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The NHS Payor File

The NHS Payor File holds the payor transactions, generates Claim Bundles and performs the connection to the Mailbox.

To Open the NHS Payor File:

1. From the ‘File’ menu select ‘Payors...’ to open the ‘Payor File’ window as shown below:

   

2. The ‘Payor File’ window has the following fields and functions:

NHS Payor Prior Approval Limit

NHS Scotland Changes 01 April 2016

Applies to Scotland only.

If the following services are used after 1 April 2016 they are no longer considered for prior approval costs:

• Examinations
• Study Models
• Photographs
• Radiographs
• Domiciliary Visits
  

  The prior approval limit has been increased from £350 to £390 effective from 1 April 2016.

Overview

The Payor Prior Approval Limit is a charging limit beyond which practices must apply for prior approval from the NHS before they charge for the services.

This limit only applies to some services, whose charges are totaled when they occur in a single Course of Treatment (COT). The charges of other services in a COT are not considered towards the limit.

EXACT flags all treatment services in the COT when the limit is exceeded and Prior Approval is required.

To view the Payor Prior Approval and the Patient Limit

1. Select File > Payors...to open the Payor File screen.
2. For the Code field click the selector button and select NHS as the Payor, to display the NHS Payor File.
3. For Payor Type select NHS Scotland.
4. You should see the last limits set, as indicated below.

   

To set the Payor Approval Limit

1. Select File > Payors...to open the Payor File screen, and then
2. For the Code field select NHS as the Payor, to display the NHS Payor File.
3. For Payor Type select NHS Scotland.
4. Under the list of historical settings, click [+1] to open the Add Payor Limit window:

   

5. Set Date to take Effect, Payor Approval Limit and Patient Limit.
6. Select OK.
7. Check that the latest setting appears correctly in the historical list.

Viewing NHS Transactions and Communications

The ‘Payor Transactions’ window is used to view all transactions and communications with the NHS, and if necessary, to review FP17 forms.

NOTE: If the practice checks all FP17 forms carefully at the time treatment is completed, it should not usually be necessary to recheck them in the ‘Payor Transactions’ window. In some cases however, Claims may need to be reviewed prior to bundling in case any need to be held for correction. Held items will remain at the practice and not be passed on to the NHS Dental Services until the practice is ready to release them.

To open the Payor Transactions Window:

1. From the ‘File’ menu click ‘Payors...’ and select the ‘NHS’ Payor, then click the or [F3] key.

   

2. The ‘Payor Transactions’ window has a number of fields and functions as shown below:

   	The ‘Key’ button opens a window explaining the status symbols that appear next to the date on each line:
   	The ‘Payor Transactions’ window will be sorted by Date order.
   	Making a selection in the ‘Provider’ box filters the Transactions to display only entries for the selected provider.

3. If a transaction is selected, the buttons shown below have the following functions:

   	If a transaction is selected (highlighted) this button will reverse the treatment back to the Current Course of Treatment Area in the ‘Chart’ tab for editing.
   	Click this Tool button to view information about the allocations for the selected transaction (if any), or the type of transaction if the transaction is not a Claim.
   	This Tool button will reprint the selected Transaction.
   	If an invoice is selected this button can be clicked to display the treatment charged within this invoice. Double clicking on the required invoice will also display this information.
   	If a transaction is selected this button can be clicked to open the FP17/GP17/FP17O/GP17O window and display the form details.
   	If an Invoice or Prior Approval is selected this button can be clicked to hold the item or to release a previously held item. An item on Hold will not be added to Claim Bundles. This prevents the item from being Transmitted to the DPD.
   	If ticked, Invoices for Open Courses of Treatment are hidden.
   	If ticked, all resubmitted transactions are hidden.

4. In addition the button can be used to delete an open transaction, and the button closes the window.

Checking the FP17 Form

1. Either
   • In the Payor File window with NHS as the selected payor, use the button to open the Payor Transactions window.

   - or -

   • Open a specific COT by selecting NHS from Administration menu, then click on Courses of Treatment and select the COT you require).

   NOTE: It is recommended that both the Show Open Treatment and Show Resubmissions check boxes are not ticked, as transactions with either of these statuses are not associated with checking the FP17/GP17 form. This will reduce the list of transactions displayed.

2. Highlight the entry in question and click the FP17 button .

   The FP17 form displays:

   

3. To view the UDA/UOA transaction details for claims and UDA management, click the Details button.

   

   This screen shows all the claimed and confirmed transactions for the current COT.

   When you have reviewed them, click the OK button to close the screen.

4. Click the Close button to return to the Payor Transactions window.
5. If errors are found within a form it can then be held for later correction.

