Headquarters Gyle Square, 1 South Gyle Crescent, EDINBURGH EH12 9EB Chairman Bill Matthews Chief Executive Ian Crichton
Practitioner Services
Dental & Ophthalmic Gyle Square 1 South Gyle Crescent Edinburgh, EH12 9EB Tel: 0131 275 6300 Text Relay: 18001 0131 275 6000 Fax: 0131 275 7266 www.psd.scot.nhs.uk
Electronic Data Interchange User Guide
The information on this sheet is intended to help your practice when using EDI or contacting Practitioner Services with EDI queries. Please keep it available for your staff to refer to. The Practitioner Services Helpdesk will be your first point of contact in the event of any queries and they will direct your call to the appropriate member of staff. Practitioner Services provide the EDI information detailed below and it should be noted that Practitioner Services staff do not have training on the use of your Practice Management Systems and any queries regarding the usage of your system should be directed to your supplier. CONTACTS Customer Services Helpdesk 0131 275 6300 Email for EDI queries [email protected] Our web site an important resource of customer service information www.psd.scot.nhs.uk/professionals/dental/index.html
General Queries
How do I get information about my system? Contact your software suppliers’ helpdesk. Do I need to leave my computer permanently on to receive my messages? No you should be able to download your messages when you send a file. Do I need a Pin number for each of my List numbers? Yes. How do I obtain a Pin number? Contact Customer Services. How do I put my Pin number into my system? Contact your software supplier for instructions. Our Pin numbers have been forgotten / lost. Pin numbers are confidential and cannot be given over the phone. Contact Customer Services who will issue a copy or new pin number if necessary. Do we need a new Pin number when we get a new dentist in the practice? Yes Contact Customer Services. When we get a new trainee dentist in the practice do we need a new Pin number? Yes Contact Customer Services. How often should a practice transmit claims? Transmission is at the practice’s convenience; however, it is better to send files regularly in case of problems or queries. Leave yourself time before the end of schedule. What do I do if I am not sure whether or not Practitioner Services have received my files? Check your response messages for an acknowledgement from Practitioner Services this acknowledgement should show either “accepted” or “rejected.” My files have been sent but no response message has been received. When files have been received at Practitioner Services a response message will be transmitted back to the practice. When the response time seems unreasonable, contact Customer Services.What if I have a file that is rejected? Contact Customer Services and they will advise as to why it was rejected, occasionally the resolution of the problem may involve advice or action from your software supplier. What do I do when I don’t understand some rejection messages? When the claim has been rejected by Practitioner Services, each error message has a message number. We advise practitioners to check our web site in the first instance where we have Plain English meanings to the error messages http://www.psd.scot.nhs.uk/professionals/dental/error messages.html When you are uncertain about the action to take, contact Customer Services How do we know when the end of schedule is? Practices should check this information as detailed on our website, also a broadcast message is sent as a reminder. http://www.psd.scot.nhs.uk/professionals/dental/keyscheduledates.html How do practices know the Discretionary Fees / Codes? Refer to the Dental Information Guide Booklet published by Practitioner Services. Contact Customer Services for any other Discretionary fees and codes. http://www.psd.scot.nhs.uk/professionals/dental/docs/pubs/information_guide_2010_001.pdf We are unable to generate Discretionary codes into our claim. Detail the full code + fee into your Observations and Practitioner Services staff will include the items in the claim. Can software suppliers be issued with ALL Discretionary fees? Practitioner Services can only issue the more common codes see the Dental Information Guide Booklet. Contact Customer Services Helpdesk for any other Discretionary fees and codes. Can I get Prior Approval via EDI? No, General dental treatment prior approval claims are submitted using the GP17(1) form. Can I submit Orthodontic claims via EDI? No, Orthodontic claims should be submitted for paper processing using the GP17(O) form. What is ‘proof of exemption?’ As from 15th Jan 2001 onward the dentist should indicate whether or not an exemption certificate was produced at the time of treatment for all patients claiming exemptions. How do I include proof of exemption onto an EDI claim? Contact your software supplier, as your software package should allow you to do this.
Should l get both a paper and an electronic schedule? Yes, however, the paper schedule will contain complete details of all processed EDI and GP17 paper claims, Registrations, Adjustments etc. The electronic schedule will only show claims processed by EDI. How do I get an electronic schedule to reconcile the claims I have transmitted? Contact your software supplier to find out how to reconcile claims on your software system. What if I require an Adjustment to a claim that has been paid? Submit request on a Dental 283 Adjustment form to Practitioner Services, Customer Administration Section. Retransmitting a paid claim is a common practice error that causes an instant rejection, do not retransmit paid claims. .
