An NHS Orthodontic claim is submitted in two stages. The Assessment claim and the Completion claim.

Once you have completed your Orthodontic case assessment, return to your treatment plan. Click on Submit. (If you need help with completing your orthodontic case assessment, take a look at our web page.)

Dentally knows the Treatment Plan contains Orthodontic treatments, and so only allows you to Submit an NHS Orthodontic claim. You now select whether to submit the First or Second Claim.

Submit the First claim when you have assessed the patient and fitted an appliance OR have assessed the patient and are not undertaking any further treatment at this point

Submit the Second claim when you wish to inform NHSBSA that the orthodontic course of treatment is completed.

Check the Exemption and contact fields are correctly filled in. Check that the treatment you are claiming for is correct. Notice that the Treatment Plan that the claim refers to is shown in the screen so that you can quickly refer to it if you need to during the submission process.

Clinical & Claim Details:

UOA Value, Patient Charge & Clinical Dataset:
​The UOA value is dictated by the Assessment Type of the claim and the patient's age at the time of the initial Assessment. The patient charge is confirmed along with the Clinical Data Set, confirming the details of the treatments included on this claim.

The Clinical Dataset:

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

The Referral and Assessment dates are set here, click the date and change where required.

If the patient is not ready for an appliance to be fitted, you may set the assessment type "assess and advise" or "assess and refuse" and you will be awarded 1 UOA.

If an appliance has been fitted and an Orthodontic case started, mark the claim "Assess and Appliance Fitted" and complete the Appliance Fitted date. You will be awarded 21 or 23 UOAs depending on the patient's age at the time of assessment.
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Deductions & Contact Information Sharing:

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.

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.

​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.

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:

When you are ready, click on Submit. The claims wait in a queue for up to 1 hour before they are submitted to the NHS servers. This allows you to edit and change the submission. After the hour, the status changes from Queued to Submitted. You can check the status of claims from the NHS Claims Report.

When the course of treatment is finished and the appliance is removed, you use the SAME treatment plan to send the second part of the claim which closes it. You are not awarded any further UOAs.
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From the SAME treatment plan, click on Submit Second Claim.

There are 3 completion choices - Treatment abandoned, Treatment discontinued, and Treatment Completed.

Dates: It is important that the Assessment and Completion dates are correct on this closure claim. The Assessment date should be set as the last visit by the patient and that final assessment - therefore the Completion and Assessment dates should be the same.

The Completion type should be selected.

If Treatment is Completed, a further Aesthetic component also becomes mandatory.

If the Completion type selected is 'Treatment Abandoned' a reason for this should be selected from the two options of 'Patient Failed to Return' or 'Patient Requested'.

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You can filter your NHS Claims Report by Ortho submissions, as well as by claim Status, Practitioner and date range.

Ortho claims are easily distinguishable from non-ortho claims as they tell you the number of UOAs awarded, the reason for treatment and the claim status.
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This web page tells you about the process to submit and report on Ortho claims in England and Wales.
If you need help with completing your orthodontic case assessment, take a look at our web page.
We have a suite of web pages for the Ortho process in NHS Scotland.
​Submit a Prior Approval in NHS Scotland
​Submit an Ortho Exam claim in NHS Scotland
​The NHS Scotland Ortho Submissions Report.
If you need any more help, please contact the Dentally Support Team.
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