Transcript Ophthalmic Payments - Health and Social Care Information

Ophthalmic Payments
National User Group Meeting
8th July 2010
Electronic Links
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Activity Details
– 222 active stores
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189 Specsavers
30 practices using the Optix system
2 Vision Express (Winchester 29/06)
1 Independent
– 18 activation requests outstanding
– 125 stores using automatic process
– 88 PCTs over 44 payment agencies
Electronic Links
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Claim Volumes
– Period May 2007 – Jul 2010
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1,238,683 manual approvals
1,406,723 automatic approvals
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2,645,406 total claims
Electronic Links
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GOS 6 Claims
– Pilot expected with Healthcall
– During 2010
– Pilot site within West Yorkshire
CSA
Electronic Links
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GOS 3, GOS 4 & GOS 5
– NHS development completed for
April 2009
– Ocuco have sent test GOS 3, GOS
4 & GOS 5 claims for processing
– No supplier asked to be accredited
to submit GOS 3, GOS 4 or GOS 5
claims to live payment system
Closed Change Requests
3231 Essex, Extend the
possible duplicate check to
only use the previous 6
months
Rejected by OPUG
21st January
3342 Suffolk, A 6 month
warning check on a GOS1,
GOS5 or GOS6 claim
3617 LASCA
29th January
3533 Bromley
Withdrawn
Withdrawn
Closed Change Requests
3529 Devon, Monthly
expenditure reports to show
number of claims per type
16th February
3530 Devon, Monthly
16th February
expenditure reports to all have
CSV option
3531 Devon, Monthly
expenditure reports to have
the ability to select multiple
payment periods
16th February
Closed Change Requests
3596 Cambridge, Monthly
16th February
expenditure reports to have
the ability to select multiple
payment periods, include claim
counts and total spend values
3676 Suffolk, New Pension
23rd February
rules
3464 Kent, PCT read only user 26th February
role
Closed Change Requests
3392 LASCA, New report to
show electronic submission
batch details
3733 LASCA
5th March
3668 LASCA ,Alternate
shading on some reports
3808 Devon
30th April
Withdrawn
Withdrawn
Closed Change Requests
3470 Salford, A parameter
7th May
switch to select to use the PCT
telephone number or paying
organisation telephone number
on all reports/letters
3395 LASCA, Enhanced
27th May
service report to list claims
using payment periods
3783 Devon, Monthly
expenditure total report to
show levy value
30th June
Closed Change Requests
3776 LASCA, Electronic 30th June
claims to access
archived payment cycles
3528 WYCSA,
2nd July
Performance Indicator
for GOS4 Small Glasses
Open Change Requests
3340 Suffolk
3341 Suffolk
Pre-notification module to highlight
higher fee when more than 2 GOS6
claims generated for same address
(currently in peer testing)
An extra column could be added to
the 'Create new patient' screen in
which a user could enter either a 1,
2 or 3 and this could be carried over
to the Pre-notification Details screen
(currently in peer testing)
Open Change Requests
3532
Bromley
Include patient search when
processing electronic claims
3815
WYCSA
Enter GOS 3 in batches
Advantages for change request 3815:• Cost saving
Disadvantages for change request 3815:• A large slice of development time & costs will be required for this CR
• SBE 515 return will not show 100% vouchers and will therefore need to
be completed manually at 100%
• SBE 515 2% sample option is no longer available
• Some Performance Indicator reports will show no information on
voucher activity
• All Post Payment Checks will not include voucher claims
• All fraud prevention and detection tools will have no data for vouchers
claims (tints and prisms per voucher etc)
• Open Exeter patient lookup will be not be available on voucher claims
• Possible duplicate voucher claims will not be identified
Open Change Requests
3883 North
Remember position when using the
Yorkshire
List Contractor function
3927 LASCA Store and view the user code and
date entered in ‘notes’ section on all
GOS claims
3932
Cambridge
Monthly Expenditure total payment
value to have an option to
include/exclude the levy value from
the CSV
3939
Batch method to update contractor
Hertfordshire code on selected incorrectly entered
individual claims
Early Re-Test Codes
– 1. Patient is at risk of frequent
changes of prescription for reasons
not requiring medical referral or for
reasons already known to a medical
practitioner;
– 2. Patient has pathology likely to
worsen, for example age-related
macular degeneration, cataract,
corneal dystrophy, or congenital
anomalies;
Early Re-Test Codes
– 3.Patient has presented with
symptoms or concerns requiring
ophthalmic investigation:
• 3.1 resulting in referral to a medical
practitioner;
• 3.2 resulting in issue of a changed
prescription;
• 3.3 resulting in either no change or no
referral (the patient's record should
indicate any symptoms shown to support
this category of claim, if necessary).
Early Re-Test Codes
– 4.Patient:
• 4.1 needing complex lenses;
• 4.2 with corrected vision of less than
6/60 in one eye.
Early Re-Test Codes
– 5. Patient:
• 5.1 has presented for a sight test at the
request of a medical practitioner;
• 5.2 is being managed by an optometrist
under the GOC referral rules, for
example suspect visual fields on one
occasion which is not confirmed on
repeat, or abnormal IOP with no other
significant signs of glaucoma;
• 5.3 is identified in protocols as needing
to be seen more frequently because of
risk factors.
Early Re-Test Codes
– 6. Other unusual circumstances
requiring clinical investigation.
Early Re-Test Codes
• Summary of valid early re-test
codes:
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1
2
3.1
3.2
3.3
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4.1
4.2
5.1
5.2
5.3
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Standby Service
• Please use the stand by service during
unplanned interruptions of the Open
Exeter service and it’s associated
applications
• https://nww.standby1.openexeter.nhs.uk/nhsia/index.jsp
General Purpose Audit
Report
• Change Request Enhancements
– More flexibility within searches
– More capacity within searches
– All payment cycles are now listed
• Multiple payment cycles can now be selected
– Archived claims are now included
automatically, depending on selection
General Purpose Audit
Report
General Purpose Audit
Report
• Viewing Results
– Screen shows claim details
– Further searches on results available
General Purpose Audit
Report
General Purpose Audit
Report
General Purpose Audit
Report
General Purpose Audit
Report
• Report screen shows available
options:
– Order options are:
• Optician code, month of claim, patient’s date of
birth, patient’s surname, patient’s forenames and
patient’s postcode
– Output options are:
• Report, File (CSV) or Both
General Purpose Audit
Report