Creating NHS claims

With Dentrix Ascend, you can create a claim, which you can send to the NHS (National Health Service), for a patient's course of treatment. Creating a claim also posts an NHS patient charge in the patient's record.

To create an NHS claim

How to get there

1. Use the Patient Search box to access a patient's record.

   Notes:

   • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

   • You can include inactive patients in the search results by setting the Include inactive patients switch to On.

2. On the Patient menu, under Clinical, click (or tap) Chart.

   The patient's clinical record opens with the Chart tab selected.

3. Click (or tap) the NHS Claims tab.

   The NHS claims, if any exist, for the patient appear.

1. On the NHS Claims tab of a patient's clinical record, click (or tap) Create Claim.

   

   The NHS Claim - new dialogue box appears with the Charge tab selected by default.

   

2. At the bottom of the dialogue box, make sure that only the check boxes of the procedures that apply to this claim are selected.

3. Set up the following options:

   • FP17PR Form - Select the FP17PR form that the patient has completed online for the course of treatment that is associated with this claim. A completed FP17PR form is required for the performer to claim in accordance with regulations regarding the submission of electronic claims.

   • NHS Exemption - If the patient is exempt from being charged for dental treatment, select the correct reason. If an FP17PR form is attached, and if an exemption has been specified on that form, that exemption is selected by default; otherwise, if an exemption has been specified in the patient's record, that exemption is selected by default.

     With an exemption selected, the Supporting Details box is available. Enter details to help substantiate the exemption. If an FP17PR form is attached and supporting details have been specified on that form, those details are entered in the box by default; otherwise, if supporting details have been specified in the patient's record, those details are entered in the box by default. The supporting details can be up to 50 characters in length.

     

   • Ethnicity - Select the patient's ethnicity or Not stated. If an FP17PR form is attached, and if an ethnicity has been specified on that form, that ethnicity is selected by default; otherwise, if an ethnicity has been specified in the patient's record, that ethnicity is selected by default.

   • NHS Patient Charge - Select the amount that the patient is responsible for paying, or select the £ option to enter a different fee in the corresponding box. One of the following patient charge options may be selected by default:

     • £0.00 - This option is selected automatically if an NHS Exemption is selected, or if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned one of the following treatment categories: Prescription only, Denture repairs, Bridge repairs, Arrest of bleeding, or Removal of sutures.

     • £22.70 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 1 or Urgent treatment.

     • £62.10 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 2.

     • £269.30 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 3.

     • £ - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Reg 11 replacement appliance. If a non-orthodontic replacement appliance under Regulation 11 has been provided, enter the correct charge (for example, 30% of the Band 3 charge per appliance) in the box next to the £ option.

     Notes:

     • The acceptable patient charges come from the fee schedule set forth by the NHS.

     • Changing the NHS Patient Charge selection on the Charge tab may affect the Treatment Category selection on the Claim tab.

4. Click (or tap) the Claim tab.

   

5. Set up the options in the following sections:

   • Contract & Performer Details - Select the applicable NHS contract and performer.

     

     Set up the following options:

     • NHS Contract - Select the NHS contract to associate with this claim.

     • Performer - If there is one provider for all the procedures on the claim, that provider is selected by default, but you can select a different provider. If there are multiple providers for the procedures on the claim, no provider is selected by default, so select the correct provider.

   • Treatment Category - Select the applicable treatment category.

     

     One of the following treatment categories may be selected by default:

     • Band 1 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 1, or if the £22.70 option is selected under NHS Patient Charge on the Charge tab.

     • Band 2 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 2, or if the £62.10 option is selected under NHS Patient Charge on the Charge tab.

     • Band 3 - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Band 3, or if the £269.30 option is selected under NHS Patient Charge on the Charge tab.

     • Urgent treatment - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Urgent treatment, or if the £22.70 option is selected under NHS Patient Charge on the Charge tab.

     • Reg 11 replacement appliance - This option is selected automatically if the highest-priority treatment category that is assigned to any of the procedures on this claim is Reg 11 replacement appliance. If a non-orthodontic replacement appliance under Regulation 11 has been provided, under NHS Patient Charge on the Charge tab, £ should be selected, and the correct charge should be entered (for example, 30% of the Band 3 charge per appliance) in the box next to the £ option.

     • Prescription only - This option is selected automatically if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned the following Prescription only treatment category. With this option selected, £0.00 should be the NHS Patient Charge on the Charge tab.

     • Denture repairs - This option is selected automatically if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned the following Denture repairs treatment category. With this option selected, £0.00 should be the NHS Patient Charge on the Charge tab.

     • Bridge repairs - This option is selected automatically if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned the following Bridge repairs treatment category. With this option selected, £0.00 should be the NHS Patient Charge on the Charge tab.

     • Arrest of bleeding - This option is selected automatically if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned the following Arrest of bleeding treatment category. With this option selected, £0.00 should be the NHS Patient Charge on the Charge tab.

     • Removal of sutures - This option is selected automatically if the only treatment provided, during the course of treatment that is associated with this claim, corresponds to a procedure that has been assigned the following Removal of sutures treatment category. With this option selected, £0.00 should be the NHS Patient Charge on the Charge tab.

     Note: Changing the Treatment Category selection on the Claim tab, may affect the NHS Patient Charge selection on the Charge tab.

   • Clinical Data Set - Record the applicable clinical data.

     

     Any of the following data may be recorded by default, according to the default data sets that have been specified for the procedures on the claim:

     • Scale & polish

     • Fluoride varnish

     • Fissure sealants

     • Radiograph(s) taken (number of radiographs not teeth)

     • Endodontic treatment

     • Permanent fillings & Sealant restoration

     • Extractions

     • Crown(s) provided

     • Upper Denture - Acrylic

     • