Ophthalmic Payments

National User Group Meeting 21st January 2010

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• 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

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• Claims Volumes

– Period May 2007 – Jan 2010• 919,581 manual approvals• 1,055,749 automatic approvals

• 1,975,330 total claims

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• GOS 6 claims

– Pilot expected with Healthcall– Early in 2010– Pilot site within West Yorkshire

CSA

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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

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• 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

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• 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

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• 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

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• 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 Requests3092 Suffolk, Claims user role to include pre-notification premises details

14th July

3084 Dudley, Retain practice code for entry of next individual claim

24th July

3105 Kent, Private Sight Test statements, including email option

31st July

3202 North Yorks, Retain performer code for entry of next claim

14th August

Closed Change Requests3106 Kent, Statement adjustment fields (+/-) for Glaucoma

10th September

3124 Lancashire, 10 new local enhanced services codes

10th September

3110 Lancashire, Submission date shown for EC batches

29th September

3122 Birmingham, Frequency of re-test reason report by practice

11th November

Closed Change Requests2742 Dorset, Batched Additional Services claims

24th November

3125 Lancashire, Batched Additional Services claims

24th November

3132 Cambridge, Select payment cycle when using EC batch approval

26th November

3334 Essex, NHS number on all PPC letters

2nd December

Closed Change Requests2851 Hampshire, Improve linking of pre-notification lists to residential homes

4th December

3150 Essex, Monthly Expenditure Report

8th December

3388 Cumbria, display service date when listing possible duplicate claims

12th December

3332 Kent, Monthly Expenditure Report

22nd December

Closed Change Requests3502 Cornwall, GO & DOM added to the Type target on the Contractor List

24th December

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 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

3342 Suffolk A 6 month warning check on a GOS1, GOS5 or GOS6 claim

(currently in peer testing)

Open Change Requests

3392 Lancashire New report to show electronic submission batch details (currently in development)

3395 Lancashire Enhanced service report to list claims using payment periods

3464 Kent 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 Monthly expenditure reports to all have CSV option

3531 Devon Monthly expenditure reports to have the ability to select multiple payment periods

3531 Devon Monthly expenditure reports to have the ability to select multiple payment periods

Open Change Requests

3532 Bromley Include patient search when processing electronic claims

3533 Bromley Open Exeter patient search does not always locate patient

3596 Cambridge Monthly expenditure reports to have the ability to select multiple payment periods, include claim counts and total spend values

Import Pre-notification detailsCR 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 detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 2851

Import Pre-notification detailsCR 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 https://nww.openexeter.nhs.uk/nhsia/opthelp/Ophthalmics/eng/indexElectronic.html

• Pass the utility to the practice

• Terms & conditions for use apply

• FAQ’s available

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