eDental User Guide, EXACT v12.8
Scotland NHS eDental
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Contents Contents ............................................................................................................................................................................... 3 Procedures ........................................................................................................................................................................... 4
NSS Practitioner Services eDental
5
Overview of eDental ............................................................................................................................................................. 5 Purpose ........................................................................................................................................................................... 5 Features .......................................................................................................................................................................... 6 Benefits ........................................................................................................................................................................... 9 Requirements ................................................................................................................................................................. 9 eDental Terminology .................................................................................................................................................... 10 Configuring EXACT for eDental ........................................................................................................................................... 11 Phase 1.......................................................................................................................................................................... 11 Phase 2.......................................................................................................................................................................... 12 Using eDental ..................................................................................................................................................................... 14 Changes in EXACT following eDental setup .................................................................................................................. 14 EDI transmission is no longer possible ................................................................................................................. 15 NHS GP17 Form changes for eDental ................................................................................................................... 16 eDental Claims Central ......................................................................................................................................... 18 Provider Name for eDental transmission ............................................................................................................. 18 Requesting a CHI Number .................................................................................................................................... 20 eDental COT ......................................................................................................................................................... 27 eDental Continuation COT ................................................................................................................................... 36 Patient change of Exemption Status .................................................................................................................... 38 eDental Appointment Workflow .......................................................................................................................... 44 eDental Clinipad procedures ................................................................................................................................ 45 Claims Central ............................................................................................................................................................... 50 Claims Central - Completed COTs......................................................................................................................... 53 Claiming a Completed COT .......................................................................................................................... 57 Claims Central - Awaiting Transmission ............................................................................................................... 59 Claims Central - Awaiting Response ..................................................................................................................... 60 Claims Central - Unresolved Responses ............................................................................................................... 61
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CAUTION - Fix Unresolved Responses BEFORE transmitting .......................................................................63 Example - Resolve missing Signee on Completion .......................................................................................63 Resubmitting a COT from the Response window ........................................................................................65 Acknowledgements and Responses ..............................................................................................................................66 Managing Payment Schedules ......................................................................................................................................66 Importing a Schedule File .....................................................................................................................................66 Viewing and Reconciling Payment Schedules ......................................................................................................68 Training Competencies for eDental ....................................................................................................................................71 Index ...................................................................................................................................................................................74
Procedures To revert to EDI transmission .......................................................................................................................................15 To Request a CHI Number .............................................................................................................................................20 To register an unsuccessful attempt to Request a CHI Number ...................................................................................26 To change the option to Patient is pregnant: ...............................................................................................................39 To change the option to Patient/partner gets income support: ..................................................................................42 To launch Claims Central ..............................................................................................................................................50 To Claim a Completed COT ...........................................................................................................................................57 To resolve an Unresolved Response and remove it from the Response window ........................................................62 To update Signee on Completion from the Unresolved Responses screen ..................................................................63 To Resubmit a COT from the Response window ..........................................................................................................65 To import a Schedule File .............................................................................................................................................66 To view Payment Schedules .........................................................................................................................................68
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NSS PRACTITIONER SERVICES EDENTAL The EDI+paper system for Scottish NHS claims is being replaced with the eDental system-to-system capability. This is in place from April 2017, but roll out to practices is managed by the NHS. The EDI transmission service becomes non-functional for payment claim submissions after 31 December 2017, so before this date your EXACT system needs to be updated and configured to enable the eDental capability, and your practitioners need to be fully appraised of the new workflows and procedures. This eDental update is available from EXACT v12.8 onwards, but should only be commenced when your practice is selected by the NHS.
IMPORTANT: Once your dental practice is enabled for eDental you cannot return to EDI claiming except by means of a functional backup of EXACT from before the eDental conversion. If you have any doubts or reservations about converting to eDental, please create a full backup before continuing (see also EXACT network backups).
Overview of eDental Purpose NHS Modernisation A range of services have been deployed to extend the delivery of pharmacy based care in Scotland. The NHS has expedited roll out of these new services by introducing a centralised infrastructure that provides software applications to support each service. This infrastructure was developed as part of the NHS Scotland / Scottish Government ePharmacy programme, but it has been extended to support further practitioner groups. The applications are collectively known as the ePractitioner Services (EPS) applications. The EXACT eDental feature falls within these services, and is formally known as The electronic transmissions for NSS Practitioner Services eDental. As eDental modernises the processing of claims and prior approvals, NHS dental practices are expected to increase the use of electronic resources and to thereby benefit from streamlined claims payment processing, optimised working practices, reduced use of paper, and improved sharing of historic data.
