OHSA Topics
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EXACT OHSA CDA Claiming 2023
Setting up EXACT for the OHSA
Using OHSA Features
A Payor is a fund or plan that provides financial assistance to the patient. A payor can be charged for a portion or all of the cost of treatments performed on the patient. The transaction will be displayed in both the Patient and Payor Transactions windows.
In New Zealand, payors include private medical insurance (not dealt with in this Help documentation) and the Ministry Of Health, via the District Health Boards, who pay for dental services using the Combined Contract.
The Combined Contract allows for three different claim types:
- Oral Health Services Agreements (OHSA) for adolescent dental patients
- School Dental Services (SDS)
- OHSA Exceptional Circumstances. (OHS Ex. Circ.)
In EXACT these are configured as three individual payors and you can determine which claim type to use for a patient by setting the Default Payor in the patient’s record.
The instructions for setting up OHSA will load the Schools, TFEA (Decile), Ethnic Type information required by all three claim types.
Separate instructions must be followed to create payors for each claim type; OHSA, SDS and OHS Ex. Circ. and load the fees/rules to be used with each.
Dental practice Providers also need to be configured with an Agreement Name/Number and a Payee number in their Provider Details area.
The topics in this section cover the following areas:
- Setting up EXACT for the Oral Health Services Agreement Scheme.
- Charting and Charging Treatment
- Prior Approvals
- Claiming
- Payments
- Adjustments.
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