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Acronyms and Terminology

Creating a Course of Treatment (COT)

An appointment is required for a COT - it is advisable to create it before the COT

Any patient starting an NHS COT must have an appointment in the appointment book for the day of their visit. If a patient ‘walks in’ to the practice without an appointment it is advisable to create one in the system before creating the Course of Treatment.

If there is no prior appointment, EXACT will prompt you to create it during the COT.

To start a new Course Of treatment (COT) with NHS

1. In the Chart tab, click the Add COT button to display the Add COT window (image below).
2. Specify NHS in the Payor field (if you leave this blank, EXACT will create a Private Course of Treatment)
3. Click the OK button (image below).
4. If you have not previously captured NHS fields for this patient, you will be presented with a NHS Patient Mandatory Fields screen, for capturing information that is required by NHS.

   NOTE: You must complete these fields to be able to continue.

   

   Guidelines:

   • If this information is unavailable at the time the appointment is booked or marked as arrived, the practitioner may Cancel and continue with the appointment, in which case this prompt will appear again when the practitioner opens a new COT for the patient.
   • If this prompt appears when opening an NHS COT, then this will be the last opportunity to enter this information... and if you do not enter the information at this point, you will not be able to save the patient file, so patient information will need to be gathered prior to the patient leaving the practice.
   • If the data is captured at the time the appointment is made, this prompt will not show again.
5. Complete the fields and then click OK to display the Treatment Plan Type:

   

   
   

   NHS patients under the pilot/prototype program fall into four Treatment Plan Types:

   Assessment	This is either an initial Oral Health Assessment (OHA) when the Patient first comes in (this can only be conducted once), or the Oral Health Review (OHR), which is a "repeat OHA". For OHA on edentate patients see also: Video 04: Special Oral Health Assessment Requires the following forms and actions: Exemptions and charges form Medical history Social history BPE Intra-oral assessment Extra-oral assessment (not mandatory) Clinical history Full Case System generated full risk assessment based on the input to the other forms FP17 on TC
   Additional Treatment	Any treatment required following an assessment or review. This includes urgent treatment where the patient does not wish to have a full assessment or review. No risk assessment will be calculated for this appointment type.
   Treatment outside of Pilot/Prototype	All treatments that cannot be categorised with the above two treatments, such as a treatment on referral into the Practice or orthodontic treatment. Requires the following forms and actions: Exemptions and charges form FP17 on TC
   Private Only	This is available from Phase IV (Prototype) as an option so that if a patient at your practice appears in your capitation list, all private course of treatment details for this patient will be sent with your appointment data transmissions.

6. With the Treatment Plan Type finalised, you need to complete the Exemptions and Charges Form (this has not specifically changed for the NHS Pilot/Prototype), and then click OK:

   

   
   

7. When you click OK, the Charting tab screen is pre-populated for charting and treatments on this patient, according to the Treatment Plan Type.

   For example:

   

   These are the assessment items that are mandated by the Department of Health.
   All items must be completed as part of the assessment, with the exception of the Soft Tissue Extra Oral Exam, which is optional.
   Complete all base charting before selecting the Full Risk Assessment, as the Full Risk Assessment software initially calculates scores from the base chart data.

TIP to save time:

Reception staff can open a Course of Treatment and enter Medical and Social History data before the clinician sees the patient (the clinician can save and close these items once the patient is in the chair):

Completing the Exemptions and Charges Form

If you are an activated NHS Pilot/Prototype practice, you can also create an NHS course of treatment by means of the Treatment Plan Types.

Alternatively, clicking the button to create a new NHS course of treatment will also activate the Exemptions and Charges window. Completing this form will ensure that for Exempt or Partial Remission patients, the Course of Treatment created displays the correct patient fees.

Note that there are two different forms displayed - one for patients over 18 years of age, and another (with fewer fields and options) for patients under 18. The children's form is lower on this page; the following is the adult's example:

Some of the boxes may be greyed out. This indicates the option is not applicable to the patient. For example: no under 18 options available if the patient is over 18; male patients will not have the pregnancy/baby options.

When marking a patient's exemption follow the guidelines below:

• For the Patient/Partner options, the Supporting Details text box becomes available when one or more of the Patient/Partner options is selected. You can then enter relevant information (such as the partner's name if the exemption relates to the partner).
• Partial Remission Limit: When the Parent/partner has HC3 certificate option is selected, the Partial Remission Limit box becomes available. Here you will need to enter the Partial Remission value, and in the Supporting Details you will need to enter the HC3 certificate number.
• Proof of Exemption Seen/Not Seen: One of these must be selected if the patient has any exemption.

Patient Pays/Does not Pay Section

The NHS regulations require a new section on a claim showing why in certain circumstances a patient paid, or did not pay for a service. This is done by checking the boxes in the following area of the Exemptions and Charges window:

Where applicable, check the appropriate box when opening an NHS Course of Treatment.

The Exempt Symbol

If an Exemptions and Charges box is ticked the patient will be given an Exempt Symbol. This symbol is located right of the toolbar in the Patient file. It will be displayed the next time the patient’s file is opened.

The exempt symbol will remain in the patient’s file until all ticks are removed from the Exemptions & Charges list in the FP17 form (at such time as the patient is no longer exempt).

Child Arrangements

If a patient is a child, the Exemptions and Charges dialogue screen will appear as shown below. As children are automatically exempt they do not have the same options as adult patients. In this screen you will need to select whether or not you have seen proof of the child’s age. If they need to pay for their treatment you need to indicate why.

Regulation 11 Replacement Appliance / Ortho Appliance Options

If the patient needs to pay because they are receiving a Regulation 11 replacement appliance, click the checkbox, and they will automatically be charged 56.70.

If two replacements are required, click the x2 checkbox, as shown above.

Similarly, if an ortho appliance is required, click the Ortho Appliance field checkbox.

The total for the appliance(s) displays automatically and cannot be altered. Any additional charted items will be assigned a zero value.

For UDA contracts, this total value is displayed on the chart, TC dialog and paper forms. The UDA value is set to 12 whether or not the x2 box is ticked.

For Regulation 11 Ortho Appliances, the total amount is displayed on the chart and TC dialog only, as paper forms are not currently printed for ortho courses. UOA values are set to 0 whether or not the x2 box is ticked.

