Changes in EXACT following eDental setup

The move from EDI transmission to eDental transmission is irrevocable unless a practice installs a previous EDI-based backup.

The topics below describe the primary EXACT changes in a practice that has transitioned to eDental.

EDI transmission is no longer possible

To revert to EDI transmission

RECOMMENDED: As a precaution, back up your entire EDI system before converting to eDental.

NHS GP17 Form changes for eDental

Treatment on referral - select a Referral Reason

When users tick the Treatment on referral checkbox, they need to choose from three Referral Reasons:

Radiographs Available - Remarks

Optionally add remarks under the Radiographs Available field:

Failed to Return

Under the Failed to Return choice there is now a Fee code required checkbox.

This includes an Observations text box section for users to note services.

Example:

A patient receives a 1401 Amalgam Filling but does not pay for treatment and fails to return. The practice can request reimbursement for 1401 work completed by entering the fee code/s,

Patient Refused Treatment

Under the Patient Refused Treatment choice there is now an Observations text box section for users to note reasons or details for patients refusing treatment:

Signee On Completion not applicable

If the patient failed to return, they would not have signed on completion, so if you tick the Failed to Return checkbox as shown above, and TC the Course of Treatment, EXACT greys out the Signee On Completion section as not applicable:

Under the Signee tab only the Signee on Acceptance section would then still apply.

eDental Claims Central

With eDental enabled, the Claims Central button for a NHS Scotland payor will launch a Claims Central window in which to view claim status, transmit claims or view the last received schedule.

Provider Name for eDental transmission

• The Edit Provider Wizard - NHS Lists page

• The Provider > NHS Details tab

Edit Provider Wizard - NHS Lists:

Requesting a CHI Number

A CHI Number is mandatory for eDental claims. Providers are prompted for it when TCing a claim where the CHI number is missing.

NOTE: Sometimes the system cannot locate a CHI Number for a patient, but Providers can still claim so long as they have requested a CHI Number.

Historical

Before EXACT v12.9 the Patient Details tab had a passive CHI Number field, shaded grey to indicate that it was uneditable, and incoming NHS response files auto-populated the CHI Number.

From v12.9 the CHI Number field is editable and it has an associated button; Request CHI, for CHI Lookup by the practitioner:

To Request a CHI Number

When recording Patient Details it may be necessary to look up a CHI Number (for example because the patient doesn't know it, or the patient is a child).

1. Select the Request CHI button once eDental is enabled.

2. When you click the Request CHI Number button, EXACT runs a validation data check for Patient information and warns you of missing information. For example:

   
   
   

3. In this case, select OK, populate the patient fields with the information, and then try again to Request CHI.

   You should see the request being processed:

   Possible Errors at this point:

   CHI Request - Timeout error if the patient details request takes too long:

   
   
   

   CHI Request - ACK (Acknowledgement) error if there is a system error

   
   
   

   No results found:

   
   
   

   If the CHI Request is successful you will see primary results for original patient or multiple names:

   At this point,

   • EXACT is waiting for you to select a patient in the results, or if you cannot select any, run a Secondary Search from the top button.

   • The Secondary Search button is enabled against the primary search name only, not against the results below. With no result selected in the results pane the bottom buttons don't apply, except for the Patient Not Found button.

   • If all searches fail, select Patient Not Found to register a search failure with the NHS, which will then function in lieu of a result, allowing you to continue.

   
   
   

   If you select a result, the lower Secondary Search and Treatment Details buttons are enabled:

   
   
   

   If there is only one result found, select it to view Treatment Details or perform a Secondary Search.

   
   
   

   Treatment Details button - Choose the Treatment Details button to display past treatment(s) the SNHS has on record for a patient:

   
   
   

   A successful result shows the CHI Number:

   
   
   

4. Once the patient's name is listed, select it and then click the Accept Selected Patient button.
   
   

   If the patient details are THE SAME AS those stored...

   The CHI Number will successfully populate the field in the Patient Details tab:

   
   
   

   If the patient details are DIFFERENT to those stored...

   When a result is found and you click the Accept Selected Patient button, if there are any differences, a Patient Difference window appears, with just the differences listed.

