Ophthalmic Payments

National User Group Meeting

16th January 2014

Presented byMark 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:– 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

• Background

• Setup

• Sending electronic statements

• Available downloads– NHS Ophthalmic Decrypt Utility

Electronic Statements

• Background

– 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

• Setup– Sending email address

• Set email address for your Payment Authority

– Practice email address & password• Practitioner electronic claims settings

• Sending payment statements– All statement reports (email option)

Electronic StatementsSending email address

Electronic StatementPractice email & password

Electronic StatementsSending emails

Electronic Statements

• 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

• 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)

• Activity Details– 399 active stores

• 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)

• Claim Volumes from May 2007

– 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 theopticians 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 fromthe 29th August 2013.

Open Change Requests

4796 HoldSystem 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 hasoccurred.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 ReportRequirement 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 target90% 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