Linking a COT to an appointment (required)

All COTs must have a related appointment, so practitioners are only able to continue with a COT if it is linked.

Each time that a practitioner completes any one of the NHS treatment items in Treatment Plans, EXACT checks whether the current appointment is linked to an appointment in the book.

If it is, EXACT uses the planned appointment.

If not, it pops up a screen for to either

• Link to an existing appointment, or
• Create and link an appointment.

This achieves the following:

• Creates an appointment with the logged in practitioner for the current time
• Changes the patient status to ‘In the chair’ (which is useful for walk in patients where an appointment has not previously been made in the appointment book).

For example, if you have not yet created an appointment, EXACT prompts you to Create and Link Appointment for Today (if you already have an appointment booked, you won't see this button)

Click this button to define the appointment as follows:

You will then see the appointment at the top of the Course Of Treatment area, with the current time and the current user (In this example, "RGP"):

Charging as each appointment is completed

Once each appointment is completed the practitioner can charge. Run a Treatment Complete (TC) after stabilisation and then after each subsequent IC appointment.

Treatment Complete (TC) should be a clinical decision based on the following guidance from the Department of Health:

“Dental contract reforms pilots: Courses of treatments (COTs) (Including any associated patient charges)”.

For a copy or explanation of this guidance contact your PCC Regional Support Lead.

NHS OHA - Base Charting

A base chart must be completed for all patient Assessments to include:

• The state of the tooth
• The state of the tooth surface
• Caries present
• Un-erupted/missing teeth

The system will then calculate a DMF (Decayed/Missing/Filled) score from the base chart data. The NHS requires you to review and manually edit before confirming that it is complete and accurate.

The information is transmitted through to the Board and to the Department of Health.

Importance of Base Charting

For NHS Pilot/Prototype practices base charting is particularly important because it is used in two automated processes:

• EXACT automatically feeds the base chart data into the Full Risk Assessment, which a clinician runs after patient assessment.
• EXACT automatically transmits base chart data to NHS Dental Services.

  Please ensure that all clinical staff in the practice understand how to base chart in EXACT (learning resources include the Help information and the base charting video on the Portal).

Standard Base Charting

Conduct standard base charting procedures from the Base tab:

Quick Chart option

Use the Quick Chart for fast base charting with your configured "favourite" items:

To display it, hover over a tooth to see the tooltip, right-click and select Show Quick Chart Menu:

See also Video Quick Chart Menu

Use CP-codes wherever possible

Wherever possible use the CP (Care Pathway) codes in base charting. These codes have been made available specifically for the NHS Pilot/Prototype, and are setup correctly for transmitting data to NHS Dental Services.

See the standard CP-codes in the Base tab:

NOTE: In the Prototype (Phase IV) many of these CP codes are un-checked in the Service Items List and therefore are not applicable for the NHS Prototype, so you will see them as inactive:

If none of the delivered codes are appropriate you can customise a service, following certain guidelines

Base charting Caries

Use the following CP-codes to enable proper system calculations:

CP-CARARR Arrested Caries Present

CP-CAREAR Early Caries Present

CP-CAREST Established Caries Present

NOTE: The decayed teeth calculation on the DMF will look only at teeth with Established Caries.

Base charting un-erupted teeth

Do not use the missing tooth service as 1) it will cause incorrect calculation of the DMF, and 2) it will then need to be voided once the tooth erupts.

Use the following to enable proper system calculations:

ERUPT-EXFOL (Unerupted or exfoliated teeth)

This will turn the tooth outline on the chart grey and show as un-erupted in the Base Charting history.

When the tooth erupts, base chart it again using the same code. You may see a screen prompt asking if you want to void the original service. Answer NO if the tooth is newly erupted - this will change the tooth frame to black and mark the tooth as Erupted in the base charting history.

Base charting deciduous teeth

Use the same ERUPT-EXFOL code and procedures as for un-erupted teeth (above). The deciduous tooth will disappear entirely from the chart. If you mark it as erupted again, the tooth will appear again on the chart with the regular black outline.

To start the Full Risk Assessment and edit the DMF calculations

When you complete base charting, check (tick) CP RISK-F Full Risk Assessment to run the Full Risk Assessment Wizard:

The DMF screen shows calculated scores from your base charting and enables you to adjust them.

Customising a Base Charting Service

If none of the delivered codes are appropriate you can customise a service, but you need to follow some guidelines so that the software can calculate the DMF:

To customise a service item for use in NHS base charting

Go to Configure > Services...

In the Service list, locate and double-click the service that you want to customise, to open the Edit Service Item window:

Treatment Plan Types

Use this screen to define the kind of treatment plan and the domains for assessment.

Type of Treatment Plan (you must select one):

NHS patients under the pilot/prototype program fall into four Treatment Plan Types:

Optional domains:

A checked, greyed out checkbox indicates a compulsory domain (for example: )

Examples with Assessment treatment plan:

Conducting an NHS Oral Health Assessment

1. Create an NHS Course of Treatment (COT) for the patient, selecting the Assessment option:

   

   Work through the process, and after completing the Exemptions and Charges Form, the Charting tab screen will be ready for inputs on this patient:

   

2. Your task is to complete all of the NHS Assessment Items in the list. So long as they are incomplete, these items are represented with unchecked boxes (as below) and possibly blue text (this is customisable). The NHS Assessment is complete when every box is checked.

   Either click the checkbox or double-click the icon to open each item to edit its fields:

   

   IMPORTANT: You need to fully complete all assessment items (so that they all show as checked (ticked)). EXACT allows you to open each of these assessment items, partially complete it, close it, and then come back later to complete it - this is particularly useful for Receptionists who capture data off printed patient medical history forms. It also speeds the Assessment process once the patient is in the chair. To re-open an Assessment item, double-click its icon.

   When you fully complete an assessment item, it shows in the list with a checked box and black text. For example:

   

   
   

3. Each time that you complete any one of these NHS assessment items, EXACT checks whether the current appointment is linked to an appointment in the book. If not, it pops up a screen for you to either
   • Link to an existing appointment, or
   • Create and link an appointment.