   Examples:

   The differences are potentially in these fields: First Name, Last Name, Gender and Date of Birth (as in the screen on the left above).

   
   
   

   To maintain the current information, simply leave the checkboxes un-ticked and click OK.

   
   
   

   To use New information, tick the checkbox/s, and then click OK to import the new details back into EXACT. For example:

To register an unsuccessful attempt to Request a CHI Number

Status of the CHI Number is always displayed in the Arrivals Task List

If your practice uses the Appointment Workflow, the CHI Number status (required or not required) always displays to the Receptionist:

eDental COT

These are changes to SNHS COTs following the practice upgrade from EDI transmission to eDental.

eDental NHS COT Exemptions and Charges window

Supporting Details for HC2 or HC3 exemption

If a patient chooses HC2 or HC3 exemption; these both require the patient's nine character HC2 or HC3 Certificate Number in the Supporting Details field.

NOTE: A Certificate Number cannot be more than 9 characters long. A warning will appear if it is longer than 9 characters.

Signee On Acceptance:

When you create a Scottish NHS COT and complete the Exemptions and Charges window, you are also required to complete the Signee On Acceptance with a date defaulted to today.

Select either Patient or Representative (of the Signee).

An example of a Representative would be a parent signing on behalf of a child.

If you select Representative, you must complete both First Name and Last Name fields. Failure to do so will result in a warning:

Click the Date Signed field drop down arrow to display a calendar selector, from which you can select the Date Signed:

If you attempt to select a future date you will see a warning:

SNHS COT Start - Warning on missing information

For an existing patient, at the start of SNHS COT creation, you will see a warning for any required fields that are missing, and you won't be able to create the new COT until these are completed.

Examples:

SNHS COT TC - missing details

When you attempt to TC an SNHS COT, you will see a warning for any required fields that are missing, and you won't be able to TC until these are completed.

NHS COT TC - Signee On Completion

Prior to EXACT v12.9 the NHS GP17 window opened to the Exemptions/Charges tab.

From EXACT v12.9 it opens to a Signee tab that shows previously entered Signee On Acceptance and an additional Signee On Completion:

NOTE: In EXACT a user can Complete the TC process without Completing.

NOTE: If your practice has the To Depart bar (workflow Departure Task List) enabled, the GP17 part 2 for completing the Signee On Completion details will appear as a link in the bar.

IMPORTANT: If Signee On Completion information is NOT completed, a claim will NOT be transmitted on Claims Central (it will be sent to 'Unresolved Response')

Tooth History - prior to sending a Claim to the NHS you can complete and save the Signee on Completion

In the Tooth History screen you can open a TCed claim, add any incomplete Signee On Completion details and Save, prior to sending the Claim to the NHS.

Appointment Workflow Departure Task List (To Depart bar)

If your practice uses Appointment Workflow, a notification to Sign GP17PR Part 2 will display in the To Depart bar when a Provider has not completed Signee on Completion:

eDental Continuation COT

A continuation COT is notification on the NHS GP17 form that Treatment will be continued by another dentist on this same COT.

(The second checkbox (for the second dentist) is greyed out until the first dentist has clicked the first checkbox)

On the NHS GP17, dentist DD ticks Treatment will be continued by another dentist:

During later treatment dentist JJ ticks Treatment is being continued by another dentist:

... and dentist JJ then selects the specific Continuation COT as created by dentist DD:

Example: Provider JJ continues treatment on COT 1003 that Provider DD had initially completed

1. COT 1003 initial treatment:

   1. Dentist DD treatment completes (TCs) a Scottish NHS COT for a patient - COT 1003

   2. Dentist DD ticks

      Treatment will be continued by another dentist to indicate that there is further treatment to be done on this COT by a different dentist.

   
   
   

2. COT 1003 continuation treatment:

   1. Dentist JJ later TCs continuation treatment for the same patient, on the same COT.

   2. On the NHS GP17, dentist JJ ticks

      Treatment is being continued by another dentist.

      A field next to COT being continued becomes enabled.

      The list button displays any previous COTs marked as continuation COTs.

