eOrtho Discontinuation & Continuation

Discontinued Treatment

If treatment has commenced, Dentist 1 can request a final payment claim for the work done to date. If some treatment is partially complete, Dentist 1 must first request a discontinued fee request before submitting for final payment.

If there is NO partially completed treatment on the COT:

1. Dentist 1 will need to move all of the incomplete treatment from the COT to the Misc tab.

2. Next tick and charge all completed treatment and click the Ortho button.

3. Dentist 1 will then need to select the FINAL PAYMENT claim type and enter the mandatory data then click Send

4. Finally, TC the COT and the final payment will be paid in a schedule; you will need to process this payment as normal.

If there is partially completed treatment on the COT:

1. Dentist 1 will need to tick and charge the completed treatment on the COT. Any incomplete and partially completed items should be left as unticked on the COT then Dentist 1 should click the Ortho button

2. Dentist 1 will then need to select the DISCONTINUED FEE REQUEST claim type and enter the mandatory data (the incomplete treatment card contains optional data. However, if 1 optional item is entered, all must be entered.)

3. Dentist 1 must specify whether the patient failed to return or refused treatment. You must indicate in observations whether the patient has been de-bonded or not then select Send
   A successful claim will be returned with an authorisation status. The NHS will indicate the code and fee that should be claimed in the final payment.

4. Once the request has been authorised Dentist 1 can remove any incomplete treatment from the COT.

5. Chart all of the services returned by the NHS (329X) and assign the appropriate authorised fees the click the Ortho button on the patient’s chart

6. Dentist 1 will then select the FINAL PAYMENT claim type and enter the mandatory data then click Send.

7. Finally, TC the COT and the final payment will be paid in a schedule; you will need to process this payment as normal.

If Dentist 1 has applied for discontinuation on paper and is sending the final payment using EXACT & Connect. They must ensure the authorised treatment returned by the NHS is charted on the EXACT COT first.
Note, this process can also apply to Dentist 2, or any subsequent Dentist that does not complete the treatment plan. Dentist 1 and 2 are used purely for simplicity.
The NHS has also specified that only items 32(A)1 to 32(a)4 and 32(A)5 are valid treatments to discontinue

Claim Continuation - No change in treatment

1. The dentist completing the claim (Dentist 2) will need to create a new NHS orthodontic COT if Dentist 1 partially completed the treatment that Dentist 2 is required to complete and chart the new 3913 discretionary service only so that the NHS can pay Dentist 2 for completing the work.

2. If Dentist 2 is claiming an interim payment they will need to click the Ortho button
   Once in SOE Connect select the INTERIM PAYMENT claim type then enter the mandatory data select More Actions then press Request Continuation.

3. If Dentist 2 is claiming the final payment then click the Ortho button
   Once in SOE Connect select the FINAL PAYMENT claim type then enter the mandatory data select More Actions then Request Continuation. The NHS should return a fee for 3913 if appropriate and instruct you to resubmit the claim for payment

4. Once they know the fee Dentist 2 should add the approved fee to the 3913 service in EXACT then click the Ortho button

5. In SOE Connect the claim type should already be set to Final Payment. Simply select More Actions then Request Continuation

6. Finally, TC the COT and the final payment will be paid in a schedule; you will need to process this payment as normal.

Please note that if Dentist 2 is required to reply to the NHS, the reply must still be sent as a “Request continuation” so that continuation details are included appropriately.

Also, if Dentist 1 was not required to obtain prior approval because of a high tiering level, but Dentist 2 takes over the treatment and has a lower tiering level than the treatment value. Even though no change to the treatment plan has occurred, Dentist 2 must apply for PA re-approval for continuation. This assumes Dentist 1 has made some claim for the treatment (discontinuation or otherwise). If Dentist 1 has not claimed, Dentist 2 would simply start the treatment plan from scratch as the NHS would have no record or interest of what Dentist 2 was continuing. See steps below on how to apply for PA re-approval for continuation.

PA Re-approval for Continuation - Change in Treatment when dentist changes

1. In EXact Dentist 2 will need to create a new NHS orthodontic COT. If Dentist 1 has partially completed the treatment that Dentist 2 is required to complete.
   Dentist 2 will need to chart the new 3913 discretionary service on the newly created NHS orthodontic COT so that the NHS can pay Dentist 2 for completing the work. Any additional treatment Dentist 2 thinks is necessary will also need to be added to the newly created NHS orthodontic COT.

2. In SOE Connect Dentist 2 will need to select the PRIOR APPROVAL claim type and enter the mandatory data, including observations. Under the More Actions options, the Request Re-approval for continuation send option should be selected. The NHS should approve the Prior Approval and return a fee for 3913 if appropriate.

3. Any fee approved by the NHS for the 3913 service should be manually entered against this service in EXACT by Dentist 2.

4. If Dentist 2 is claiming an interim payment then they will need to click the Ortho button
   DO NOT TC the COT.

5. In SOE Connect Dentist 2 should select the INTERIM PAYMENT claim type and enter the mandatory data and use the Request Continuation send option then Interim payment will be paid in a schedule; you will need to process this payment as normal.

6. If Dentist 2 is claiming final payment then they will need to click the Ortho button
   It is essential to ensure you have the appropriate value, approved by the NHS, entered against the 3913 service before claiming for final payment.

7. In SOE Connect select the FINAL PAYMENT claim type and enter the mandatory data then use the Request Continuation send option

8. Finally, TC the COT and the final payment will be paid in a schedule; you will need to process this payment as normal.

Please note that if Dentist 2 is required to reply to the NHS, the reply must still be sent as a “re-approval for continuation” in the case of prior approval, or “Request continuation” for any other type of claim. This ensures continuation details are included appropriately.