   For example, if you have not yet created an appointment, EXACT prompts you to Create and Link Appointment for Today (if you already have an appointment booked, you won't see this button).

   

   Click this button to define the appointment as follows:

   

   You will then see the appointment at the top of the Course Of Treatment area, with the current time and the current user (In this example, "RGP"):

   

4. When you have successfully completed the NHS Assessment item, it will show as completed in the COT area. For example, here the Medical History item has been completed, shows a checked box, and displays in black text:

   

Managing Non-compliance during Oral Health Assessment

The Oral Health Assessment or Review process requires that data be solicited from a patient and recorded across a series of Medical, Social and Clinical screens.

This data relates to one of the four domains (Caries, Tooth Surface Loss, Perio and Soft Tissue) shown in the Full Risk Assessment.

A Full Risk Assessment requires that all data is collected, so a shortfall in data compromises the assessment.
When the clinician marks fields as Non Compliant, the system may generate a total score of Incomplete - Patient Non Compliant.

Patients can be non compliant in two ways

Patients may fail to comply with requests for data (i.e. they are non compliant) in two ways:

• There is limited access to the patient's mouth.
• The patient refuses to answer questions / provide data.

EXACT enables clinicians to manage patient non compliance

The system provides the means for clinicians to

1. Record patient non compliance during the data gathering process:

   

2. Clearly see which domain calculated scores have been rendered incomplete due to non compliance.
3. Review and manually override system-generated assessment scores that have been skewed or rendered invalid by patient non compliant behaviour (the clinician needs to be confident of a domain score):

   

   The Full Risk Assessment Summary displays Incomplete statuses that apply to domains:

   

   

4. Manually remove or add Patient Actions and Dental Team Actions:

   

Examples of Non Compliance recording fields:

Soft Tissue:

Medical History

A medical history is required to be completed for an Assessment COT.

Patient medical history details are not transmitted to the NHS Dental Services, but EXACT does inform the NHS that the Medical History has been recorded.

IMPORTANT: EXACT will only inform the NHS of Medical History completion if you use this NHS Medical History screen (if you use the standard EXACT medical tab to record details the NHS will never know!).

There are no medical history questions specifically for the New Dental Contract Pilot, so practices can continue to use either the default form in EXACT or their current medical history form, which should be entered into the system through the medical history service code in the COT, rather than the medical history tab.

Additional items can be typed into the free text fields. For example:

The information entered via the medical history service code will be saved for future viewing in the medical history tab.

To assess Medical History for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Medical History:

   

   NOTE: You must use this means of recording Medical History for NHS patients so that EXACT can transmit to the NHS a confirmation that the mandatory medical history was recorded. If you use the standard EXACT Medical screen, NHS will receive no confirmation that you completed a Medical History for this patient.

   The default Medical History screen displays:

   

   This is the same screen that you would access by means of the Update Medical History button in the Medical tab or in the Medical screen popup tooltip. It is customised for the Practice and has been pre-selected from options in the Medical History Configuration settings. NHS does not prescribe what questions to ask on this form, but requests that a medical history be completed.

   In most cases, you can update the screen by simply clicking options on-screen. Instead of a simple OK button, you are required to confirm changes by means of a dated button:

   

2. Click the Confirm Medical History on [date] button.
3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Social History

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Social History:

   

2. Complete all fields in the Social History screen, as mandated by the NHS (all of this information will be transmitted):

   

   The fields in this screen may vary depending on the patient characteristics.

   For the Current Problems section you need to select at least one option.

   Optionally type notes into the Invoice Notes and Clinical Notes text boxes.

   If you mark any of the questions as Non Compliant, it may result in the applicable domain score not being calculated, and the domain score will show "Incomplete - Patient Non Compliant". You can then opt to manually edit the domain score, if you feel that you can determine the score. For example:

   

   For more information on the definitions for these fields please contact the Department of Health or the PCC.

   If you try to click OK without completing all fields you will be prompted for completion:

   

   NOTE: If you opt to close the window anyway, the Social History Assessment will not show as completed, and ultimately you will not be able to complete the Full Case Assessment until you come back and complete the missing fields.

3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Basic Perio

The BPE with Bleeding form is mandatory for the New NHS Contract. It must be completed for every patient, unless a patient is non compliant.

To assess Basic Perio (with Bleeding) for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Basic Perio:

   

2. Complete the BPE (Basic Perio Exam) screen. This screen has been updated in accordance with guidelines from the British Society of Periodontology:

   (* is Furcation)

   All the BPE information must be completed to continue. BPE must be completed in this manner – any BPE information entered into the Perio tab will not be transmitted as part of the New NHS Contract. The information entered via the BPE service code will be saved for future viewing in the Perio tab.

   Bleeding	Tick the boxes to indicate whether bleeding is occurring in the relevant quadrant.
   BPE Grid	Drop downs for each quadrant, which allow the user to select one of the options. Blank is the default (not recorded). The screen allows you to record furcation by means of the asterisk * options. X dentes, a sextant with all teeth missing. If all teeth in a sextant are marked as missing, the BPE for that sextant will default to X. If you are not using a mouse, move around the dropdown boxes clockwise by pressing the tab key. The default first BPE grid entry is the top left. Non Compliant – The BPE can be marked as non-compliant if this is the case. This will result in no score being calculated for the Perio domain:
   Notes	Free text box (notes are optional).

3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Soft Tissue Intra Oral

The Intra Oral Assessment form is preset for the New NHS Contract. It is mandatory, and when you tick it, EXACT will load the Intra Oral Assessment window with Not Done defaulted.

Alternatively, you can delete the service code from the COT.

If you complete an Intra Oral Assessment, you must also complete the Risk Assessment section.

After saving, you can view the Intra Oral Assessment via the Pathology tab.

To assess Intra Oral Soft Tissue for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Intra Oral Soft Tissue:

   

   Complete the assessment in the same screen as you would use for the Pathology tab, with a few differences:

   

2. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Soft Tissue Extra Oral

The Extra Oral Assessment form is preset for the New NHS Contract.

However, it is not mandatory, and items that you record are not transmitted to NHS Dental Services.

When you tick it EXACT will load the Extra Oral Assessment window with Not Done defaulted. This is the only extra oral option that can remain “Not Done”.