   3. Dentist JJ selects COT 1003 that Dentist DD completed, and clicks OK:

Patient change of Exemption Status

The SNHS want to be informed when circumstances change for a patient who

1. Starts a COT as a full or partial paying patient, and then

2. Becomes exempt, with no payment required.

Specification information:

This is discussed in SNHS' eDental Functional Specification section 2.4.17 Patient change of Exemption status (pg 26).

This specification includes which fields are expected to be sent (viewable in XML), on pg 178 (AM-25124-DFD003-eDental System Supplier Specification-v2.4.DOC).

SCENARIO 1: Paying patient - circumstances change to non paying

To change the option to Patient is pregnant:

1. Click the Exemptions button at the bottom of the Chart screen:

2. In the Exemptions and Charges window, click the Re-enable exemptions button and then select Yes to the Enable Exemptions warning:

3. In the re-enabled window, click to select the following checkboxes / options:

   • Patient is pregnant (PR)

   • Proof of exemption seen

     If you fail to check either proof Seen or proof NOT seen, a warning message will later display:

   • Patient signed GP17PR Part 1b but their circumstances changed (with or without Clinipad)

   ... and then select Yes to the Not Exempt to Exempt question:

   
   
   

4. Select OK for the Exemptions and Charges for COT XXXX screen.

5. TC the patient COT.

6. Check the Patient Transaction History.

   You should see the original charge (14.00 in our example) changed to patient charge 00.00:

SCENARIO 2: Partial paying patient - circumstances change to non paying

To change the option to Patient/partner gets income support:

1. Click the Exemptions button at the bottom of the Chart screen:

2. In the Exemptions and Charges window, click the Re-enable exemptions button and then select Yes to the Enable Exemptions warning:

   
   
   

3. In the re-enabled window, complete the following checkboxes / options:

   • Patient/partner gets income support
     
     

     Proof of exemption seen
     If you fail to check either proof Seen or proof NOT seen, a warning message will later display:

   • Patient signed GP17PR Part 1b but their circumstances changed (with or without Clinipad).

   • Enter the NI Number of the person receiving the benefit.

   • Signee on Acceptance is the Patient

eDental Appointment Workflow

The Appointment Workflow aids eDental both at patient arrival in reception and at patient departure:

Arrival Task List - notification that the CHI number is either required or is present.

Departure Task List - Sign GP17PR Part 1 and / or GP17PR Part 2

Arrival Task List

The Arrivals Task List displays the CHI Number as either missing or present, and it prompts for GP17PR when required.

In the appointment book, when a patient is Arrived, under the Patient Details heading / hyperlink the arrivals task popup displays one of two messages:

Patient requires a CHI Number for eDental claiming:

CHI Number is present:

Send GP17PR to Clinipad for signing by the patient:

Departure Task List:

This includes prompts to have the patient sign GP17PR Parts 1, 2, or both.

Prompt to have patient sign GP17PR part 1

From v12.12 Receptionists can be prompted via the departure task list to secure a Part 1 patient signature:

Receptionists who click Cancel must provide a reason:

This is recorded in the Appointment Workflow Compliance Report, regardless of whether Clinipad is turned on or off:

Prompt to have patient sign GP17PR part 2

When TCing a COT where the Signee On Completion ("part 2") has not been completed, if a Provider Cancels on the Send to GP17PR to Clinipad prompt (so the patient does not complete part 2), then the To Depart departure task list bar will include a task to Sign GP17PR part 2

i.e. a Provider who uses Clinipad does not capture part 2, so EXACT lists the part 2 capture in the To Depart bar.

Prompt to have patient sign GP17PR part 1 and 2

When TCing a COT where neither the Signee on Acceptance (part 1) nor the Signee On Completion (part 2) has been completed, if a Provider Cancels on the Send to GP17PR to Clinipad prompt (so the patient does not complete part 1 and 2), then the To Depart departure task list bar will include a task to Sign GP17PR part 1 and 2

i.e. a Provider who uses Clinipad does not capture part 1 and 2, so EXACT lists these tasks in the To Depart bar, for Receptionist attention:

eDental Clinipad procedures

Arrival Task List - Arrive and Send to Clinipad

When arriving a patient, in the Arrivals Task List a practitioner can choose to Arrive and Send to Clinipad in order to complete the details for GP17PR Part 1.