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eDental replaces EDI+Paper The EDI + paper system for claims is being replaced with the new eDental system-to-system capability, which is underpinned by the existing ePractitioner infrastructure. The eDental system is expected to
Increase the use of electronic communications
Increase the quality of data held by NHS and dental practices
Provide a faster, more efficient and improved service
Deliver consistent technology-based solutions across primary care practitioner groups
Re-use existing ePractitioner and software components
Establish a new national electronic Prior Approval process by providing a reusable infrastructure and components
EXACT software has been updated in v12.8 to support this eDental initiative. It includes a transition procedure, after which your practice becomes irrevocably committed to eDental.
Features Claims Central A Claims Central (on page 50) console provides a single point for Claims management:
Editable, Lookup CHI Number
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The CHI Number (see "Requesting a CHI Number" on page 20) field is editable and it has an associated button; Request CHI, for CHI Lookup by the practitioner:
Exemptions and Charges window - Signee On Acceptance: When you create a Scottish NHS COT and complete the Exemptions and Charges window, you are also required to complete the Signee On Acceptance with a date defaulted to today.
See also: eDental COT (on page 27)
Continuation COT on the GP17 form A dentist can record the fact that treatment will be continued by another dentist (Continuation COT (see "eDental Continuation COT" on page 36)). On the NHS GP17, dentist 1 ticks Treatment will be continued by another dentist:
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During later treatment dentist 2 ticks Treatment is being continued by another dentist:
See also: Continuation COT (see "eDental Continuation COT" on page 36)
Clinipad integration Arrival Task List - Arrive and Send to Clinipad: When arriving a patient, in the Arrivals Task List a practitioner can choose to Arrive and Send to Clinipad in order to complete the details for GP17PR Part 1.
See also: eDental Clinipad procedures (on page 45)
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Benefits General
Leverage your electronic communications technology.
Increase the quality of your data.
Provide a faster, more efficient and improved service to patients.
Electronic Submissions Benefit from the advantages of fully electronic workflows between your practice and the NHS.
Integrate GP17 Forms with Clinipad With Clinipad, patients can themselves partially complete GP17 Part 1 on arrival at Reception, and GP17 part 2 on departure from Reception. See eDental Clinipad procedures (on page 45)
Track Continuation COTs on the NHS GP17 Form A continuation COT is where one Provider starts treatment and another Provider continues it. eDental software provides for notification on the NHS GP17 form that Treatment will be continued by another dentist on this same COT, then has the means for the continuing Provider to accept and continue the treatment. See eDental Continuation COT (on page 36)
Requirements EXACT Requirements:
EXACT version 12.8 or later
Prerequisites for ePharmacy Adapter installation: (The Adapter has possibly already been installed in your practice)
Installing person has Administrator permissions
.NET version 4 or later
SQL Server is installed correctly
Latest ePharmacy installation software
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eDental Terminology Applicable terms from the NSS Practitioner Services eDental. Client - A system that uses ePractitioner services. EPMS - ePractitioner Message Store EPS - ePractitioner Services / ePharmacy Services PRS - Patient Registration Service SWAN - Scottish Wide Area Network - the NHS Scotland national data network MIDAS - NSS Practitioner & Counter Fraud Services Dental Payment Engine Release - Formal issue of a set of items with specific functionality. XML - eXtensible Markup Language
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Configuring EXACT for eDental This configuration should not be done without prior consent from PSD eDental transition team first. You will receive a call from PSD eDental Transition team advising you when to start each phase. You will need to log in as an EXACT administrator. If you have any questions or need assistance please contact our support team on 01634 266800.
Phase 1 Before activating the first phase you will need to ensure all claims have been sent to the NHS on the date agreed by the Practitioner Services. Once you have sent these claims you need to do the following: Got to File->Payors and bring up the NHS. Click on Transmit Setup.
Choose the Prepare for eDental option and click Next. EXACT will advise if any claims are still awaiting transmission, please ensure all COTs are sent for claiming before going any further. If any first or last names are missing in the providers file then EXACT will advise you fill this in. Please double check all names to ensure they are correct, there is an edit option that will allow you to edit any names. Click Finish. Phase 1 is now complete, you will no longer being able to make any claims until eDental has been fully implemented, however you can receive any acknowledgements/responses of the claims you have recently sent.
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Phase 2 Please activate Phase 2 on the transition date agreed on with the practitioner services. Before activating Phase 2 please ensure all claim acknowledgments/responses have been received, you can do this by going to File>Payors, bring up the NHS and click on Transmit Claims. To activate phase 2 you must do the following: Go to File->Payors and bring up the NHS Click on Transmit Setup.
Choose the eDental option and click Next.
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Click Next again. Make sure you have completed all the prerequisites, check to say you have completed these and click next.
Enter your site number and the name of the computer you have installed the SQL Server on. Click Confirm. If you do not know your Site number please contact Practitioner Services
Click Finish. You have now successfully transitioned to eDental.
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Using eDental Changes in EXACT following eDental setup The move from EDI transmission to eDental transmission is irrevocable unless a practice installs a previous EDIbased backup. The topics below describe the primary EXACT changes in a practice that has transitioned to eDental.
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EDI transmission is no longer possible Following successful eDental setup, the previous EDI transmission method is no longer possible if an Administrator-level user reopens Transmit Setup, they are prevented from going back to EDI transmission. Only the eDental option is available:
To revert to EDI transmission The only way for your practice to revert to EDI transmission is by installing a pre eDental EXACT backup in which the EDI system was used. RECOMMENDED: As a precaution, back up your entire EDI system before converting to eDental.
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NHS GP17 Form changes for eDental
Treatment on referral - select a Referral Reason When users tick the Treatment on referral checkbox, they need to choose from three Referral Reasons:
Radiographs Available - Remarks Optionally add remarks under the Radiographs Available field:
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Failed to Return Under the Failed to Return choice there is now a Fee code required checkbox. This includes an Observations text box section for users to note services. Example: A patient receives a 1401 Amalgam Filling but does not pay for treatment and fails to return. The practice can request reimbursement for 1401 work completed by entering the fee code/s,
Patient Refused Treatment Under the Patient Refused Treatment choice there is now an Observations text box section for users to note reasons or details for patients refusing treatment:
Signee On Completion not applicable If the patient failed to return, they would not have signed on completion, so if you tick the Failed to Return checkbox as shown above, and TC the Course of Treatment, EXACT greys out the Signee On Completion section as not applicable:
Under the Signee tab only the Signee on Acceptance section would then still apply.
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eDental Claims Central With eDental enabled, the Claims Central button for a NHS Scotland payor will launch a Claims Central window in which to view claim status, transmit claims or view the last received schedule.
See also: Claims Central (on page 50)
Provider Name for eDental transmission Provider Name for eDental Transmission After eDental is enabled, the Provider page shows required First Name and Last Name fields in the Provider Name for eDental Transmission area below the List number.
This area appears in two places for Provider details:
The Edit Provider Wizard - NHS Lists page
The Provider > NHS Details tab
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Edit Provider Wizard - NHS Lists: When a new Provider is added after eDental is enabled, the Add Provider wizard shows these new fields on Provider - NHS Lists page:
The Providers > NHS Details tab
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Requesting a CHI Number CHI Number Request in the Patient Details tab Need for the CHI number A CHI Number is mandatory for eDental claims. Providers are prompted for it when TCing a claim where the CHI number is missing.
NOTE: Sometimes the system cannot locate a CHI Number for a patient, but Providers can still claim so long as they have requested a CHI Number.
Historical Before EXACT v12.8 the Patient Details tab had a passive CHI Number field, shaded grey to indicate that it was uneditable, and incoming NHS response files auto-populated the CHI Number.
From v12.8 the CHI Number field is editable and it has an associated button; Request CHI, for CHI Lookup by the practitioner:
To Request a CHI Number When recording Patient Details it may be necessary to look up a CHI Number (for example because the patient doesn't know it, or the patient is a child). 1. Select the Request CHI button once eDental is enabled. 2. When you click the Request CHI Number button, EXACT runs a validation data check for Patient information and warns you of missing information. For example:
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3. In this case, select OK, populate the patient fields with the information, and then try again to Request CHI. You should see the request being processed:
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Possible Errors at this point: CHI Request - Timeout error if the patient details request takes too long:
CHI Request - ACK (Acknowledgement) error if there is a system error
No results found:
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If the CHI Request is successful you will see primary results for original patient or multiple names:
At this point, o
EXACT is waiting for you to select a patient in the results, or if you cannot select any, run a Secondary Search from the top button.
o
The Secondary Search button is enabled against the primary search name only, not against the results below. With no result selected in the results pane the bottom buttons don't apply, except for the Patient Not Found button.
o
If all searches fail, select Patient Not Found to register a search failure with the NHS, which will then function in lieu of a result, allowing you to continue.
If you select a result, the lower Secondary Search and Treatment Details buttons are enabled:
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If there is only one result found, select it to view Treatment Details or perform a Secondary Search.
Treatment Details button - Choose the Treatment Details button to display past treatment(s) the SNHS has on record for a patient:
A successful result shows the CHI Number:
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4. Once the patient's name is listed, select it and then click the Accept Selected Patient button. If the patient details are THE SAME AS those stored... The CHI Number will successfully populate the field in the Patient Details tab:
If the patient details are DIFFERENT to those stored... When a result is found and you click the Accept Selected Patient button, if there are any differences, a Patient Difference window appears, with just the differences listed. Examples:
The differences are potentially in these fields: First Name, Last Name, Gender and Date of Birth (as in the screen on the left above).