Alternatively, you can delete the service code from the COT.

If you complete an Extra Oral Assessment, you must also complete the Risk Assessment section. After saving, you can view the Extra Oral Assessment via the Pathology tab.

To assess Extra Oral Soft Tissue for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Extra Oral Soft Tissue:

   

2. Complete the assessment in the same screen as you would use for the Pathology tab, with a few differences:

   

3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Clinical History

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

This Clinical History form is preset for the New NHS Contract, to be completed for every patient.

1. Click the checkbox or double-click the icon for Clinical History:

   

2. Complete the NHS-prescribed fields in the Clinical History screen:

   

   NOTE: The Clinical History can be partially completed and saved, but all Clinical History information must be completed in order to complete the Full Risk Assessment.

   Each of the items in the assessment can be marked as non-compliant if this is the case. This will result in no score being calculated for the applicable domain. This will be shown on the domain screen and the summary screen of the full risk assessment:

   

   Questions on this Form change according to the patient’s age. Patients aged 12-18 will have additional questions related to unerupted canines and orthodontic appliances:

   

3. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Full Case

The Full Case Assessment simply holds the Patient Charge, which initially is the same charge as for Practices outside of the NHS Pilot/Prototype system (this may change after legislative amendments).

To assess the Full Case for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox for Full Case Assessment:

   

   This assessment item immediately registers as complete (there is no other dialogue):

   

2. If you don't already have an appointment in the appointment book, you will be prompted to link this COT to an appointment (all COTs must be linked to appointments).
   See Linking a COT to an appointment (required) for procedures.

   If you do have an appointment booked, the link will be created automatically.

Full Risk (system generated)

EXACT generates a Full Risk Assessment based on the information captured in base charting and in each of the forms from the NHS Oral Health Assessment.

The Risk Assessment Summary screen allows practitioners to review the scores for each of the domains, all patient actions, and all dental team actions.

EXACT calculates a Recall Interval based on the New Contract guidelines.

Where required, it suggests an Interim Care Interval.

Recall Intervals and Interim Care Intervals can be changed.

The selected Recall Interval is transferred to the Recall tab and to any Recall Prompt.

It is recommended that practitioners always check/tick Preview Care Plan on Finish as this automates the printing of Patient Actions for the patient's reference.

To assess Full Risk for NHS Oral Health Assessment

(This follows Starting a new NHS COT > Conducting an NHS Oral Health Assessment)

1. Click the checkbox or double-click the icon for Full Risk Assessment:

   

   You will see a DMF (Decayed/Missing/Filled) screen with scores that the system has calculated from the base chart data on the state of the tooth, the state of the tooth surface, caries present and un-erupted/missing teeth. (This is the reason that base charting needs to be completed before the full risk assessment)

   

2. (Compulsory for NHS) Review these scores, edit them where necessary and check (tick) to confirm that this is a complete and accurate record. The information is later transmitted through to the Board and to the Department of Health.
   Note that changing the scores on the DMF screen does not retrospectively change the base charting on the tooth chart, and that the DMF will adjust automatically if a tooth with base-charted Caries is subsequently restored.
3. Complete the Full Risk Assessment Wizard. This uses the matrix in the backend of the EXACT system to provide a RAG (Red, Amber, Green) Score for each one of four domains:

   Caries Domain

   Tooth Surface Loss Domain

   Perio Domain

   Soft Tissue Domain

4. You may be prompted to link this COT to an appointment (all COTs must be linked to appointments). 

To preview and print the Patient Self-care Plan after the Full Risk Assessment wizard is closed

1. Reopen it by double clicking on the Full Risk Assessment icon in the COT.
2. Move through the wizard to the summary screen and tick Preview Care Plan on Finish.

Caries Domain 

1. EXACT calculates a Caries Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

To manually override the Calculated Score in a Caries Domain Full Risk Assessment

EXACT initially calculates the score/colour for the Caries Domain, based on Clinical and Patient findings.

However, you have the option to override this score/colour if you disagree with it, and your override action is then recorded as a deviation from the NHS matrix, and is reported to NHS.

Select an option from the Override Score dropdown menu.

To manually Insert an action in a Caries Domain Full Risk Assessment

Click the Insert button , choose from the Add Action list, then click OK:

To manually remove a selected action in a Caries Domain Full Risk Assessment

Select the action, click the Remove button and then click Yes to confirm:

Tooth Surface Loss Domain 

1. EXACT calculates a Tooth Surface Loss Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

Perio Domain

1. EXACT calculates a Perio Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

Recall Periods for Red Perio Patients

In the pilot phases of this programme, if a patient scored red in the perio domain of the full risk assessment, the recall interval at the end is automatically set to 9 months.

In the prototype phase, this recall period was been increased to 12 months.
Note that you can still manually change it to a different period.

Soft Tissue Domain

1. EXACT calculates a Soft Tissue Domain RAG score (from healthiest green, through amber, to unhealthiest red) based on the Clinical and Patient Findings.

   

2. Review the RAG score/colour to see if it is appropriate.
   Note that it is based on the Clinical and Patient Findings (all of the findings that have contributed to the score).

   If you believe EXACT's calculation to be inaccurate, override the score/colour, by selecting an option from the Override Score dropdown menu.

   

3. The final state of the Calculated Score determines
   • The Patient Actions that EXACT prescribes. These will form the basis for a discussion with the patient on the care pathway and preventative plan, and map to the Patient Self-care Plan,
   • The Dental Team Actions that EXACT prescribes. These map to the preventative services that automatically populate the patient Course of Treatment once the Full Risk Assessment is complete.
4. Optionally add or remove Patient and Dental Team actions as follows:

   Click the Insert button , choose from the Add Action list, then click OK:

   

   Select the action, click the Remove button and then click Yes to confirm:

   

5. Ultimately the patient will be issued a Patient Self-care Plan printout with the Patient Actions that he/she should carry out, and the Dental Team Actions will form the line items in the Course of Treatment.

Summary Screen

The Risk Assessment summary screen consolidates Patient Actions and Dental Team Actions.

It requires decisions on the following:

• Interim Care (IC) Interval
• Recall Interval
• Advanced Care.

It also requires an indication of whether any private treatment has been planned as part of the patient care pathway.

