the box provided. All other questions are mandatory and a selection must be made for each one Prior Approval Details tab Medical history If you answer Yes to the question Does patient have a medical condition or taking medication pertinent to their oral health, you must enter details in the comments box provided. The other two questions are lifestyle questions, on smoking and drinking, and a guide to the number of alcoholic units contained in each drink is provided on the next page for reference. 32

33 Alcoholic units per drink 33

34 14.3 Prior Approval Details tab General Condition If certain questions on this tab are answered Yes, additional details must be entered in the boxes provided. For the question Does patient currently wear dentures?, if you answer either Upper or Lower, the material must be selected. If you answer this question Both, there is no need to select a material Prior Approval Details tab Radiograph Details All questions on this tab are mandatory. The teeth shown in the intraoral radiographs must be detailed on the chart on the right hand side of the screen. 34

35 14.5 Prior Approval Details tab Vitality Test If a vitality test is available, a + or must be entered for each tooth present. 35

36 14.6 Prior Approval Details tab Prior Approval Arrangement If any treatment is to be provided privately, details must be entered in the box provided. If treatment is to be carried out under sedation, but is not being administered by the operator, the name of the person administering the sedation must be entered in the box provided Treatment tab Chart All permanent teeth are defaulted to P for Present. For permanent teeth not present, you need to change the P to one of the other options listed at the bottom of the tab, ie M - missing, U - Unerupted or Z - Missing and space closed. 36

37 If all permanent teeth are missing, use the All Permanent Teeth Missing button to change the P to M for all teeth. Note: Retained deciduous teeth are to be treated as permanent teeth. Use the tick boxes to indicate if any deciduous or supernumerary teeth are present Treatment tab Other Treatment Entering non-tooth specific treatments is identical to the method used on the Other Treatment tab for Payment Claims, shown on page

38 The common non tooth specific items at the top of the tab are slightly different and the field for No of Colour Photographs (3A) replaces the field Referral (no. of claims) Treatment tab Tooth Specific Treatment This tab is identical to the Tooth Specific Treatment tab for Payment Claims, shown on page Treatment tab Value Summary This tab is identical to the Value Summary tab for Payment Claims, shown on page Treatment tab (BPE) Basic Periodontal Exam Observations tab This is slightly different from the corresponding tab in Payment Claims. If the BPE is unavailable, you must enter a reason in the box provided. Observations should only be used for clear requests and/or instructions pertinent to the request and not already covered elsewhere on the request. Observations are no longer required for Special Needs, Referral, Domiciliary Visits or Free Replacement. 38

39 14.13 Submission tab This is the final tab for Prior Approval claims. If you wish a Dental Adviser to review your claim, select the Request a Review checkbox and add a reason in the Observations tab. The Approval Date and Prior Approval Reference will be blank until the request has been submitted and approved. Click the Save button to place the request on the List of Claims table with a status of Ready. Click the Submit button to submit the prior approval request. These can only be submitted individually. Once the claim has been submitted and approved, the Approval Date and Prior Approval Reference will be populated. Note: Do not submit attachments at this point, if we wish to see them we will request them. 39

40 14.14 Requests tab If we require additional information, in order to properly review your request, we will return the claim to you. It will appear on your List of Claims table with a status of Request. When you view the claim, there will be a new tab called Requests, where you can read our message to you and write a response and/or upload attachments. Select which correspondence to read on the left hand table and the details will appear in the reading pane at the top right. Any responses you have sent are also available to view in this table. You can only respond or upload attachments when viewing our latest correspondence. If we only require clarification on something, you can use the Response Area to reply with a typed message. If we have asked you to submit attachments, and you have electronic files, click the Upload Attachments button, which will take you to a secure web page. Here, you can upload your attachments by browsing to the files you have saved on your computer, see below. 40

41 15. Attachment upload Do not submit evidence for different requests at the same time, only for the request you are currently viewing. The list number and practice reference number are shown at the top of the page. When you click the Add file button, on the page shown above, you will be presented with the screen below: 41

42 There is no limit to the number of files you can add. You must select the Attachment type from the dropdown menu. If you select radiograph or photograph as the Attachment type, you must also: enter the date they were taken; and a description of what teeth or area of the mouth the image shows. If you have selected other, you must also complete the Description box. If you are attaching more than one item, ensure all attachments are prepared in advance of selecting the Upload Attachments button. When a field requires to be completed, it will be highlighted orange at the left hand side. Once you have completed a field, the highlight will change to green. The Upload files button will not be accessible if any required fields have not been completed. When several files are selected for upload, they will stack on top of each other and the page will scroll, if required. 42

43 When you have finished adding files, click the Upload files button to submit. You will be advised that your files are uploading (above left), then receive confirmation of a successful upload (above right). At this point you still have the opportunity to add further files, if you have forgotten any. When you have finished uploading your files, you can close the submission upload window. You must return to the Submission tab of the request, where a new area called Supplementary Information will now be visible, see image below. 43

44 If you have submitted electronic attachments, you must tick the box Electronic Attachment Uploaded to indicate this. If you have sent physical evidence, you must indicate the type of evidence, for example, models, radiographs, etc, so we know what we are expected to receive in the post. All physical evidence must have the patient s name, date of birth and the Claim ID number attached. When we receive the physical evidence, we will send you a message to confirm we have them. If you indicate Prior Approval no longer required, you must specify whether it was patient or dentist initiated and also indicate the reason in the box provided. When you have completed all relevant fields on this tab and/or sent physical evidence, you must re-submit the claim. If we do not receive a reply to our request after 28 days, we will send you a reminder. If we have still not received a reply after a further 14 days, the case will be closed and you will be informed. 44

45 16. Summary of changes to observations A number of changes have been made to the way we process your claims and one of the biggest areas of change is around observations. We have reduced the need for you to use this area, other than for information required in order to process a claim. We have listed the main changes below, using the following key to indicate when observations are required: Observations are still required Observations are no longer required 16.1 Item 41b and 45c (Special needs) An extra payment can be claimed when a dentist requires extra time to treat a patient. A dentist can claim double the capitation or continuing care payment if it is necessary to spend at least double the normal time treating the patient. Observations are no longer required to claim special needs. 45

46 16.2 Referral for specialist treatment If a patient has been referred to you for specialist treatment, you can claim an extra payment. You need to enter the total number of referral claims (code 4600) within your web form claim and indicate the primary reason for referral, from a pre-set list: 1) Facilities; or 2) Experience; or 3) Expertise. Where you are claiming a referral, you must also ensure you select I wish to be treated as a referred patient on the patient declaration of acceptance. Observations are no longer required to claim referral fees Trauma Where you are indicating there is trauma to the mouth, this must only be highlighted in cases where there is external trauma to the mouth, such as a blow to the jaw. Details of the trauma are no longer to be included on the claim. Observations are no longer required for trauma. 46

47 16.4 Domiciliary visits If you are claiming for domiciliary visits, you no longer need to provide observations. Observations are no longer required for domiciliary visits Free repair and replacement Claiming an item for free repair and replacement can only be accepted where it is as a result of trauma arising from a source external to the mouth. Refer to the Statement of Dental Remuneration (SDR) for acceptable free replacement items. Observations are no longer required to claim free repair and replacement Patient Failed to Return (PFTR) Where a patient has failed to return, you must tick the The patient has failed to complete the treatment (PFTR) box on the dentist completion tab. Depending on whether you are making a fee request, you should follow either step 1 (NO fee request) or step 2 (fee request), as detailed below: 47

48 Step 1 - PFTR with NO FEE being requested Select PFTR on the dentist completion tab and select NO for Are you making a fee request. Observations are not required for a PFTR that does NOT include a fee code request. Step 2 - PFTR with a FEE being requested If you are claiming for a treatment not covered by a code in the Statement of Dental Remuneration (SDR) or the Discretionary Fee Guide, select PFTR on the dentist s completion tab and select YES for Are you making a fee request. Detail the treatment carried out that you wish a fee for, in the remarks box. Additional note: formal observations are also required if a patient returns to complete treatment previously paid as incomplete treatment on a PFTR claim. This claim will require observations entitled balance adjustment, detailing only the treatment that is now completed and the details to identify the PFTR claim, for example the list number, treatment start date and case ID of the claim. Keep comments short, succinct and meaningful. 48

49 16.7 Patient refused treatment When a patient has refused treatment, you must select the declaration The patient refused treatment and I have provided the care and treatment the patient was willing to undergo on the dentist completion tab. You must enter the reason the patient refused treatment in the box provided. Observations are required if patient has refused treatment 16.8 General observations The use of the general observations box should be kept to a minimum in order to avoid unnecessary delays in processing Continuation Cases If a course of treatment is started under one list number and completed under different list number within the same practice, this is a continuation case. The date of acceptance must be the same on all parts of a continuation case, to reflect that it is one course of treatment. 49

50 You must enter the Claim ID of the previous continuation part and the continuation part number on the Claim Details tab. Do not enter these details in observations. For part 2 and above, claim type I am registered with another dentist at this practice must be selected on the Dentist Declaration tab. The previous case ID can be found on your eschedule report once processed, paid and reported, or it may still be on the List of Claims table within the web form. The Claim ID contains 12 digits and is made up as follows; first 5 numbers are the dentist list number, ie 12345, the following 6 numbers are the claim number created by the PMS, ie and the final digit is the submission count. Using the examples above, the first time submitted Claim ID would be If this claim had been returned to you and re-submitted, the Claim ID changes to This keeps all Claim IDs unique. If the claim has previously been submitted for prior approval and been approved, you must also enter the Prior Approval Reference Number and Approval Date on the Claim Details tab. Separate parts must be submitted in the correct sequence and it is advisable to allow at least 1 day between submitting the different parts, otherwise there is a risk your claim may be rejected. The patient charge is calculated across all continuation parts and therefore cannot exceed the statutory amount. 50

51 An example of a continuation case, below, shows the information required on both claims. The start date is the same for Parts 1 and 2; also the registration should remain with the dentist who completed Part 1. The completion date on Part 1 must be the last date the patient was treated by the first dentist and must be before the dentist s resign date (if dentist has resigned). Part 1 claim details Dentist list number: Claim number: Start date: 10/01/2017 Completion date: 20/03/2017 Patient wishes to be registered with this dentist Claim Details tab: No entries needed Part 2 claim details Dentist list number: Claim number: Start date: 10/01/2017 Completion date: 25/07/2017 Patient is registered with another dentist within this practice Claim Details tab: Continuation Previous Claim ID: enter Continuation Part No: enter 2 If claim required approval, enter Prior Approval Reference Number and Approval Date 51

52 Any incomplete treatment started on Part 1 should have the remainder of the fee paid on Part 2, add details in observations. Part 1 claim details Dentist list number: Claim number: Start date: 10/01/2017 Prior approval date: 10/02/2017 Completion date: 20/03/2017 Patient wishes to be registered with this dentist Claim Details tab: No entries needed Observations: No entry needed Part 2 claim details Dentist list number: Claim number: Start date: 10/01/2017 Prior approval date: 10/02/2017 Completion date: 25/07/2017 Patient is registered with another dentist within this practice Claim Details tab: Continuation Previous Claim ID: enter Continuation Part No: enter 2 If claim required approval, enter Prior Approval Reference Number and Approval Date Observations: Balance adjustment fee request for fit of denture previously claimed as on part 1. 52

53 Note: If you realise the combined cost of all parts of a continuation case is above the prior approval limit, after you take over treatment, you must stop treatment and apply for approval. As you will only be submitting the treatment you intend to carry out, as your part of the continuation case, tick the box for Request a Review on the Submission tab and add the claim reference number of the first part of the continuation case in observations, to ensure we review both parts of this treatment Regulation 9 Regulation 9 is the process for obtaining funding to replace lost/broken dentures, splints, bridges and orthodontic appliances, due to an act or omission by the patient. You must obtain the Regulation 9 decision from your NHS Board before submitting the claim for processing. Submit the claim and add Reg 9 NHS Board decision ed in observations. The NHS Board letter should then be ed to NSS.psd-customer-admin@nhs.net with Reg 9 and the patient s name in the subject field of the . This must be sent from your NHS.net address. Note: In some cases the dentist may agree with the patient to take a deposit up to the whole cost of replacement, to allow treatment to commence in the event that NHS funding is refused and the treatment item is provided privately. If all or part of the funding is approved, then an appropriate amount of the deposit taken should be returned to the patient. 53