Clinipad workflow

The Clinipad screen shows when the device is in use, as described below.

1. A patient completes information on Clinipad and signs.

2. The practitioner clicks the Return button:

3. The practitioner clicks the Check and Dismiss button to save changes that the patient may have entered:

   
   Check and Dismiss:

   
   
   

Starting a COT when the GP17PR Part 1 has been signed via Clinipad

Patients may choose Exemptions on the Clinipad, and this information will appear when a Provider starts an NHS COT in the Exemption window.

For a Provider starting a new SNHS COT, green text indicates that the patient has electronically signed their GP17PR, and the Provider can click a View Signed GP17PR button:

Starting a COT when the GP17PR Part 1 HAS NOT been signed via Clinipad

For a Provider starting a new SNHS COT, red text indicates that the patient HAS NOT YET electronically signed their GP17PR, and the Provider can click a Send GP17PR button:

TC a COT, prompt for Send GP17PR part 2 to Clinipad

With Clinipad workflow enabled, when a Provider Completes a COT, the Send a GP17PR to Clinipad prompt will appear:

To Depart departure task list - prompt to Send GP17PR part 1

From v12.12 Receptionists can be prompted via the departure task list to secure a Part 1 patient signature:

Receptionists who click Cancel must provide a reason, and this is recorded in the Appointment Workflow Compliance Report:

NOTE: The only way to turn off the Departure Task List notifications is to disable the Appointment Workflow.

To Depart departure task list - prompt to Send GP17PR part 2

When TCing a COT where the Signee On Completion ("part 2") has not been completed, if a Provider Cancels on the Send to GP17PR to Clinipad prompt (so the patient does not complete part 2), then the To Depart departure task list bar will include a task to Sign GP17PR part 2

i.e. a Provider who uses Clinipad does not capture part 2, so EXACT lists the part 2 capture in the To Depart bar.

To Depart departure task list - prompt to Send GP17PR part 1 and 2

This is possible when Part 1 and Part 2 are on the same day.

NOTE: If Part 1 is completed on Clinipad, Part 2 also needs to be completed on Clinipad.

When TCing a COT where neither the Signee on Acceptance (part 1) nor the Signee On Completion (part 2) has been completed, if a Provider Cancels on the Send to GP17PR to Clinipad prompt (so the patient does not complete part 1 and 2), then the To Depart departure task list bar will include a task to Sign GP17PR part 1 and 2

i.e. a Provider who uses Clinipad does not capture part 1 and 2, so EXACT lists these tasks in the To Depart bar, for Receptionist attention:

Claims Central

With eDental enabled, the Claims Central button for a NHS Scotland payor will launch a Claims Central window in which to view claim status, transmit claims or view the last received schedule.

1. Select File > Payors.

2. Select the Scottish NHS (SNHS) Payor:

3. Click the Claims Central button for the NHS Scotland payor to launch the Claims Central window:

Claims Central functionality

From this Claims Central window practitioners can

• Choose Claim (and Transmit) to send any unheld claims in Completed COTs. Users can Claim but not choose to Transmit.

• During Claiming a user can also then choose to Transmit.
  If there are pending claims (for example, from earlier) in Awaiting Transmission, the practitioner can choose Transmit:

• View the progress of transmissions via a status bar:

  NOTES:
  
  You can opt to Claim but not to Transmit.
  
  While this bar displays you cannot Transmit again, and a warning message will appear if you attempt to do so.
  
  You can close the page and the transmission will continue to process (you don’t have to wait for it to finish), but ensure you don’t close EXACT before it is finished.

• View treatment Completed (TCed) COTs ready for transmission, Hold / Unhold them, and Resubmit them.

• View completed COTs that are Awaiting Transmission to the SNHS, and remove them from this Awaiting Transmission list where necessary. 

