Transcript Slide 1

Ophthalmic Payments
National User Group Meeting
16th January 2014
Presented by
Mark Green & Mark Hillman
Ophthalmic Payments Service
• Central Ophthalmic Payments system
continues to use old PCTs as the
organisational structure within England
• Local Code to indentify a Contractor
• Constrained by Organisation Code to
provide unique code per contractor
• No changes
Ophthalmic Payments Service
• No longer doing a full PCT migration:
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Minimise risk
Continuity of service
eGOS practices remain operational
Large effort
Small benefit
• Focus will be on reconfiguring the
organisation hierarchy within the central
Ophthalmic Payments system
Current Organisation Hierarchy
Possible Organisation Hierarchy
Ophthalmic Payments Service
• PCSS offices can decide to re-structure
– Support log will be required
– Provide new structure for organisations
– Change to be implemented by HSCIC
between payment cycles
• You will be able to log into all
responsible organisations using one
Open Exeter account
Ophthalmic Payments Service
• Grouping of organisations for
payments can be changed or remain
the same as today
• Local Contractor codes remain
unchanged
• No additional work required for PCSS
staff
– But update your organisations from PCTs
Electronic Statements
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Background
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Setup
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Sending electronic statements
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Available downloads
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NHS Ophthalmic Decrypt Utility
Electronic Statements
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Background
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Payment system makes over 81,000
payments
Covers 9,849 contractors
eStatements has been identified to help
reduce costs
1,400 enabled to use eStatements
New report to list eStatements details
Print Optician Email
Statement Settings Report
Electronic Statements
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Setup
– Sending email address
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Set email address for your Payment
Authority
– Practice email address & password
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Practitioner electronic claims settings
Sending payment statements
– All statement reports (email option)
Electronic Statements
Sending email address
Electronic Statement
Practice email & password
Electronic Statements
Sending emails
Electronic Statements
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NHS Ophthalmic Encryption
Utility (Version 1.5)
– All electronic statements are
encrypted for non NHS.NET email
accounts
– A practice can use our decrypt
utility for free but must
– Agree to terms & conditions of use
Electronic Statements
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Available downloads
– Data File Formats for Electronic
Submission of Contractor Claims
– User guide & FAQs
– NHS Ophthalmic Payments Decrypt
Utility Overview & file (Version 1.5)
– NHS Ophthalmic Payments Decrypt
Utility terms & conditions of use
Electronic Links (eGOS)
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Activity Details
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399 active stores
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261 Specsavers stores
93 practices using the Optix system
24 Vision Express stores use Ocuco
21 Independents
– 125 PCT/LHBs over 54 payment agencies
Electronic Links (eGOS)
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Claim Volumes from May 2007
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9,289,327 GOS 1
8,705 GOS 3
1,581 GOS 4
3 GOS 5
84 GOS 6
Non CR deliverables
• ISFE / regulation work
• Performance improvements
• Re-platforming Ophthalmic Payments
system
• Options for Organisation Migration
Completed Change Requests
5183
Add details (apart from password) from the Contractor Payment
information/Electronic Claims Settings page to the
opticians list report or create a separate report.
Released on 29/10/2013. Functionality is provided via: System
Administrator Setup -> Opticians Details Reports -> Print Optician
Email Statement Settings List
5433
Enhance the current reports to collect the ethnicity data that is entered
into the system
This CR has been closed and the additional ethnic information will
be available within the EHEW statistical report from
the 29th August 2013.
Open Change Requests
4796 Hold
System to amalgamate statements based on email addresses.
5032 Facility be introduced on GOS3/4 at the 3 month after collection stage,
to prevent old claims going through.
5108 Allow duplicate statements for those performers on a list outside of
Essex to be available once the monthly cleardown has
occurred.
Requirement needs to be clarified as the system should be able to
produce Duplicate Performer Statements for all PCT areas outside
of Essex. It may be that this functionality is already provided.
5140 Block claims for a small glasses supplement if the patient is a child NOT
Under 7 years.
5143 Batched Enhanced Service Information to be included within the
General Purpose Audit Report
Requirement needs to be clarified. Would batched data be
considered for the General Fraud Audit as there is no patient
details data to check for fraud on Batched claims?
Open Change Requests
5274 Facility required to upload a batch total for GOS 1's per premise from a
spread sheet into OE each month.
Consideration needs to be given - as we are trying to move away
from “non-descript” batches and encourage more use of
Electronic Links to provide more richer data for better fraud
checking and more accurate control over payments to Opticians.
5323 Is it possible to have asterix's marked as mandatory fields
5552 Enhance the report on the General Purpose Audit Reporting screen for
Additional Services to include the clinical data
5553 amend the Fraud Officer access to enable Post Verification Teams to
view the Statistics menu
5563 PPV adjustments as separate items to any other adjustments
Service Performance - targets
Priority
Maximum Response
Target
Maximum Resolution Target
Examples
1
30 minutes
1 day
Unavailability of the entire system, a key module
or major function, causing significant business
impact.
2
1 hour
1 day
Unavailability of the entire system, a key module
or major function, causing limited business impact.
3
2 hours
5 days
Problems causing inconvenience, minor disruption
or restricting performance.
4
4 hours
As agreed
Non urgent problems causing slight irritation but
where workarounds are available; cosmetic or
general enquiries for information.
98% of reported support calls to be responded to within target
90% of reported support calls to be resolved within the target
Service Performance - achievement
2013/14
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
No. Calls
60
34
25
30
19
21
14
18
Response % - (98%
target)
100
100
100
100
100
100
100
100
Resolution % - (90%
target)
95
88
96
97
100
95
93
94
Availability (%)
100
100
100
100
100
100
100
100