54 Note: In cases where prior approval is involved, if the total value is over 390, minus the value of the Regulation 9 item, approval must still be obtained irrespective of the Regulation 9 claim. However, if the appliance/ prosthesis is the only item claimed on the form and is under 390, prior approval is not required. 17. New rejection messages Using the web form ensures you only submit claims with all mandatory data fields completed and successfully submitted claims will be validated earlier in the claiming process. This has created new error/response messages, some of which you will already be familiar with, as only the reference number of the message has changed, for example: MSG_245 will now display as E000626, but retain the same wording Your claim was not received within 3 months of the completion date. Any claim returned to you with an error must be corrected and re-sent. We improved the wording of the response messages and additional guidance on our web site: We may, on very limited occasions, reject a claim from MIDAS as a paper rejection letter, for example, duplicate claims: 54

55 Where a claim with similar treatment has been paid in a previous schedule for that patient, you will receive a rejection letter with the reason clearly stated. You should check the details of the duplicate claim against previous submissions and practice records. There are then 3 options: 1. Claim was submitted in error and the previous submitted claim is paid, or can be adjusted by sending a Dental 283 adjustment form to NSS.psd-customer-admin@nhs.net; 2. Claim was valid but contained wrong details. Create and submit a new claim with the correct details. Observations are required referring to the rejected duplicate claim and the changes made on this claim to correct it. 18. General changes and notes 18.1 Items requiring radiographs Where the SDR states an item requires radiographs, validation ensures that either you have indicated radiographs are available or an item 2 treatment code is claimed. If radiographs are not available or an item 2 treatment code is not claimed, the claim will be returned immediately. In cases where it is not appropriate to take radiographs, for example, the patient is pregnant and there are no recent radiographs available (we will accept a recent radiograph taken within 6 months), you can declare No radiographs supplied on the Claim Details tab and provide details in the box provided. 55

56 18.2 External trauma For patients under 18 year of age with external trauma of the mouth, external trauma must be selected on the Claim Details tab if an item 2 treatment code is added to the claim Claim type Where the claim type has been selected as I am registered with another dentist at this practice, the patient must be found in our system as being registered with a different list number at the same practice on the acceptance date of the claim. If not, the claim will convert to occasional treatment and may cause some or all treatment to be invalid and removed from the paid claim Free replacement If you make a claim for an item under free replacement, but we identify that it is not an eligible item, we will reject the claim with an error but will advise you of the item that is not eligible Tooth specific treatment Where you have charted teeth that an item of treatment is not permitted on, the claim will fail with the response message no tooth notation identified. For example: item 0701, sealant for wisdom teeth, being claimed on the 6s or 7s. Similarly, claiming an addition to a partial upper denture but lower tooth notation provided would fail with response message no tooth notation identified. Each tooth number must be a valid deciduous or permanent tooth number for example 11, , We will also advise you of the fee code and the teeth in question. 56

57 18.6 Discretionary fees All possible codes are now available to the profession. Where a code for treatment is not in the Statement of Dental Remuneration you will be able to select it from the list of all possible other codes, published in the Discretionary Fee Codes guide on our web site: A small number of discretionary codes will require a Dental Adviser to award you a value upon request. If you have been awarded a fee from a Dental Adviser you should enter the value for that item code on the Value Summary tab and refresh the table to add that value onto the claim Submitting claims and prior approval requests Payment claims can be submitted in bulk, only requiring you to enter your Personal Identification Number (PIN) once. Prior approval requests can only be submitted individually, where you need to enter your PIN for each request submitted Supporting information If we wish to see any additional information for prior approval requests, for example radiographs, photographs and models, we will send you a message detailing what information we require and a web link to allow you to upload digital copies. 57

58 18.9 Request to delete a paid claim If you wish to have a paid claim deleted, do not submit a claim with observations to do this. A Dental 283 form should be completed and ed to NSS.psd-customer-admin@nhs.net 19. Providing tooth notation information When you are providing us with details of tooth notation within correspondence, administration forms or claim observations, you must use the Federation Dental International (FDI) notation. The first image, below, explains how each tooth is numbered using FDI and the second image shows the FDI number of each tooth. 58

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