To Hold a TC'd Course of Treatment

1. In the ‘Payor Transactions’ window, highlight the COT or Prior Approval to be ‘held’ and click the Hold/Release button. A ‘hand’ symbol will appear next to the ‘Transaction’ symbol as shown below:

   

2. This item will not be added to any new Claim Bundles created, and will therefore not be passed on to the NHS Dental Services.
3. To Release a COT or Prior Approval repeat Step 1. The ‘hand’ symbol will be removed and the COT will then be available for Claim Bundling.

Claim Bundles

The first step towards transmitting Claims is to create Claim Bundles. EXACT requires that individual Patient Claims be combined into Claim Bundles for each provider before being transmitted.

The Claim bundling process locates TC’d Claims not already in a Claim Bundle, generates a new Claim Bundle, and moves the TC’d Claims into it.

For example, in the following ‘before’ picture below, note that a number of charges for Edward McEwan, for provider RGP, show as TC’ed but not bundled:

After the Claims have been ‘Bundled’ by clicking the ‘Claim button, as shown in the following ‘after’ picture all TC’d charges for the selected provider or providers have been Bundled into a single file that can be viewed from the ‘Administration’ menu, under ‘NHS’, ‘List Claim Bundles’.

Not included in the Claim Bundle are:

• Any Open Course of Treatment, as not ready to be claimed
• Any Completed Claims for a provider not selected when creating the Claim Bundle.

Creating Claim Bundles

The first step towards transmitting Claims is to create Claim Bundles.

EXACT requires that individual Patient Claims be combined into Claim Bundles for each provider before being transmitted.

The Claim bundling process locates TC’d Claims not already in a Claim Bundle, generates a new Claim Bundle, and moves the TC’d Claims into it.

To Create Claim Bundles

1. From the ‘File’ menu click ‘Payors...’, select the NHS payor, and click on the button; the “NHS Claim” window will open as shown below:

   

2. If all TC’d charges are to be Bundled, click the button and select all NHS dentists.
3. The ‘Date to’ field will have defaulted to the current date, so that all charges for the selected dentists will be included in the Bundle.
4. Click ‘OK’. A prompt to enter a PIN number may appear:

   

   NOTE: EXACT can store the dentist's 6-digit PIN within their Provider File, on the "NHS Details" tab. If the PIN is not entered there, you will be prompted for it every time the Claim button is clicked.

5. EXACT will now create the Claim Bundle(s).

   NOTE: A Completion Bar will be displayed to indicate progress. The length of time this takes varies. As a general rule the process is very quick if Claim Bundles are created regularly (e.g. every day), and slower if transactions have been allowed to accumulate before Claiming.

6. Once the Claim Bundle(s) have been created the option to print the Claim Summary will appear a shown below:

   

7. Click the ‘Print Claim Summary’ button to print or preview the report as shown below, or click the ‘Done’ button to move onto the transmission process.

   

8. Claims can now be transmitted to NHS Dental Services.

Claim Messages

EXACT may display the following messages during the Claiming Process:

Opening the List Claims Window

The ‘List Claims’ window shows all Claim Bundles. Claim Bundles have their own unique Transaction symbol .

To Open the List Claims Window

1. From the ‘Administration’ menu click ‘NHS’, then select ‘List Claim Bundles’

   Shown in this window are the amounts Claimed, the amounts still outstanding and the Claim Bundle acknowledgement status.
   

2. The ‘List Claims’ window has the following fields and functions:

   Sort by date		The List of Claim Bundles is presented in Date Order with new items added to the bottom of the list. For speed searches, in the Date field enter a date to zoom to.
   	Opens the ‘View Claim’ window and displays the Individual Claims for the Highlighted Claim Bundle.
   	Prints the Claim Summary for the highlighted Claim Bundle.
   	Prints a list of Claims made between two dates (includes a Total).
   	Deletes the highlighted Claim Bundle. This will release all of the Claims within the Bundle. The Claims can then be included in a new Claim Bundle.

   NOTE: Claim bundles should be deleted only if:

   The bundle is not yet transmitted and there is no intention to transmit.

   The bundle was rejected.

   There has been a problem with the transmission of the Claim Bundle.

3. Additionally the window has the following columns:

Claim Bundle Status

Three status symbols display the transmission progress of a Claim Bundle (see below). If no status appears, the Claim Bundle has yet to be transmitted.

Each time a connection to the Mailbox occurs EXACT will check for new messages. Claim Bundle Acknowledgement messages will be processed and the Claim Bundle Status updated as appropriate.

NOTE: If a Claim Bundle is not acknowledged as being received by WebEDI or Global Crossing, a transmission problem may have occurred. Before taking action ensure that sufficient time has been allowed for the acknowledgement to be received (minimum 1 day).