NOTE: You can use the < Prev button to return to previous screens (for example as a means of adding or removing actions in those screens)

When you click the Next button you will advance to a Care Plan screen from where you can

• Opt to Preview the Care Plan
• Finish the Risk Assessment

Care Plan Finish Screen

(This follows Creating a Course Of Treatment (COT) > Conducting an NHS Oral Health Assessment > NHS OHA - Full Risk (system-generated))

This is the last screen before finishing the Full Risk Assessment.

It shows the Patient Actions that will display on their Care Plan.

Because each action has a check box, you have the option to exclude it from the Care Plan.

See also: Video 06: Care Plan and Pathway

To finish the Full Risk Assessment from the Care Plan Finish screen

1. Follow the Full Risk Assessment Wizard to the last screen:

   

   Notice that by default the check box for Preview Care Plan on Finish is checked (so by default you will preview the Care Plan as the Patient will see it). This is because you are required to issue a Patient with a copy of the Care Plan after each Assessment Appointment.

   

   You can opt to de-select this check box and not preview or print the Care Plan, but then you will need to make another arrangement to issue the patient with such a plan, in order to meet the requirements of the NHS England guidelines.

   Recommendations from this screen will populate Section 3 of the Care Plan, and the plan will also show the Interim Care and Recall periods:

   

2. Review the fields on this screen and check or un-check as appropriate.
3. Type any further recommendations into the Other recommendations text box.
4. When you are satisfied with the selections, click the Finish button.

   You will immediately see the Course of Treatment area being populated with the Care Pathway (see image below, you can sort and order these actions into multiple appointments as required).

   If you opted to Preview the Care Plan on Finish, you will also see a preview of the plan 

5. Print out the Care Plan.
6. Use it for discussion with the patient, and then issue it to them to take away, following NHS England guidelines.

To re-step through (replay) the sequence of Full Risk Assessment screens

You can step through a read-only version by means of the i (information) button in the Care Pathways tab. 

To complete the Risk Assessment in the Chart tab

When you click the Finish button, you will also immediately see the Course of Treatment area being populated with the Care Pathway, as it was defined in the Summary screen (it lists all Dental Team Actions for the current appointment):

Sort and order these actions into multiple appointments as required:

Note: You can condense and restore long COTs by clicking the "–" and "+" icons

What if you cannot complete all Dental Team Actions in one appointment?

Even with assessment actions split across multiple appointments, EXACT is still able to correctly calculate the cumulative fields for the Summary Full Risk Assessment.

Previewing and Printing a Care Plan

The Care Plan Form contains a summary of findings plus all information that a Patient needs to continue.

To Preview and Print from the Risk Assessment Summary

From the Care Plan finish screen for Full Risk Assessment,

Close or Print as necessary from the preview screen:

Using NHS Patient Care Pathways Tab

Location of the Care Pathways Tab

Purpose of the Care Pathways Tab

The primary purpose of this tab is to display the patient's current Care Pathways status.

For each assessment and review the Care Pathways tab displays Date, domain scores, IC Recall and Recall Interval:

You can see the RAG (Red, Amber, Green) score for each of the four domains, plus the IC Recall and the Recall Interval.

If you show sufficient Care Pathways tab screen area (see resize procedure below), you will also see previous assessments

Displaying and Resizing the Care Pathways Tab

1. Click the Setup button in the Service List area, to open the Service list Setup Wizard

   

2. Tick the Select which tabs you use in the activity areas checkbox.
3. From the Wizard, select Care Pathways Tab in the left pane and move it to the right pane, then re-order the right pane tabs with the up and down arrows.

   

To resize the Care Pathways tab

Previewing and Printing from the Care Pathways Tab

1. From the Care Pathways tab, select the Date that you require, then either
   • Click the Print Patient Actions button

   - or -

   • Right-click and select Print Patient Actions.

     

2. Print as required from the Care Plan Form screen.

   

Re-displaying the Full Risk Assessment Wizard

1. In the Care Pathways tab, select the Care Pathway by date.
2. Either
   • Right-click and select the More Information option

     

   - or -

   • Select the i (Information) button to re-display the Full Risk Assessment.
3. Use the <Prev and Next> buttons to step through it:

   

Re-printing a Care Plan

1. Select the Care Pathways tab at in the Activities areas at right of the Chart screen:

   

   

   If it is not displayed, add it by means of the Service List Spanner button

2. If you see multiple Care Pathways displayed, check carefully by date before selecting the correct one and then select the Print Patient Actions button:

   

3. When the Care Plan Form print preview displays, select the Print button:

   

Managing the COT List

Following the Full Risk Assessment the Course Of Treatment (COT) area may appear very busy. It includes checked Assessment Items and a long list of treatments.

You have the option of dealing with all of these in the current appointment, or of adding further appointments (for example, you wish to investigate more thoroughly, or a Therapist or Extended Duties Dental Nurse is going to help with the treatment).

To assign appointments

There is flexibility in how you want to assign treatments to Appointments.

Include treatments in the same Appointment as the Assessment:

... or choose where you would like additional appointments.

To create another Appointment in the COT list

Right-click at the point where you wish to add an appointment, and select Add Appointment from the right-click menu:

Add as many more as you require.

For example, here the dentist added another appointment:

Repeat this process to add as many appointments as necessary to cover the initial Dental Team Actions.

Booking the Interim Care Appointment

Once the initial Dental Team Actions are completed, it is necessary to book the Interim Care appointment, with an interval as defined in the Summary Screen for Full Risk Assessment.

Charging for the Appointment and Updating Recall Manager

Once all the listed items have been checked (Ticked) for the first appointment, you can click the Charge button to both charge for the appointment and to inform the system that it is completed:

You will be prompted to print the invoice:

When you charge for an appointment, EXACT calculates a recall period

When you charge for an appointment, EXACT calculates a recall period, and populates Recall Manager with the necessary data for recalls.

NOTE: It later amends the data after the patient has been stabilised (Stabilisation is when all Dental Team Actions are completed, any subsequent treatment is completed, and the patient is "TC"ed (Treatment Completed)).

When you charge for an appointment, the list of items contracts:

TCing a completed Course of Treatment

"TC"ing is the process of completing a Course of Treatment (COT) in EXACT.

