Transcript Ophthalmic Payments - Health and Social Care Information

Ophthalmic Payments
National User Group Meeting
21st January 2010
Electronic Links
•
Activity Details
– 201 activation requests processed
– 192 active stores
•
•
•
•
182 Specsavers
8 Optix practices
1 Vision Express
1 Independent
– 109 stores using automatic process
– 83 PCTs over 42 payment agencies
Electronic Links
•
Claims Volumes
– Period May 2007 – Jan 2010
•
•
919,581 manual approvals
1,055,749 automatic approvals
•
1,975,330 total claims
Electronic Links
•
GOS 6 claims
– Pilot expected with Healthcall
– Early in 2010
– Pilot site within West Yorkshire
CSA
Electronic Links
•
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
Electronic Links
•
Processing Possible Duplicates
– More individual GOS 1 claims
stored
– More possible duplicate claims
identified
– Raised questions regarding the
GOS Regulations when a patient is
tested and advised otherwise on
their previous sight test date
Electronic Links
•
Processing Possible Duplicates
– DoH response:
•
providing that the sight test is done in
good faith, claim should be paid
•
a matter of judgement locally as to
whether the PCT thinks the patient
was deceptive or mistaken and then
whether they want to pursue
Electronic Links
•
Processing Possible Duplicates
– Electronic processing changes for
possible duplicates:
•
validation checks updated to enable
PCT to control how to proceed on each
possible duplicate claim indentified
•
Check Possible Duplicate Electronic
Claims menu to list possible duplicate
claims
Check Possible Duplicate
Electronic Claims
Check Possible Duplicate
Electronic Claims
Electronic Links
•
Processing Possible Duplicates
– Manual approval changes for
possible duplicates:
•
extended duplicate check
automatically enabled on approval
•
all patients previous claims available
for viewing
Check Possible Duplicate
Electronic Claims
Closed Change Requests
3092 Suffolk, Claims
user role to include prenotification premises
details
14th July
3084 Dudley, Retain
24th July
practice code for entry of
next individual claim
3105 Kent, Private Sight 31st July
Test statements,
including email option
3202 North Yorks,
Retain performer code
for entry of next claim
14th August
Closed Change Requests
3106 Kent, Statement
adjustment fields (+/-) for
Glaucoma
3124 Lancashire, 10
new local enhanced
services codes
3110 Lancashire,
Submission date shown
for EC batches
3122 Birmingham,
Frequency of re-test
reason report by practice
10th September
10th September
29th September
11th November
Closed Change Requests
2742 Dorset, Batched
Additional Services
claims
3125 Lancashire,
Batched Additional
Services claims
3132 Cambridge, Select
payment cycle when
using EC batch approval
3334 Essex, NHS
number on all PPC
letters
24th November
24th November
26th November
2nd December
Closed Change Requests
2851 Hampshire,
Improve linking of prenotification lists to
residential homes
4th December
3150 Essex, Monthly
Expenditure Report
8th December
3388 Cumbria, display
12th December
service date when listing
possible duplicate claims
3332 Kent, Monthly
Expenditure Report
22nd December
Closed Change Requests
3502 Cornwall, GO &
24th December
DOM added to the Type
target on the Contractor
List
Open Change Requests
3231 Essex
Extend the possible
duplicate check to only
use the previous 6
months
3340 Suffolk
Pre-notification module
to highlight higher fee
when more than 2 GOS6
claims generated for
same address
Open Change Requests
3341 Suffolk
3342 Suffolk
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
A 6 month warning
check on a GOS1,
GOS5 or GOS6 claim
(currently in peer testing)
Open Change Requests
3392 Lancashire
3395 Lancashire
3464 Kent
New report to show
electronic submission
batch details (currently
in development)
Enhanced service report
to list claims using
payment periods
New PCT user role
Open Change Requests
3470 Salford
A parameter switch to
select to use the PCT
telephone number or
paying organisation
telephone number on all
reports/letters
3528 West Yorkshire
A performance indicator
report to show small
glass supplements for
GOS4 claims only
3529 Devon
Monthly expenditure
reports to show number
of claims per type
Open Change Requests
3530 Devon
3531 Devon
3531 Devon
Monthly expenditure
reports to all have CSV
option
Monthly expenditure
reports to have the
ability to select multiple
payment periods
Monthly expenditure
reports to have the
ability to select multiple
payment periods
Open Change Requests
3532 Bromley
3533 Bromley
3596 Cambridge
Include patient search
when processing
electronic claims
Open Exeter patient
search does not always
locate patient
Monthly expenditure
reports to have the
ability to select multiple
payment periods,
include claim counts and
total spend values
Import Pre-notification details
CR 2851
•
Pilot at Hampshire
– Started on 13th February 2009
– Completed on 3rd November 2009
•
Released Nationally on 4th
December 2009
•
Refer to online help prior to use
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
Import Pre-notification details
CR 2851
• Excel form approved by Domi
Eye Care Committee, FODO,
AOP and OPUG
• New form available from import
screen & online help
• Encryption to protect patient
details
•
NHS Ophthalmic Encryption Utility
NHS Ophthalmic Encryption
Utility
• Practice responsible for
protecting patient data
• Practice can use this utility for
free
• Utility has ability to:– encrypt a data file for transmission
– decrypt files with .ecf extension
NHS Ophthalmic Encryption
Utility
• Available to NHS personnel only
at
• Pass the utility to the practice
• Terms & conditions for use apply
• FAQ’s available
https://nww.openexeter.nhs.uk/nhsia/opthelp/Ophthalmics/eng/indexElectronic.html
NHS Ophthalmic Encryption
Utility
English GOS Fees 2010/2011
• Voucher values and sight test
values will be available on 1st April
2010
• No back pay for 2010/2011
Welsh GOS Fees 2010/2011
• Voucher values and sight test
values should be available on 1st
April 2010
• Possibly no back pay for
2010/2011
• Waiting for confirmation from the
Welsh Assembly
LHB Restructuring & Ophthalmic
Payments
• Completed during October 2009
• No outstanding issues