• View claims that are Awaiting Response from the SNHS

• View the Unresolved Responses claims. This link opens up the same workflow options that are available from Administration > NHS > Responses, providing you with a means to take appropriate action to resolve issues.
  For example, you can update the Signee on Completion details directly from this list.

  
  
  

• View the Last Received Schedule.

  The Last Received Schedule displays the date of the last valid Schedule that was imported.

  To view all schedules, go to the previous location: Administration > NHS > Payment Schedules.

  
  
  

• Import a Schedule file

  The default location for incoming schedule files is DATA\XMIT\XMLIN

Completed COTs

The View Completed COTs window displays treatment completed (TCed) Scottish NHS COTs ready for transmission:

The Date column shows the TC Date.

Hover your mouse cursor over an icon in the Error column to see a tooltip explanation.

Any Held COTs display a hand icon in the Held column:

The buttons Hold All, Unhold All, Hold/Unhold, Resubmit and View COT are greyed out if not applicable.

Hold All

Choose the Hold All button to put all completed COTs on hold, as indicated with icons under the Held column:

Unhold All

Choose the Unhold All button to put all completed COTs on hold, as indicated with no icons under the Held column:

Multiple buttons are active when a single completed COT is selected:

Hold / Unhold

This is a toggle for the selected completed COT:

Resubmit

A Resubmit explanation / caution displays when you click the Resubmit button:

If you choose Yes on the Resubmit caution, EXACT calls the standard Resubmit workflow, and the COT reappears with Services ticked and with the Patient Transactions column showing the red resubmit icon:

NOTE: Resubmitted claims disappear from the View Completed COTs window.

View COT

Click the View COT button to call the existing workflow to view the claimed COT:

Claiming a Completed COT

1. In Claims Central find the Completed COT listed against the Completed COTs hyperlink:

2. Click the Claim button and then follow the procedure listed below:

   1. In the NHS Claim window, select the appropriate Provider/s and Date to field, then click OK.

   2. In the NHS Claim popup, click Done.

   3. In the Transmit Claims window click OK.

3. You should now see the progression of your Claim reflected in the Claims Central data as follows:

   1. The Claim moves to Awaiting Transmission:

   2. The Claim is transmitted and disappears from the Claims Central window:

   
   
   

   NOTES:
   
   If the Claim does not follow this progression, something is unresolved and needs to be addressed.
   
   The system limits you to 9 resubmissions per COT before displaying an error message and stopping further attempts for that particular Claim.

Awaiting Transmission

This displays completed COTs waiting for transmission to the SNHS:

These are the 'Claims' that have been created and not yet sent.

Possible actions:

• Click the Transmit button if the Awaiting Transmission line shows a numerical value, and a transmission isn’t already in progress.

• Click to open the View COTs Awaiting Transmission window, where you can optionally do the following:

  • Click the Remove button to remove a selected COT from Claims Central.

  • Click the View COT button to view details of the selected COT. Example:

Awaiting Response

This displays claims awaiting response from the SNHS:

NOTE: Responses will likely be picked up with the next transmission.

Troubleshooting

This troubleshooting issue relates to the Claims Central management window in NSS Practitioner Services eDental.

Symptom:

You have claims in Awaiting Response status, but when you click the Transmit button nothing appears to happen.

Reason:

Possibly your Adapter database has been lost or corrupted.

Solution:

Please contact your Support Desk.

Support Personnel can access a set of tools that will likely be able to recreate your data from the XML cache in EXACT, enabling you to properly process the claims.

Unresolved Responses

The Unresolved Responses link from Claims Central opens up the same workflow options that are available from Administration > NHS > Responses, providing you with a means to take appropriate action to resolve issues.

Displayed below is an example where a Claim was TCed without Signee on Completion:

Background

If you send a Claim and receive an error or response that requires action, a copy of the claim, with response, appears in the Unresolved Responses > Response window.

Example:

Here are two claims copied to Unresolved Responses:

These two examples require the Completion Signee, as indicated by the message Claim Mandatory: Completion signee has not been chosen

Multiple issues can cause a Claim to have an Unresolved Response status.

