Ophthalmic Payments

National User Group Meeting 8th July 2010

Electronic Links

• Activity Details– 222 active stores

• 189 Specsavers• 30 practices using the Optix system• 2 Vision Express (Winchester 29/06)• 1 Independent

– 18 activation requests outstanding– 125 stores using automatic process– 88 PCTs over 44 payment agencies

Electronic Links

• Claim Volumes

– Period May 2007 – Jul 2010• 1,238,683 manual approvals• 1,406,723 automatic approvals

• 2,645,406 total claims

Electronic Links

• GOS 6 Claims

– Pilot expected with Healthcall– During 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

Closed Change Requests3231 Essex, Extend the possible duplicate check to only use the previous 6 months

Rejected by OPUG 21st January

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

29th January

3617 LASCA Withdrawn

3533 Bromley Withdrawn

Closed Change Requests3529 Devon, Monthly expenditure reports to show number of claims per type

16th February

3530 Devon, Monthly expenditure reports to all have CSV option

16th February

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

16th February

Closed Change Requests3596 Cambridge, Monthly expenditure reports to have the ability to select multiple payment periods, include claim counts and total spend values

16th February

3676 Suffolk, New Pension rules

23rd February

3464 Kent, PCT read only user role

26th February

Closed Change Requests3392 LASCA, New report to show electronic submission batch details

5th March

3733 LASCA Withdrawn

3668 LASCA ,Alternate shading on some reports

30th April

3808 Devon Withdrawn

Closed Change Requests3470 Salford, A parameter switch to select to use the PCT telephone number or paying organisation telephone number on all reports/letters

7th May

3395 LASCA, Enhanced service report to list claims using payment periods

27th May

3783 Devon, Monthly expenditure total report to show levy value

30th June

Closed Change Requests3776 LASCA, Electronic claims to access archived payment cycles

30th June

3528 WYCSA, Performance Indicator for GOS4 Small Glasses

2nd July

Open Change Requests3340 Suffolk Pre-notification module to highlight

higher fee when more than 2 GOS6 claims generated for same address (currently in peer testing)

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 (currently in peer testing)

Open Change Requests3532 Bromley

Include patient search when processing electronic claims

3815 WYCSA

Enter GOS 3 in batchesAdvantages for change request 3815:-• Cost saving

Disadvantages for change request 3815:-• A large slice of development time & costs will be required for this CR• SBE 515 return will not show 100% vouchers and will therefore need to be completed manually at 100%• SBE 515 2% sample option is no longer available• Some Performance Indicator reports will show no information on voucher activity• All Post Payment Checks will not include voucher claims• All fraud prevention and detection tools will have no data for vouchers claims (tints and prisms per voucher etc)• Open Exeter patient lookup will be not be available on voucher claims

• Possible duplicate voucher claims will not be identified

Open Change Requests3883 North Yorkshire

Remember position when using the List Contractor function

3927 LASCA Store and view the user code and date entered in ‘notes’ section on all GOS claims

3932 Cambridge

Monthly Expenditure total payment value to have an option to include/exclude the levy value from the CSV

3939 Hertfordshire

Batch method to update contractor code on selected incorrectly entered individual claims

Early Re-Test Codes

– 1. Patient is at risk of frequent changes of prescription for reasons not requiring medical referral or for reasons already known to a medical practitioner;

– 2. Patient has pathology likely to worsen, for example age-related macular degeneration, cataract, corneal dystrophy, or congenital anomalies;

Early Re-Test Codes

– 3.Patient has presented with symptoms or concerns requiring ophthalmic investigation:

• 3.1 resulting in referral to a medical practitioner;

• 3.2 resulting in issue of a changed prescription;

• 3.3 resulting in either no change or no referral (the patient's record should indicate any symptoms shown to support this category of claim, if necessary).

Early Re-Test Codes

– 4.Patient:• 4.1 needing complex lenses;• 4.2 with corrected vision of less than

6/60 in one eye.

Early Re-Test Codes

– 5. Patient:• 5.1 has presented for a sight test at the

request of a medical practitioner;• 5.2 is being managed by an optometrist

under the GOC referral rules, for example suspect visual fields on one occasion which is not confirmed on repeat, or abnormal IOP with no other significant signs of glaucoma;

• 5.3 is identified in protocols as needing to be seen more frequently because of risk factors.

Early Re-Test Codes

– 6. Other unusual circumstances requiring clinical investigation.

Early Re-Test Codes

• Summary of valid early re-test codes:

– 1– 2– 3.1– 3.2– 3.3

– 4.1– 4.2– 5.1– 5.2– 5.3– 6

Standby Service

• Please use the stand by service during unplanned interruptions of the Open Exeter service and it’s associated applications

• https://nww.standby1.openexeter.nhs.uk/nhsia/index.jsp

General Purpose Audit Report

• Change Request Enhancements

– More flexibility within searches– More capacity within searches

– All payment cycles are now listed• Multiple payment cycles can now be selected

– Archived claims are now included automatically, depending on selection

General Purpose Audit Report

General Purpose Audit Report

• Viewing Results

– Screen shows claim details

– Further searches on results available

General Purpose Audit Report

General Purpose Audit Report

General Purpose Audit Report

General Purpose Audit Report

• Report screen shows available options:

– Order options are:• Optician code, month of claim, patient’s date of

birth, patient’s surname, patient’s forenames and patient’s postcode

– Output options are:• Report, File (CSV) or Both

General Purpose Audit Report