Transmitting Claims

Transmitting connects EXACT to the mailbox. Once connected two processes occur:

• Claim Bundles ready for transmission are sent
• Any ‘messages’ from NHS Dental Services or the Mailbox Administrator are received

IMPORTANT: Transmission should take place regularly even if there are no Claim Bundles to send, as NHS Dental Services may have placed ‘messages’ in the mailbox to be received.

Messages from NHS Dental Services may include:

• Bundle Acknowledgements
• NHS Dental Services Responses
• Schedules
• Bulletins.

Setting up Web EDI

Carry this out on the PC that has the modem attached or broadband connected to it.

To Set up Web EDI

1. Before you start this you will need your site number NHS Dental Services issued to you.
2. You will need to create a WebEDI account:
   Go to: https://ebusiness.dpd.nhs.uk/reginfo.asp and follow the links from there.
   Remember to print out a copy of your account details for future reference.
3. Go to the File menu.
4. Select Payors.
5. Enter NHS or PDS in the ‘Code’ field (alternatively you may already have NHS set up on your workspace bar, if so click on this).
6. Click on the Transmit set up button.
7. Follow the wizard, in conjunction with the WebEDI information that you have and the documentation supplied. Keep the WebEDI details in a safe place; you may need to refer to them at a future date.

Transmission Problems

Occasionally when transmitting problems may occur, in which case you will be given a message informing you of some possible causes. Some common problems are listed below:

• If you are using a dial-up connection, some other equipment (such as a facsimile machine) may be using the telephone line. If so, wait until the other equipment is finished, and make sure it is turned off or disconnected when you are about to transmit.
• If you are using a dial-up connection, other applications such as PC Anywhere may block a transmission.
  If this is the case, close the application concerned.
• If using a dial-up connection, check the modem is properly plugged into the phone line.
• If using broadband ensure you can connect to the internet. You can verify this by opening your web browser (Internet Explorer, Firefox, etc.) and ensuring it is accessing the internet.
• Some WebEDI information may be incorrect (e.g., wrong username or password), in which case you will need to refer to your printout to check that all information was entered correctly.

Transmitting Claims

Before completed work can be transmitted to NHS Dental Services for processing and payment, they must first be placed into a claim bundle.

A claim bundle does not have to be of any particular size, it can contain only one claim if necessary. It is simply a way of EXACT preparing the files to be transmitted.

Consider it as, all of the electronic FP17 forms being placed into an electronic envelope for posting.

To create a claim bundle

Enter the NHS / PDS Payor file:

1. Select File > Payors : NHS or PDS from the list to display the Payor File, from where you can set up a shortcut on the Workspace.

   

2. Select the Claim button.

   A window will appear prompting the user to enter the provider(s) and up to what date would they like to claim.

   

3. Select either a single or multiple providers to be bundled into this claim. The date box defaults to today’s date but can be altered if required.
4. Click OK and the user will be prompted to enter each Provider’s six-digit PIN (Personal Identification Number).

   

   NOTE: It is possible to store each PIN against the appropriate provider; to do this go to the Provider File and enter a PIN within the NHS Details tab. If PINs are stored the above screen will not appear when creating a claim bundle.

Once the PIN is entered and you click OK, the bundle is created.

The option to print a claim summary is available, if required. Otherwise, click Cancel.

If you have not printed a claim summary, it is possible to do this at a later date by viewing and printing the individual claim.

To do this, click Administration then 'NHS' and 'List Claim Bundles'.

From here double-click on the claim to view the names of the patients and the amounts being claimed. Alternatively use the print claim button at the bottom right hand side of the screen.

To Transmit Claims

1. If any calling or remote control programs such as PC Anywhere are running and waiting for a call, cancel these and close the programs.
2. Exit EXACT and login again.
3. If the modem uses a shared telephone line it is advisable to either turn off or disconnect any faxes, EFTPOS systems or other devices that may use the phone line.
4. From the ‘File’ menu click ‘Payors...’ and select the NHS payor.
5. Click the Transmit Claims button.

   A window will appear to select the date range.

   

6. Amend the dates if necessary then click 'OK' to confirm.
7. The transmission progress screen will appear and EXACT will connect to the mailbox.
8. The status of the call will be displayed, similar to the example shown below:

   

   1. The ‘Progress’ area displays the progress of the transmission
   2. The 'To Send' section of the window displays the name of the bundles being transmitted to NHS Dental Services. Once the file has been sent to the board a tick is placed in the 'Sent' column.
   3. The ‘Response Files’ area displays files received from NHS Dental Services.
9. A progress bar will appear to indicate the length of the transmission. Once a transmission has been completed the following screen will appear:

   

10. Click on the ‘View Responses’ button to be linked directly to the Response screen. The ‘View Schedule’ button will link directly to the schedules. Alternatively you could choose to close the screen and view the responses or schedules later by going to ‘Administration’, selecting 'NHS' and choosing the relevant item, or click the button in the UDA Manager screen..