To see if there is a planned Interim Care (IC) appointment, look at the Care Pathways tab on the right of the screen in the Patient file:

Following the Assessment, you will need to TC prior to the first IC appointment.

Overview of the TC process:

When all Dental Team Actions and any subsequent treatment is completed for the assessment you can TC the COT, with the following results:

• The patient is considered stabilised.
• EXACT updates Recall Manager with relevant recall data.
• EXACT creates line items for the suggested Interim Care, including
  • Dental Team Actions based on the previous Summary Screen for Full Risk Assessment, and
  • An 0601 Patient Instruction for Oral Hygiene (if this is advice only it carries no charge, but if it contains treatment items such as scale or fissure sealants it carries a charge).
• EXACT suggests an Interim Care (IC) appointment date.
• EXACT populates the Appointment Workflow Departure List with a prompt for the receptionist to process the suggested appointment.

Multiple ICs:

Each IC can be followed by a subsequent IC if there is sufficient time before the current date and the next recall period. If there is insufficient time, no subsequent IC will be booked and the patient will be recalled as normal for their Oral Health Review.

To TC a completed NHS Assessment Course of Treatment

1. Ensure that all Appointment lines are checked (ticked)

   

2. Click the TC button to display the Treatment Plan Completion window:

   

   Check on validity of the COT completion date: When you TC a COT a check is made to see if the contract is valid for the completion date of the COT. If it is valid for the completion date, the TC dialog displays with the contract disabled. If the contract is invalid for the completion date, and if there is only one valid contract, that valid contract displays with the control disabled. If the contract is invalid for the completion date, and there is more than one valid contract, the contract control displays as a combo box where you can choose a contract.

   You are asked whether you wish to continue with this care pathway (i.e. is the patient going to return for the IC?)

   The Yes option is checked by default. If the patient is willing to return for the IC appointment, to continue simply click OK.

   However, if the patient has stated that they do not wish to continue with treatment, select No and then select a reason from the dropdown menu:

   

   This will complete the treatment.

3. The FP17 form appears as usual, and you click the Send Claim button to continue.

   REMINDER: Select the Best Practice Prevention check box (mandatory) before you send the claim.

   

4. EXACT then does the following:
   • populates the COT

   

   • Sends all completed treatment items to History as they are completed.
   • Recalculates the recall due date based on the recall period from the date of stabilisation:

     

   • Suggests an approximate appointment date:

     

   • Automatically populates the Appointment Workflow Departure List with the suggested appointment. The Receptionist is then prompted to confirm this booking or arrange a more suitable one as the patient departs the practice. It is advisable to book the appointment at this time so that the patient is in the system.

Option to use a report as an IC Recall List

If you do not book the appointment as the patient leaves, a further option is to periodically run a report that will display patients with IC appointments due for the following month (use this report as the IC recall list).
See Video 10: Book Interim Care

Charges for IC Appointments

The IC Appointment is free of charge if the items are limited to advice only. Treatments are charged. For advice on charges please speak to your regional support lead.

Procedures for Incomplete Appointments

When to TC and when to Mark As Incomplete

If items in an appointment cannot be finished during the appointment and you know that the patient will not be returning, TC at this point.

If items in an appointment cannot be finished during the appointment and you know that the patient is likely to return,

mark it as incomplete.

Scenario: Eight Dental Team Actions were planned for an appointment, but by the end of it only two of the eight are completed, leaving six incomplete.

To deal with an Incomplete Appointment

1. Right-click the Appointment header line.
2. From the right-click menu, select Mark Appointment Incomplete...
3. In the Treatment Plan Completion screen, click OK.

   EXACT then moves the completed actions to history with an AutoNote showing that it is incomplete, sets the actions as un-editable, and creates a New appointment populated with the incomplete Actions:

   

   NOTE: Although these assessment actions are now split across multiple appointments, EXACT is still able to correctly calculate the cumulative fields for the Summary Full Risk Assessment.

4. Continue the treatment or appointment as necessary.

To reverse an Appointment marked as Incomplete

1. Right-click the Appointment header line.
2. From the right-click menu, select Undo Mark Appointment Incomplete

   

   The appointment items then become editable and are shown in black text:

   

   The items that were initially moved to a New appointment remain in the New appointment but you can optionally drag them back to the initial appointment.

Charting the Required Treatment

After completing the Full Risk Assessment you need to chart any treatment that is required, if you have not done so already.

Conducting an NHS Assessment for Edentulous Patient

Base charting must be completed in order for EXACT to calculate the DMF correctly.

See  Video 02: Base Charting

Note that it is not necessary to complete all domains for an edentulous patient.

To conduct an NHS Assessment for an edentulous patient

1. Proceed as for a normal assessment by starting from the Chart tab > Add COT button... but in the Treatment Plan Type screen, select the Assessment and Edentate options:

   

   Notice that only the Soft Tissue domain is compulsory.

2. Make a clinical decision on whether to include Caries, Tooth Surface Loss and Perio domains (tick any that apply).
3. Click OK to continue.
4. Work through the actions that are listed under the Appointment.

   Notice that you only need to complete fields that relate to the compulsory Soft Tissue domain plus any domain/s that you optionally chose to include.

   

   Under the BPE action, the missing tooth "X" is pre-populated in the grid:

   

   Under the Full Risk Assessment you will only see scores for the compulsory Soft Tissue domain plus any other domain/s that you opted to include:

   

   The system will calculate Patient Actions and Dental Team actions for these applicable domains only.

Conducting an NHS Oral Health Assessment for Under 3s

Base charting must be completed in order for EXACT to calculate the DMF correctly.

Un-erupted teeth must be base charted correctly (not as missing teeth).

See  Video 02: Base Charting

Note that it is not necessary to complete all domains for an Under 3 year old patient.

To conduct an NHS Oral Health Assessment for an Under 3 year old patient

1. Proceed as for a normal assessment by starting from the Chart tab > Add COT button
2. EXACT will identify from the Patient Details that this patient is under 3 years old, and will specify domains accordingly:

   

   Notice that only the Caries domain is compulsory.