To resolve an Unresolved Response and remove it from the Response window

1. First fix the issue that caused this claim to be listed as an Unresolved Response (don't simply retransmit). .

   See also:

   CAUTION - Fix Unresolved Responses BEFORE transmitting

   Example - Resolve missing Signee on Completion

   
   
   

2. Once the issue has been fixed, in the Response window, either

   • Tick the appropriate checkbox as completed.

     - or -

   • Select the listed Response and click the Resolve button

   The Response will disappear from the Response window.

CAUTION - Fix Unresolved Responses BEFORE transmitting

CAUTION: You must deal with the source causes - simply Transmitting again does not automatically resolve unresolved responses!

If you fail to properly action Unresolved Responses and simply try to Transmit again, EXACT attempts to Transmit, fails, and re-lists the same Unresolved Responses once again, resulting in a duplication.

So if you failed to deal with the Completion Signee requirement in the above two Unresolved Response examples, and you simply re-transmitted them, the result would be four Unresolved Responses listed:

Example - Resolve missing Signee on Completion

A response might be unresolved for multiple reasons, but EXACT detects if a practitioner neglected to complete the required Signee on Completion, and displays this in the Unresolved Responses list.

1. From the Response window, click the GP17 button:

2. In the Signee tab, tick Patient (or Representative)

3. Click the associated Save button.

4. Select Close to close the GP17 window.

   This will update the claims table and return you to the Response window.

5. In the Response window, either

   • Tick the appropriate checkbox as completed

   - or -

   • Select the listed Response and click the Resolve button.

   
   
   

   The Response will disappear from the Response window.

Resubmitting a COT from the Response window

You may choose to Resubmit a claim displayed in the Response window.

To Resubmit a COT from the Response window

1. Select the listed Response and then click the Resubmit button.

   
   
   

   IMPORTANT: The resubmitted Response will not automatically disappear from this window when you click the Resubmit button; you need to click the Resolve button or tick the Response checkbox to remove it.

   
   
   

   If a practitioner reopens the Response window and tries to Resubmit an item that was already successfully resubmitted, a warning may appear: "This transaction has already been resubmitted":

   
   
   

2. To remove the resubmitted Response from the window, either click the Resolve button or tick the checkbox associated with the selected Response:

Acknowledgements and Responses

Acknowledgements (ACK) inform the practice that the ePractitioner Message Store has encountered a difficulty relating to a transmission, and the transmission has therefore not been forwarded through to the MIDAS dental payment engine. These errors take many forms and many of them may be resolved simply with a repeat transmission.

Responses (RESP) are return messages in response to successful transmissions to the MIDAS dental payment engine.

Managing Payment Schedules

Importing a Schedule File

1. Select File > Payors.

2. Select the Scottish NHS (SNHS) Payor:

3. Click the Claims Central button for the NHS Scotland payor to launch the Claims Central window:

4. Select the Import button.

5. Locate the schedule in its default location, DATA\XMIT\XMLIN and import it.

Viewing and Reconciling Payment Schedules

1. Either

   • Click the Payment Schedules hyperlink on the Claims Central window:

     
     
     

   - or -

   • Open Administration > NHS > Payment Schedules, enter date range and Provider and click OK:

   
   
   

   The Payment Schedule List displays:

   Note the on-screen instructions:

   ____________________________________

   To process the schedule payment:

   Double click on an unticked schedule line to view details and reconcile.

   Compare screen amounts with paper schedule:

   Compare DSD 'Scale Fee' on screen with 'Item of Service' total on paper.

   Compare DSD 'Patient' fee on screen with the 'Patient Charges' net on paper.

   If the amounts don't match, return to the 'Payment Schedule Detail' window to add or remove negative entries until they do.

   Process payment.

   ___________________________________

   
   
   

2. Double-click an un-checked schedule to open the Payment Schedule Detail window:

   
   
   

3. Reconcile schedules by following the instructions on this screen:

   ___________________________________

   To reconcile the schedule:

   1. Double click on entries showing differences to explore the reason.

   If you agree with the difference, click 'Adjust' to accept it.

   If you disagree with the difference, click 'Resubmit' to resend it.

   2. Use 'Add Item' to add in negative entries from the paper schedule.