To maintain the current information, simply leave the checkboxes un-ticked and click OK. Scotland NHS eDental
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To use New information, tick the checkbox/s, and then click OK to import the new details back into EXACT. For example:
To register an unsuccessful attempt to Request a CHI Number What if you cannot locate a CHI Number, even after the Secondary Search? In this case you need to click the Patient Not Found button:
When you then Save the patient details EXACT captures your attempt to locate a CHI Number with a unique reference number that the NHS will recognise in lieu of the CHI Number - you will be allowed to submit the Claim to the NHS without EXACT further requiring a CHI Number.
Status of the CHI Number is always displayed in the Arrivals Task List If your practice uses the Appointment Workflow, the CHI Number status (required or not required) always displays to the Receptionist:
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eDental COT These are changes to SNHS COTs following the practice upgrade from EDI transmission to eDental.
eDental NHS COT Exemptions and Charges window
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Supporting Details for HC2 or HC3 exemption If a patient chooses HC2 or HC3 exemption; these both require the patient's nine character HC2 or HC3 Certificate Number in the Supporting Details field. NOTE: A Certificate Number cannot be more than 9 characters long. A warning will appear if it is longer than 9 characters.
Signee On Acceptance: When you create a Scottish NHS COT and complete the Exemptions and Charges window, you are also required to complete the Signee On Acceptance with a date defaulted to today.
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Select either Patient or Representative (of the Signee). An example of a Representative would be a parent signing on behalf of a child. If you select Representative, you must complete both First Name and Last Name fields. Failure to do so will result in a warning:
Click the Date Signed field drop down arrow to display a calendar selector, from which you can select the Date Signed:
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If you attempt to select a future date you will see a warning:
SNHS COT Start - Warning on missing information For an existing patient, at the start of SNHS COT creation, you will see a warning for any required fields that are missing, and you won't be able to create the new COT until these are completed. Examples:
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SNHS COT TC - missing details When you attempt to TC an SNHS COT, you will see a warning for any required fields that are missing, and you won't be able to TC until these are completed.
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NHS COT TC - Signee On Completion Prior to EXACT v12.8 the NHS GP17 window opened to the Exemptions/Charges tab. From EXACT v12.8 it opens to a Signee tab that shows previously entered Signee On Acceptance and an additional Signee On Completion:
NOTE: In EXACT a user can Complete the TC process without Completing. NOTE: If your practice has the To Depart bar (workflow Departure Task List) enabled, the GP17 part 2 for completing the Signee On Completion details will appear as a link in the bar.
IMPORTANT: If Signee On Completion information is NOT completed, a claim will NOT be transmitted on Claims Central (it will be sent to 'Unresolved Response')
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Tooth History - prior to sending a Claim to the NHS you can complete and save the Signee on Completion In the Tooth History screen you can open a TCed claim, add any incomplete Signee On Completion details and Save, prior to sending the Claim to the NHS.
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Appointment Workflow Departure Task List (To Depart bar) If your practice uses Appointment Workflow, a notification to Sign GP17PR Part 2 will display in the To Depart bar when a Provider has not completed Signee on Completion:
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eDental Continuation COT Overview A continuation COT is notification on the NHS GP17 form that Treatment will be continued by another dentist on this same COT.
(The second checkbox (for the second dentist) is greyed out until the first dentist has clicked the first checkbox) On the NHS GP17, dentist DD ticks Treatment will be continued by another dentist:
During later treatment dentist JJ ticks Treatment is being continued by another dentist:
... and dentist JJ then selects the specific Continuation COT as created by dentist DD:
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Example: Provider JJ continues treatment on COT 1003 that Provider DD had initially completed 1. COT 1003 initial treatment: a. Dentist DD treatment completes (TCs) a Scottish NHS COT for a patient - COT 1003 b. Dentist DD ticks Treatment will be continued by another dentist to indicate that there is further treatment to be done on this COT by a different dentist.
2. COT 1003 continuation treatment: a. Dentist JJ later TCs continuation treatment for the same patient, on the same COT. b. On the NHS GP17, dentist JJ ticks
Treatment is being continued by another dentist.
A field next to COT being continued becomes enabled. The list button displays any previous COTs marked as continuation COTs. c. Dentist JJ selects COT 1003 that Dentist DD completed, and clicks OK:
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Patient change of Exemption Status Overview The SNHS want to be informed when circumstances change for a patient who 1. Starts a COT as a full or partial paying patient, and then 2. Becomes exempt, with no payment required. Specification information: This is discussed in SNHS' eDental Functional Specification section 2.4.17 Patient change of Exemption status (pg 26). This specification includes which fields are expected to be sent (viewable in XML), on pg 178 (AM-25124DFD003-eDental System Supplier Specification-v2.4.DOC).
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SCENARIO 1: Paying patient - circumstances change to non paying Last week a 31 yr old female patient had a 1401 Amalgam filling, and plans to come back within a week. The COT was started with no exemptions ticked, then ticked completed and 14.40 Charged, but the COT was not yet TC'd. The Patient comes back in and advises "I've just found out I'm pregnant - 5 weeks along now...!".
To change the option to Patient is pregnant: 1. Click the Exemptions button at the bottom of the Chart screen:
2. In the Exemptions and Charges window, click the Re-enable exemptions button and then select Yes to the Enable Exemptions warning:
3. In the re-enabled window, click to select the following checkboxes / options: o
Patient is pregnant (PR)
o
Proof of exemption seen
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If you fail to check either proof Seen or proof NOT seen, a warning message will later display:
o
Patient signed GP17PR Part 1b but their circumstances changed (with or without Clinipad)
... and then select Yes to the Not Exempt to Exempt question:
4. Select OK for the Exemptions and Charges for COT XXXX screen. 5. TC the patient COT. 6. Check the Patient Transaction History. You should see the original charge (14.00 in our example) changed to patient charge 00.00:
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SCENARIO 2: Partial paying patient - circumstances change to non paying A patient COT started with a 1403 Amalgam filling, which is marked as completed, with 5.00 charged. The COT is NOT yet TCed because the patient was to come back again soon for further treatment (similar to scenario 1). Now the patient returns and advises the dentist "My exemption status has changed to Income Support (IS)".
To change the option to Patient/partner gets income support: 1. Click the Exemptions button at the bottom of the Chart screen:
2. In the Exemptions and Charges window, click the Re-enable exemptions button and then select Yes to the Enable Exemptions warning:
3. In the re-enabled window, complete the following checkboxes / options: o
Patient/partner gets income support Proof of exemption seen If you fail to check either proof Seen or proof NOT seen, a warning message will later display:
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o o o
Patient signed GP17PR Part 1b but their circumstances changed (with or without Clinipad). Enter the NI Number of the person receiving the benefit. Signee on Acceptance is the Patient
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eDental Appointment Workflow Arrive Patient - the Arrivals Task List displays the CHI Number is either missing or present In the appointment book, when a patient is Arrived, under the Patient Details heading / hyperlink the arrivals task popup displays one of two messages:
Patient requires a CHI Number for eDental claiming:
CHI Number is present:
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eDental Clinipad procedures Arrival Task List - Arrive and Send to Clinipad When arriving a patient, in the Arrivals Task List a practitioner can choose to Arrive and Send to Clinipad in order to complete the details for GP17PR Part 1.
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Clinipad workflow The Clinipad screen shows when the device is in use, as described below. 1. A patient completes information on Clinipad and signs. 2. The practitioner clicks the Return button:
3. The practitioner clicks the Check and Dismiss button to save changes that the patient may have entered:
Check and Dismiss:
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Starting a COT when the GP17PR Part 1 has been signed via Clinipad Patients may choose Exemptions on the Clinipad, and this information will appear when a Provider starts an NHS COT in the Exemption window. For a Provider starting a new SNHS COT, green text indicates that the patient has electronically signed their GP17PR, and the Provider can click a View Signed GP17PR button:
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Starting a COT when the GP17PR Part 1 HAS NOT been signed via Clinipad For a Provider starting a new SNHS COT, red text indicates that the patient HAS NOT YET electronically signed their GP17PR, and the Provider can click a Send GP17PR button:
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TC a COT, prompt for Send GP17PR part 2 to Clinipad With Clinipad workflow enabled, when a Provider Completes a COT, the Send a GP17PR to Clinipad prompt will appear:
To Depart departure task list - prompt to Send GP17PR part 2 When TCing a COT where the Signee On Completion ("part 2") has not been completed, if a Provider Cancels on the Send to GP17PR to Clinipad prompt (so the patient does not complete part 2), then the To Depart departure task list bar will include a task to Sign GP17PR part 2 i.e. a Provider who uses Clinipad does not capture part 2, so EXACT lists the part 2 capture in the To Depart bar.
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Claims Central With eDental enabled, the Claims Central button for a NHS Scotland payor will launch a Claims Central window in which to view claim status, transmit claims or view the last received schedule.
To launch Claims Central 1. Select File > Payors. 2. Select the Scottish NHS (SNHS) Payor:
3. Click the Claims Central button for the NHS Scotland payor to launch the Claims Central window:
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Claims Central functionality From this Claims Central window practitioners can
Choose Claim (and Transmit) to send any unheld claims in Completed COTs. Users can Claim but not choose to Transmit.
During Claiming a user can also then choose to Transmit. If there are pending claims (for example, from earlier) in Awaiting Transmission, the practitioner can choose Transmit:
View the progress of transmissions via a status bar:
NOTES: You can opt to Claim but not to Transmit. While this bar displays you cannot Transmit again, and a warning message will appear if you attempt to do so. You can close the page and the transmission will continue to process (you don’t have to wait for it to finish), but ensure you don’t close EXACT before it is finished.
View treatment Completed (TCed) COTs ready for transmission, Hold / Unhold them, and Resubmit them. See Claims Central - Completed COTs (on page 53)
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View completed COTs that are Awaiting Transmission to the SNHS, and remove them from this Awaiting Transmission list where necessary. See Claims Central - Awaiting Transmission (on page 59)
View claims that are Awaiting Response from the SNHS. See Claims Central - Awaiting Response (on page 60)
View the Unresolved Responses claims. This link opens up the same workflow options that are available from Administration > NHS > Responses, providing you with a means to take appropriate action to resolve issues. For example, you can update the Signee on Completion details directly from this list. See Claims Central - Unresolved Responses (on page 61)
View the Last Received Schedule. The Last Received Schedule displays the date of the last valid Schedule that was imported. To view all schedules, go to the previous location: Administration > NHS > Payment Schedules.
Import a Schedule file The default location for incoming schedule files is DATA\XMIT\XMLIN See Importing a Schedule File (on page 66)
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Claims Central - Completed COTs
The Completed COTs window displays treatment completed (TCed) Scottish NHS COTs ready for transmission. Any Held COTs display a hand icon in the Held column: The buttons Hold All, Unhold All, Hold/Unhold, Resubmit and View COT are greyed out if not applicable.
Hold All Choose the Hold All button to put all completed COTs on hold, as indicated with icons under the Held column:
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Unhold All Choose the Unhold All button to put all completed COTs on hold, as indicated with no icons under the Held column:
Multiple buttons are active when a single completed COT is selected:
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Hold / Unhold This is a toggle for the selected completed COT:
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Resubmit A Resubmit explanation / caution displays when you click the Resubmit button:
If you choose Yes on the Resubmit caution, EXACT calls the standard Resubmit workflow, and the COT reappears with Services ticked and with the Patient Transactions column showing the red resubmit icon:
NOTE: Resubmitted claims disappear from the View Completed COTs window.
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View COT Click the View COT button to call the existing workflow to view the claimed COT:
Claiming a Completed COT To Claim a Completed COT 1. In Claims Central (on page 50) find the Completed COT listed against the Completed COTs hyperlink:
2. Click the Claim button and then follow the procedure listed below: Scotland NHS eDental
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a. In the NHS Claim window, select the appropriate Provider/s and Date to field, then click OK. b. In the NHS Claim popup, click Done. c. In the Transmit Claims window click OK. 3. You should now see the progression of your Claim reflected in the Claims Central data as follows: a. The Claim moves to Awaiting Transmission:
b. The Claim is transmitted and disappears from the Claims Central window:
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NOTES: If the Claim does not follow this progression, something is unresolved and needs to be addressed. The system limits you to 9 resubmissions per COT before displaying an error message and stopping further attempts for that particular Claim.
Claims Central - Awaiting Transmission This displays completed COTs waiting for transmission to the SNHS:
These are the 'Claims' that have been created and not yet sent. Possible actions:
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Click the Transmit button if the Awaiting Transmission line shows a numerical value, and a transmission isn’t already in progress.
Click to open the View COTs Awaiting Transmission window, where you can optionally do the following: o
Click the Remove button to remove a selected COT from Claims Central.
o
Click the View COT button to view details of the selected COT. Example:
Claims Central - Awaiting Response This displays claims awaiting response from the SNHS:
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NOTE: Responses will likely be picked up with the next transmission.
Claims Central - Unresolved Responses The Unresolved Responses link from Claims Central opens up the same workflow options that are available from Administration > NHS > Responses, providing you with a means to take appropriate action to resolve issues. Displayed below is an example where a Claim was TCed without Signee on Completion:
Background If you send a Claim and receive an error or response that requires action, a copy of the claim, with response, appears in the Unresolved Responses > Response window. Example: Here are two claims copied to Unresolved Responses:
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These two examples require the Completion Signee, as indicated by the message Claim Mandatory: Completion signee has not been chosen Multiple issues can cause a Claim to have an Unresolved Response status.
To resolve an Unresolved Response and remove it from the Response window 1. First fix the issue that caused this claim to be listed as an Unresolved Response (don't simply retransmit). . See also: CAUTION - Fix Unresolved Responses BEFORE transmitting (on page 63) Example - Resolve missing Signee on Completion (on page 63)
2. Once the issue has been fixed, in the Response window, either o
Tick the appropriate checkbox as completed. - or -
o
Select the listed Response and click the Resolve button
The Response will disappear from the Response window.
