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Submitting an NHS Claim

🏥 NHS EN/WA only - Submitting NHS England claims

Kevin Bell avatar
Written by Kevin Bell
Updated over 2 months ago

When NHS treatment has been charted and marked as complete, you will be shown a ‘Submit’ button at the bottom of the treatment plan. This creates the NHS claim and starts the submission process.

All of the information required to submit this claim can be entered from this point on a single screen. Below the screen is broken into sections:

Clinical and Claim Data:

UDA Value, Patient Charge & Clinical Dataset:
The UDA value and patient charge are confirmed along with the Clinical Data Set, confirming the details of the treatments included on this claim. The Banding of the clam is dictated by the treatments on the plan.

The Clinical Dataset:

  • Type of treatment and what category it falls in

  • Treatment Charge Band

  • If it was provided as a free repair - this can be amended from the treatment plan itself

  • If it was entered as urgent treatment - this can be amended from the treatment plan itself

  • Date the treatment was completed (or left as incomplete)

Practitioner and Contract Details:

The practitioner can be confirmed or changed here. Only practitioners with the required NHS settings configured in their Practitioner setup can be selected here

The contract can be selected. The contract offered here by default can be set in the Practitioner Settings. If none has been set as the default, the last used by this user will be remembered.

Treatment Plan Details and Deductions:

Start & End Dates

The treatment plan's start and end dates are remembered from the dates set in the treatment plan settings, but can be amended here, just click the date and choose if the date needs to be changed.

Continuation, Phased Treatment and whether the claim is for Treatment on Referral to this practice can all be selected here.

Deductions:

The patient's exemption will be remembered from the treatment plan if it was applied there, or if it was in place before the treatment plan was started. If the exemption status needs to be changed here, you can choose between any exemptions the patient has, or select None if appropriate.

Where the contains a Regulation 11 charge for a replacement appliance, select here either 30% or 60% of the Band 3 charge depending on how many appliances are being replaced.

Contact Permission & Clinical Data:

Where the patient's records contain a mobile number and email address, ticking this option will share this contact information with the NHS. Not ticking this option will indicate that the patient has requested not to share this information. Consent should be obtained from the patient for each NHS claim submitted.

Clinical Data:

The required Decayed Missing and Filled tooth information required for your region and the patient's age will be submitted as part of the claim and can be amended here.

Declarations:

Select the appropriate Declarations or tick all by selecting the 'Accept all declarations' option. The claim cannot be submitted without selecting the mandatory option.

Once you click Submit Claim:

You will be asked to confirm that you wish to complete the treatment plan once the claim has been submitted. This follows the usual procedure of completing treatment plans and confirms the patient’s next visit date and closes the plan.

Note: Once you have submitted a claim there is a delay of 1 hour before it will be submitted to the NHS. This time allows you to amend any errors the claim might have.

Once the claim has been submitted, you will need to wait until you have received acknowledgement that it has been successfully passed to Claims Processing, before you can resubmit it for any reason.

Tips and Tricks:

Hover over the Tooltips against the options on screen for more information:

Any mandatory fields are marked with a red asterisk, if you click the Submit Claim button without completing any of these, the screen will highlight where the missing information is:

NOTE: History Audit Panel for NHS Claims. Similar to the history panel available for opted in users elsewhere in the software, there is now a panel that shows all changes made to an NHS claim in one place, meaning users can trace the chronological history of a claim more easily. This is accessible from the patient's NHS claims tab.

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Additional NHS England and Wales Support web pages

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