3. Make a clinical decision on whether to include Tooth Surface Loss, Perio and Soft Tissue domains (tick any that apply).
4. Click OK to continue.
5. Work through the actions that are listed under the Appointment.

   Notice that you only need to complete fields that relate to the compulsory Caries domain plus any domain/s that you optionally chose to include.

   The Full Risk Assessment Summary will only score for the Caries domain plus any domain/s that you optionally chose to include.

   A BPE is not required for under 3 year old patients, so will not appear as an action in the Appointment list. However, if you choose to conduct a BPE, add it to the Appointment from the Service List:

   

Conducting an NHS Oral Health Assessment for Under 7s

Base charting must be completed in order for EXACT to calculate the DMF correctly.

Un-erupted teeth must be base charted correctly (not as missing teeth).

See Base Charting and/or Video 02: Base Charting

Note that it is not necessary to complete all domains for an Under 7 year old patient.

To conduct an NHS Oral Health Assessment for an Under 7 year old patient

1. Proceed as for a normal assessment by starting from the Chart tab > Add COT button
2. EXACT will identify from the Patient Details that this patient is under 7 years old, and will specify domains accordingly:

   

   Notice that the Caries, Perio and Soft Tissue domains are compulsory.

3. Make a clinical decision on whether to include Tooth Surface Loss domain (tick to apply).
4. Click OK to continue.
5. Work through the actions that are listed under the Appointment.

   Notice that you only need to complete fields that relate to the compulsory domains plus Tooth Surface Loss, if you choose to include it.

   The Full Risk Assessment Summary will only score for the compulsory domains plus plus Tooth Surface Loss, if you chose to include it.

   A BPE is not required for under 7 year old patients, so will not appear as an action in the Appointment list. However, if you choose to conduct a BPE, add it to the Appointment from the Service List:

   

When Patients Don't Complete the Care Pathway

These are procedures to follow when patients do not complete their Care Pathway. For example, a patient does not return for the Interim Care (IC) appointment.

Scenario: The patient has completed some appointments, but is not going to return to complete the Care Pathway, which you now need to finalise.

Procedure:

1. TC the Course of Treatment (process it as complete).
2. When prompted "Do you wish to continue with this care pathway?", select No.
3. Select a Reason for discontinuing the care pathway (compulsory).
4. Click OK.
5. When prompted, send the FP17 Form as normal.

   The items that have been completed are moved to history.

   Items that are not completed show on the Misc tab:

   

   If the patient returns later you can optionally copy and paste these over to a new NHS Course of Treatment

   

   

   

   

To finalise an incomplete Care Pathway where some appointments themselves are NOT completed

Scenario: The patient has an appointment incomplete, and has now stated that they will not return to complete it, nor to complete the Care Pathway. i.e. you need to deal with both the incomplete appointment and the overall incomplete Care Pathway.

Procedure:

1. Right-click the IC header.
2. From the right-click menu, select "Delete this course of treatment".
3. Click Yes when prompted "This will delete all the chart items. Do you want to continue?".
4. Click Yes when prompted "This cannot be deleted. Do you want to discontinue?"
5. From the Treatment Plan Completion screen, select a Care Pathway Reason (reason to discontinue):

   

6. From the Treatment Plan Completion screen, select an Appointment Reason (reason to discontinue):

   

7. Click OK.

Conducting an Oral Health Review (OHR)

The "Assessment" Treatment Type can be either an initial Oral Health Assessment (OHA) when the Patient first comes in (this can only be conducted once), or the Oral Health Review (OHR), which is a "repeat OHA".

When you create the OHR, the COT content is the same as for the OHA:

The OHR Course of Treatment (COT) lists the same Dental Actions as the OHA, with a significant difference... screens are pre-populated with the data from the OHA. This is to save you time entering responses that haven't changed, but it is the practice's responsibility to ensure that all changes are properly entered.

Your task is to edit this data or add to it. For example:

When you check the box for Full Risk Assessment you will first be prompted to accept a declaration:

... and once you Accept, the Full Risk Assessment will proceed as normal.

Private Treatment Alternative within the Care Pathway

IMPORTANT:

NHS Contract practices are required to inform the NHS if as part of the Care Pathway following a Full Risk Assessment they intend to conduct private treatment outside of the Pilot.

Any additional private treatment that is provided must be transmitted at the end of the Course of Treatment.

Select the Yes option in the Private Treatment field on the Full Risk Assessment Summary:

At this stage of the Care Pathway no other information is required.

To view the Private Treatment screen for private treatment as part of the COT

When you TC an NHS COT, if any private treatment options are part of the COT they display in the Private Treatment screen.

NOTE: This screen and its associated information does not rely on you answering YES to the question on the Full Risk Assessment Summary (above).
So, even if you answered NO (no intention of private treatment), any private treatment you do then perform will appear on this Private Treatment screen anyway.

In this Private Treatment screen you are required to check (tick) those items that were provided as part of the NHS, within the patient Care Pathway, and to specify a category for each checked item (not for un-checked items).

Just the information on the checked and categorised items will be transmitted to NHS Dental Services.

Note that the system will remember the category that you assigned to the service so that future listed services will be auto-assigned the same category. You will need to manually change the category assignment if necessary.

When you select OK the FP17 screen appears as normal, and you can send the claim as normal.

Conducting Treatment Outside of the Pilot/Prototype

Treatments that do not fit into the NHS Pilot/Prototype can be fitted into the Treatment outside of Pilot Plan Type.

i.e. These treatments are considered outside the scope of the NHS New Dental Contract Pilot.

For example, when a patient has been referred from another practice, or where the patient simply needs denture repairs without any assessment.

To conduct treatment outside of the Pilot/Prototype

1. Create a Course Of Treatment (COT) for the patient, selecting the Treatment outside of Pilot option:

   

2. Complete the Exemptions and Charges Form as normal.
3. Start a course of treatment and run through it as you did prior to the Pilot process, without any NHS implications.

   

Booking IC Appointments via Appointment Workflow

EXACT suggests an approximate appointment date in the patient chart:

Because Interim Care (IC) Appointments are not integrated into EXACT's record system and automated processes, best practice is to book them in advance in order to save time and effort later.