Practice Information
What paper forms should an EDI practice use? GP17PR Practice Record form GP17RA Recalled Attendance form GP17 (1) Form used to request Prior Approval for General Dental Treatment GP17 (O) Form used for Orthodontic Treatment 283 Paid Claim Adjustment Form 286 Non Payment Enquiry form 287 Patient Detail Amendment Form Where do I get the abovelisted forms? All form versions starting with letters GP come from your Health Board. PSD forms are located: http://www.psd.scot.nhs.uk/professionals/dental/forms.html Do patients' need to sign a form upon completion of treatment? Yes, a GP17PR must be signed by the patient at the time of acceptance and completion of treatment. Who can sign GP17PR form on a patient’s behalf? Only the patient, a parent or guardian may sign. How often should a GP17PR be completed? Complete a GP17PR each time a patient comes for a new course of treatment, in the same way as previously done for GP17 paper claims. Should the GP17PR be held in practice? Yes, it must be retained by the practice How long should the practice retain a GP17PR? The regulations require the form to be held for 2 years following completion of any course of care and treatment, the British Dental Association advises it is kept for 11 years. Can details be handwritten onto the GP17PR? Yes, provided all details and signatures are present. How do I claim for treatment started before I signed up with EDI? Claims can be submitted on a GP17(1) form – do not send the claim via EDI to prevent duplication.
Submitting Claims
Must I submit a GP17 paper claim when claiming Recall Attendance via EDI? No, transmit the completed claim via EDI. The GP17RA form should be sent to Practitioner Services clearly marked FAO Customer Administration Section. My patient has PFTR and I only have a signed GP17(1) paper claim – how do I claim for this treatment? Transmit the completed claim via EDI and keep the signed GP17(1) paper claim in your practice. Is there ever a case when a GP17 paper claim is used by EDI practices? Yes, when the case involves Prior Approval [see below **]. ** What is the procedure for claiming Prior Approval? Submit a GP17 paper claim for Approval using the Fastrack envelope including supporting xrays, models or reports. The approved GP17 paper claim will be returned to the practice. When the treatment is complete, the claim is transmitted via EDI for payment. The GP17 paper claim [used earlier to submit the treatment for Approval] should be retained in practice What if the patient signed the GP71PR form but the claim now requires Prior Approval? The patient can sign a GP17 paper claim when you assess the patients treatment and realised prior approval is now required. Send the GP17 paper claim to Practitioner Services for approval using a Fastrack envelope. My claim had Prior Approval and is now PFTR how do I send the claim? Transmit the claim via EDI and send in the GP17 paper claim showing the final treatment, to Prior approval so they can update details of your original prior approval request. Clearly detail that PA is no longer required and the claim has been sent using EDI What should I do when sending an RDO claim for payment? Enter “RDO Claim” in the observations and transmit completed treatment using EDI for payment. The GP17 paper claim should be sent to Practitioner Services, clearly marked FAO RDO departmentWhat should I do if I am submitting a Continuation Case?
Transmit claims via EDI, ensuring observations are entered stating “Continuation Case” and whether claim is 1 st or 2 nd part. This enables our staff to match up the claims for processing to payment. ** Claims submitted for payment using the GP17 paper claim should not be transmitted via EDI. Send both the GP17 paper claims together to Practitioner Services clearly marked “Continuation Claims” FAO Customer Administration Section. What should I do when sending a Regulation 9 claim? Transmit claim via EDI, entering “Regulation 9” in the observation field. Send the Regulation 9 decision form to Practitioner Services clearly marked “Regulation 9” FAO Prior Approval Section, with a note explaining that it relates to an EDI claim. **Claims submitted for payment using the GP17 paper claim form should not be transmitted via EDI. Send both the GP17 paper claim and the Health Board Decision to Practitioner Services clearly marked “Regulation 9” FAO Prior Approval Section. What Code should I enter for incomplete treatment? Enter the code for incomplete treatment if it is available in the Statement of Dental Remuneration (SDR). When a code is not listed, contact the Practitioner Services Customer Services for advice you may need to submit the claim on a GP17 paper claim. What if the case was sent as PFTR and then the patient returns? There are no codes in the Statement of Dental Remuneration for a Balance fee. When the remaining part of the fee is required, send in a GP17 paper claim with an explanation in the Observations box, clearly marked “Balance Fee Request” FAO Customer Administration Section. Any new items of treatment detailed on the GP17 paper claim will be processed for payment by Practitioner Services. Practitioner Services have asked me to resubmit an individual claim how do I do this? The method depends on your software system. For training/guidance, contact your software supplier. Our practice submitted a claim showing that the patient is paying, but we have since discovered that they are exempt. What is the procedure to amend? The patient needs to apply for a refund using an HC5 form. The HC5 form explains how to obtain a refund. Completed forms should be returned to either the Department of Social Services or the Benefits Agency (Newcastle) depending on the patient’s circumstances. What about patients seen as an Emergency outwith normal hours by another dentist in my practice? Transmit the claim via EDI. The completed GP17RA form should be sent clearly marked FAO “EDI Records” Customer Administration Section.”
HELPFUL TIPS FOR HANDLING REJECTION MESSAGES
When your practice gets a message back immediately after sending files, the rejection message will NOT come from Practitioner Services. Check the file for an error and if in doubt contact your software supplier. When a claim is returned from Practitioner Services it can be resubmitted via EDI only when the amendment is clarification of items e.g. Codes, Dates or Total.Where claim has already been included in the payment schedule and you wish to request an adjustment, use the Dental 283 Adjustment Request form do not resend the claim via EDI.