Resubmitting a COT from the Response window See Resubmitting a COT from the Response window (on page 65)
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CAUTION - Fix Unresolved Responses BEFORE transmitting
CAUTION: You must deal with the source causes - simply Transmitting again does not automatically resolve unresolved responses! If you fail to properly action Unresolved Responses and simply try to Transmit again, EXACT attempts to Transmit, fails, and re-lists the same Unresolved Responses once again, resulting in a duplication.
So if you failed to deal with the Completion Signee requirement in the above two Unresolved Response examples, and you simply re-transmitted them, the result would be four Unresolved Responses listed:
Example - Resolve missing Signee on Completion To update Signee on Completion from the Unresolved Responses screen A response might be unresolved for multiple reasons, but EXACT detects if a practitioner neglected to complete the required Signee on Completion, and displays this in the Unresolved Responses list. 1. From the Response window, click the GP17 button:
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2. In the Signee tab, tick Patient (or Representative) 3. Click the associated Save button. 4. Select Close to close the GP17 window. This will update the claims table and return you to the Response window. 5. In the Response window, either o
Tick the appropriate checkbox as completed
- or o
Select the listed Response and click the Resolve button.
The Response will disappear from the Response window.
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Resubmitting a COT from the Response window You may choose to Resubmit a claim displayed in the Response window. To Resubmit a COT from the Response window 1. Select the listed Response and then click the Resubmit button.
IMPORTANT: The resubmitted Response will not automatically disappear from this window when you click the Resubmit button; you need to click the Resolve button or tick the Response checkbox to remove it.
If a practitioner reopens the Response window and tries to Resubmit an item that was already successfully resubmitted, a warning may appear: "This transaction has already been resubmitted":
2. To remove the resubmitted Response from the window, either click the Resolve button or tick the checkbox associated with the selected Response:
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Acknowledgements and Responses
Acknowledgements (ACK) inform the practice that the ePractitioner Message Store has encountered a difficulty relating to a transmission, and the transmission has therefore not been forwarded through to the MIDAS dental payment engine. These errors take many forms and many of them may be resolved simply with a repeat transmission. Responses (RESP) are return messages in response to successful transmissions to the MIDAS dental payment engine.
Managing Payment Schedules Importing a Schedule File To import a Schedule File 1. Select File > Payors. 2. Select the Scottish NHS (SNHS) Payor:
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3. Click the Claims Central button for the NHS Scotland payor to launch the Claims Central window:
4. Select the Import button. 5. Locate the schedule in its default location, DATA\XMIT\XMLIN and import it.
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Viewing and Reconciling Payment Schedules To view Payment Schedules 1. Either o
Click the Payment Schedules hyperlink on the Claims Central (on page 50) window:
- or o
Open Administration > NHS > Payment Schedules, enter date range and Provider and click OK:
The Payment Schedule List displays:
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Note the on-screen instructions: ____________________________________ To process the schedule payment: Double click on an unticked schedule line to view details and reconcile. Compare screen amounts with paper schedule: Compare DSD 'Scale Fee' on screen with 'Item of Service' total on paper Compare DSD 'Patient' fee on screen with the 'Patient Charges' net on paper If the amounts don't match, return to the 'Payment Schedule Detail' window to add or remove negative entries until they do. Process payment. ___________________________________
2. Double-click an un-checked schedule to open the Payment Schedule Detail window:
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3. Reconcile schedules by following the instructions on this screen: ___________________________________ To reconcile the schedule: 1. Double click on entries showing differences to explore the reason. If you agree with the difference, click 'Adjust' to accept it. If you disagree with the difference, click 'Resubmit' to resend it. 2. Use 'Add Item' to add in negative entries from the paper schedule. ____________________________________
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Training Competencies for eDental Are you competent for your indicated (shaded) role tasks? Competencies achieved:
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Page
From what date does the previous system of EDI transmission to the SNHS finally become redundant?
pg 5
! Once a practice is enabled for eDental there is no configuration means to revert it to EDI transmission. What precaution should your practice therefore take before conversion to eDental, as security against the unlikely event that you will need to revert?
pg 15
What additional two important transmission-related fields appear in the Provider Setup - NHS Details tab following successful conversion to eDental?
pg 18
A patient CHI number is mandatory for eDental claims. To ensure that it is included in Claims, during which procedure does EXACT prompt Providers for this number, when it hasn't been recorded for a patient?
pg 20
When requesting a CHI Number, how will the Provider know what mandatory information is missing from the patient record?
pg 20
A Provider has requested a CHI Number for a patient but the software cannot locate it. How is it possible for the Provider to still Claim without the number?
