PRSI Claims cannot be submitted to the Welfare Partners portal directly through Dentally. However, when a claim has been submitted to the Welfare Partners portal, recording it in Dentally will allow you to keep track of your claims and their statuses and report on income raised through PRSI eligible work.
A PRSI claim can be raised in Dentally to reflect a claim which has been submitted to the Welfare Partners portal by firstly creating a treatment plan for a PRSI registered patient and charting the appropriate PRSI treatments. Once the work is completed, a claim can be raised and updated in Dentally.
PRSI Claim Statuses
The status of a PRSI claim is the most important factor. Claims are marked as Raised when they are created, then should then be marked as Settled once the PRSI element has been reimbursed. Setting the status of a claim will help to report accurately on which claims are awaiting feedback, require action or can be regarded as income. Setting a claim's status needs to be a manual action undertaken by a user.
The statuses and an indication of when to use them:
Raised: The claim has been raised on the Welfare Partners portal but has had no response.
Settled: The claim has been reimbursed by PRSI and the fee received has been accepted by the practice.
Queried: The claim has not been fully reimbursed by PRSI and the practice is contesting the fee received - action required.
Rejected: The claim will not be reimbursed by PRSI and has been written off.
Raising a PRSI Claim
Where a patient is registered as PRSI as their payment plan and a treatment plan is created, the patient's PRSI eligibility details will be shown at the top of the plan.
The correct PRSI Exam, PRSI Scale & Polish or PRSI Periodontal Treatment items must be used in order to raise a claim and charge accordingly. Those treatments will raise the correct patient charge from the treatment settings, where appropriate and for the Scale & Polish and Periodontal Treatment, the patient charge can be updated as appropriate (capped as appropriate for the Scale & Polish) if it needs to differ from the default set in your treatment settings.
The PRSI fees will be displayed in the table below the plan.
With the completed treatments ticked, select the 'Create PRSI Claim' button.
A summary of the PRSI claim will be displayed, showing the treatments on the claim, any patient and PRSI fees, the PPS number of the patient and a choice to select the practitioner whose Panel number is to be used to raise the claim.
Once a claim has been raised, the patient's current eligibility will be updated to indicate the elements of it which have been used.
The PRSI claim can be seen in the PRSI Claims section of the patient's records:
The start and end dates of the claim and the treatment plan used to raise the claim can be accessed from the buttons highlighted above.
Amending an Existing PRSI Claim
Where a PRSI claim has been raised from a treatment plan and changes are required, simply navigate to the treatment plan used to raise the claim (this can be done from the TP button displayed with the PRSI claim in the patient records), make any required changes to the treatment plan and use the 'Update PRSI Claim' option.