Transmission Problems

Every practice will at some time experience a problem transmitting. Only rarely will the problem relate to equipment or configuration. It is important that any error messages received are noted to assist the Software of Excellence Support Desk when seeking help.

The majority of transmission problems dealt with by the Support Desk relate to peak transmission times. Thousands of Dental Practices transmit Claims every day. If there are an excessive number of users all attempting to transmit, accessing the Mailbox may be unsuccessful. If so, disconnect and try to transmit again after 10-15 minutes.

Avoid transmitting at lunchtime and the end of the day, as these are the peak times for internet and phone usage.

If encountering several days of restricted access to the Mailbox, contact Global Crossing unless there is a reason to believe something has changed in the software setup of the transmitting PC.

An example of an error that would occur in that case is displayed below:

To Check

• If you are transmitting claims via the internet, you can check your internet access by opening your internet browser (Internet Explorer, Firefox, etc.)
• PC Anywhere or some other Computer Communication Software program that takes control of the modem may have been left running. Exit EXACT, and login again if this is the case.
• Check all cables are connected correctly and equipment turned on.
• If the modem is external, check the indicator lights.
• Disable any other equipment that shares the same telephone line.
• Plug a phone into the telephone line and test that a number can be dialled. If the phone line does not appear to be working, contact British Telecom Faults.
• Call Waiting should not be enabled on the modem telephone line as this is known to interfere with transmission.
• If for any reason the modem is replaced or reinstalled, the communications (COM) port setting should be kept the same as it was. If it is not possible to retain the COM port setting, the new COM port will need to be entered into EXACT.

To set up a COM Port in EXACT

1. From the ‘File’ menu click ‘Payors..' and select the NHS payor, then Click the Transmit Setup button. This will open the NHS Transmission wizard.
2. Follow the instructions in the wizard until the ‘Transmission Set-up’ ‘Modem Set-up’ window opens.
3. Click on the ‘Re-Detect Modem’ button.
4. The transmission speed is typically set to 9600, although some Global Crossing Phone Lines transmit at a slower speed. Refer to your original documentation from Global Crossing if unsure of the correct transmission speed.
5. Complete the instructions in the wizard and choose ‘Finish’.
6. The connection should be tested after making changes by using the ‘Test Transmission Set-up’ button.

To test the Connection:

EXACT has a built in Connection Test Tool. This tool will ring Global Crossing and connect to the mailbox, without sending or receiving files.

There are several points at which the test may fail:

• Accessing the COM Port for the Modem
• Dialling the Number and having it answered by Global Crossing
• Using the correct Name & Password to access the Mailbox

1. From the ‘File’ menu click ‘Payors…’ select the NHS payor, then click on the button.
2. Follow the instructions in the setup wizard until the ‘the ‘Transmission Set-up – Test’ screen appears.
3. Click on the ‘Test Transmission Set-up’ button.
4. The connection to the Mailbox will now be checked. If the test fails an error message will appear. Follow the instructions to correct the problem.

Resending Claim Bundles

If acknowledgement of a Claim Bundle is not received (the Claim Bundle Status is not updated), it may be necessary to resend the Claim Bundle(s).

Before resending Claim Bundles:

• Reconnect to the Mailbox to collect new messages (the Acknowledgement may be within these).
• If unable to reconnect to the Mailbox, check for an equipment or configuration problem 
• Allow sufficient time for Global Crossings to receive the Claim Bundle(s) and place the Acknowledgement message in the Mailbox for collection.

Go to Administration > NHS > List Claim Bundles.
If you still have any Claim Bundles with the symbol next to them after performing several transmissions over a couple of days this may suggest that you had a transmission problem and you need to resend this bundle. However, if there are a number of these claims over consecutive days, and you have checked all the items in 'Transmission Problems' you may need to contact the support desk for further assistance.

Please see 'Claim Bundle Status' for more information on the keys used in the List Claim Bundles screen.

To Resend a Claim Bundle:

1. From the ‘Administration’ menu click ‘NHS’, then ‘List Claim Bundles’.
2. Using either the Scroll Bar or the Date Search facility, locate the Claim Bundle to be resent.
3. Select (highlight) the Claim Bundle and click on the button. This will remove the Claim Bundle. The individual Claims within the Claim Bundle will be placed back in the NHS Payor File and will be included in the next Claim Bundle for that provider.
4. Repeat steps 2-3 for each Claim Bundle to be resent.
5. Click the in the top right corner to close this window.
6. From the ‘File’ menu click ‘Payors...’ and select the NHS payor
7. Click the Claim button to create new Claim Bundle(s), this will select the individual Claims that were unbundled as well as any new Claims ready for Claiming. Follow the normal Claiming procedures.
8. Click the Transmit button to transmit the Claim Bundle(s) to resend.