pg 20
Because patient CHI Numbers are now mandatory for patients, in which convenient screen does EXACT display each patient's CHI Number status (CHI Number is required | CHI Number is present)?
pg 20
If a patient chooses HC2 or HC3 exemption, what related 9-character information must the patient provide, for recording in the Exemptions and Charges for COT screen?
pg 27
In the Exemptions and Charges for COT screen, the Signee on Acceptance can be either a Patient or a Representative. Who or what is a "Representative"?
pg 27
The NHS GP17 window in EXACT has a number of tabs across the bottom. Prior to EXACT v12.8 the NHS GP17 window opened to the Exemptions/Charges tab. What tab does it open to in the eDental configuration after v12.8?
pg 27
If Signee On Completion information is NOT completed, a claim will NOT be transmitted on Claims Central. Where will it be sent instead?
pg 27
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Are you competent for your indicated (shaded) role tasks? Competencies achieved:
Page
Besides the TC screen, from what other clinic screen can a Provider launch the NHS GP17 in order to complete the Signee on Completion information?
pg 27
When a Provider has not completed the Signee on Completion, where does EXACT automatically prompt for its completion before the patient departs the practice? (Tip: Appointment Workflow software is required)
pg 27
Describe the workflow for a Continuation COT, including the various checkboxes and fields that must be completed on the NHS GP17 as one dentist starts treatment and a second dentist takes it over.
pg 36
Describe and / or demonstrate how to process a patient whose Exemption Status has changed from not being exempt to being exempt, during a course of treatment. For example, a patient has partially completed a course of treatment and been charged to date, but discovers that she is pregnant, and requires exemption.
pg 38
(Clinipad users) At what points in a patient's journey through the practice can EXACT automatically prompt for the patient to be given the Clinipad for completion of
pg 45
NHS GP17 Part 1? NHS GP17 Part 2? (Clinipad users) From which screen can a Provider view a patient signature for a GP17 form Part 1?
pg 45
Demonstrate how to use the Claims Central window, including all hyperlink and button-based functions.
pg 50
From the Claims Central window, view all ready-for-transmission Completed COTs for all Providers, and perform the following actions with them:
pg 53
Hold them All and Unhold them all
Hold and Unhold a single COT
Resubmit a single COT and in this procedure do the following: - Explain the Resubmit popup caution that displays - Identify the Resubmit icon
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Are you competent for your indicated (shaded) role tasks? Competencies achieved:
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Page
From the Claims Central window, view the claims that are awaiting transmission and demonstrate how to view a COT from this list in order to establish what is preventing transmission.
pg 59
State the purpose of the Claims Central Unresolved Responses window.
pg 60
Demonstrate and describe how to resolve an Unresolved Response and remove it from the Unresolved Response > Response window.
pg 61
Explain why you must deal with the source causes of Unresolved Responses and not simply re-transmit them again, and state what is likely to happen if you do simply attempt to retransmit them.
pg 63
If a Response has already been re-submitted, but still displays in the Unresolved Responses > Response window, what two actions can you take to remove it from the window?
pg 65
Describe the difference between an Acknowledgement (ACK) and a Response (RESP) feedback from the NHS.
pg 66
Demonstrate how to import a Schedule file and Reconcile Payment Schedules.
pg 66
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NSS PRACTITIONER SERVICES EDENTAL • 5
Index
O Overview of eDental • 5
A
P
Acknowledgements and Responses • 66
Patient change of Exemption Status • 38
B
Provider Name for eDental transmission • 18
Benefits • 9
Purpose • 5
C
R
CAUTION - Fix Unresolved Responses BEFORE transmitting • 62, 63
Requesting a CHI Number • 7, 20
Changes in EXACT following eDental setup • 14
Requirements • 9
Claiming a Completed COT • 57
Resubmitting a COT from the Response window • 62, 65
Claims Central • 6, 18, 50, 57, 68
T
Claims Central - Awaiting Response • 52, 60
Training Competencies for eDental • 71
Claims Central - Awaiting Transmission • 52, 59
U
Claims Central - Completed COTs • 51, 53
Using eDental • 11, 14
Claims Central - Unresolved Responses • 52, 61
V
E
Viewing and Reconciling Payment Schedules • 68
eDental Appointment Workflow • 44 eDental Claims Central • 18 eDental Clinipad procedures • 8, 9, 45 eDental Continuation COT • 7, 8, 9, 36 eDental COT • 7, 27 eDental Terminology • 10 EDI transmission is no longer possible • 15 Example - Resolve missing Signee on Completion • 62, 63
F Features • 6, 11, 12
I Importing a Schedule File • 52, 66
M Managing Payment Schedules • 66
N NHS GP17 Form changes for eDental • 16 Scotland NHS eDental
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