How do NHS referral claims work in Wales?
Incoming referrals
Where a patient is detected to be a 'new' patient to the practice (ie. the patient has no previous NHS claims in the previous 3 years - not including urgent referral claims) and a treatment plan is started, the charting screen will give the option to mark the treatment plan as an urgent referral. This will ensure that an urgent referral Care Package is charted and charged appropriately from the beginning.
This will also mark the appropriate referral option on the NHS claim screen.
Where an incoming Urgent Referral patient is received, but the appointment is not attended, the claim fee is still claimable for this unattended visit. Where the plan is marked as New Patient Urgent Referral, the claim can be submitted without a treatment having been ticked as complete. This will automatically raise a claim for a non attended urgent referral appointment.
Where the incoming patient is being seen as a non-urgent DAP referral, this can be selected on the NHS claim screen and the appropriate marker will be sent on the claim:
Where Referral for Additional Services is appropriate (Domiciliary and Sedation) these should be charted on the treatment plan as normal. These treatments can be configured using NHS Treatment Categories 'Domiciliary Services' and 'Sedation Services'.
Outgoing referrals
Where an external referral is required, this is selected on the NHS Claim screen using the appropriate tick option (both may apply)
Referral for Advanced Services - Advanced mandatory services are sedation, domiciliary care and orthodontics, which are provided under PDS arrangements.
Referral for High Needs - Where issues such as physical health needs or mental health prevent the totality of treatment required being provided, the patient would be expected to be subject to a High Needs Referral to the Community Dental Service.