To configure the Appointment Workflow for booking IC appointments

Configure the Appointment Workflow with these options to ensure that when patients leave their IC appointments are not lost in the system:

Appointment Workflow Quick Reference:

Configuring NHS Prototype

Configuring the Appointment Workflow

NHS Pilot/Prototype practices are strongly advised to use the Appointment Workflow to book the next IC or recall appointment as the patient leaves.

The software configuration can be manually changed, but Appointment Workflow has been optimised for NHS practices with this pre-configuration:

• The Appointment Workflow is defaulted to ON for NHS Pilot/Prototype practices, with all default configuration items already checked/ticked.

  Configure > Practice Settings:

  

• The IC interval is pre populated into the Appointment Workflow next appointment booking interval field for IC appointments.
  (The IC interval is the system-calculated interval between the Assessment and the Recall, calculated across all four Domain assessment scores)
• The Appointment Workflow expected time for IC appointments defaults to 15 mins if no time is shown already.

  NOTE: EXACT allows the practice to manually edit recall (OHR) dates, because the period at which patients should be seen is always best established by clinical judgement.

NHS Reports for the BSA

Reporting on the New Dental Contract is managed by the BSA.

Your regional NHS support lead may contact you with information on when and where to send these reports and to answer any queries that you may have.

Reports required:

For reporting, you may need to supply an Appointment Summary Report from EXACT as follows:

• Run an EXACT Appointment Summary Report for the previous contract year.
• Run an EXACT Appointment Summary Report each month during the new contract period.

Reviewing the Patient Full Risk Assessment Wizard Information

From the Care Pathways Tab it is possible to review the detailed information in the Full Risk Assessment Wizard, including the assessments for all four Domains, the IC Recall Interval, and the Recall Interval.

To review the Full Risk Assessment Wizard information

From the Care Pathways Summary Tab, click the Information button:

The Full Risk Assessment Wizard opens at the Caries Domain screen.

From here you can navigate further screens by means of the click the Next> and <Prev buttons.

Approving COTs for the Day, for Transmission

There is a mandatory daily approval (checking) process for each practitioner who has worked in the NHS Pilot/Prototype, to check and then transmit all of the data for the last 24 hours to the Board and the Department of health, whether that data is in a complete or incomplete COT.

The Approvals prompt appears at the last appointment of every day for each Provider, and if they don't deal with it, it will then appear at their first appointment for the following day.

Practitioners with Superuser rights can review and approve other Practitioners' COTs.

NOTE: Any COTs listed in the Provider Overview Screen in red text are more than 3 months old and require URGENT attention.

To approve COTs for the day so that they can be transmitted to NHS

1. When the Provider goes to complete the last appointment of the day, an Unapproved COTs screen appears:

   

   IMPORTANT: It is strongly advised that you complete the Approvals at the time of prompting.

   (If you cannot do it at this time you can postpone the Approval process until later. Refer to the procedure below: To later Review and Approve COTs for the day)

2. Click Yes to continue.

   In the Provider Overview Screen you will see a list of days, each with outstanding COTs to be approved.

   To approve, select COTs and Dates (optionally use the Select All / Select None buttons), and click the Approve button:

   

   (Optional) If you need to first check a COT, select it and then click the View COT button to display the View NHS Assessment COT screen. Here you can check that all details are correct:

   

   If it is a completed course of treatment, you can also open FP17 details for the selected transaction:

   

3. When you click the Approve button to approve the COTs and Dates, you will be prompted to enter a Validation PIN for the current Provider (this PIN is unique to each NHS Dentist, and is required in order to process the Approvals):

   

   In the validation process EXACT checks all required fields and pops up a warning if any are missing. For example:

   

4. Once approved, the COTs are removed from the Provider Overview screen.
5. See Automated daily data transmission to the BSA

To later review and approve COTs for the day

Select File > Payors > View Payors > NHS > Review Screen:

This Provider Overview Screen lists only the COTs for the logged in user.

All COTs require Approval, regardless of whether they are completed.

To re-open details of a COT, double-click it, or select it and then select the View COT button.

For instructions see the procedure above To approve COTs for the day so that they can be transmitted to NHS.

To Review and Approve other Practitioner COTs for the day (Superusers)

Practitioners with Superuser status are able to review (and/or Approve) all Providers' COTs.

1. Log in as a Superuser.
2. Select File > Payors > View Payors > NHS > NHS Review Screen:

   

   

   IMPORTANT: Any COTs listed in the Provider Overview Screen in red text are more than 3 months old and require URGENT attention.

3. (Optional) Approve the COTs on behalf of the Provider.

Automated Daily Data Transmission to the BSA

Changed or new data should be automatically transmitted every day by means of software that has been configured by Software of Excellence Support personnel.

If you are unsure if this has been configured for your practice, please call the SoE Support Desk for confirmation.

Noteworthy points about the transmission:

The transmission does not affect normal activity within the EXACT software or the practice.

It is fully automated through the EXACT Scheduler, so personnel need take no action.

By default the transmission time is 10.30 a.m, when dental practices are normally open with their servers running, but this time can be customised by Software of Excellence (please contact the Help Desk if required).

If a transmission for some reason does not occur, it will be queued for transmission the following day.

It is the Practice's responsibility to always check that the data has been transmitted by reviewing the data transmission status (Superuser login required).

Automated transmission procedure

The practice chooses a time for daily data transmission to the BSA (by default this is 10.30 a.m.)

At this time, the following data is automatically transmitted without affecting practice activities (no intervention required):

• Authorised data from the previous day.
• Authorised data from any prior days that hasn't already been transmitted.
• COTs that have changed since they were originally transmitted .

  IMPORTANT! It is essential that you continue to transmit bundles of FP17 forms as you did prior to the Contract. This is a separate process to the Pilot/Prototype data, which is transmitted automatically every day. If you need more information on this, please contact the SoE Support team.

Reviewing Data Transmission Status

To review data transmission status

Select Administration > NHS > Transmission Status:

... to display the Transmission Status screen:

Submitting an Orthodontic Claim for COT - NHS FP17

The FP17 claim process is the same as it was prior to the start of the NHS Pilot/Prototype.

It is separate to, and in addition to the NHS Pilot/Prototype transmission, so it still needs to be carried out.

If you need help with this process, please call the Software of Excellence Help Desk.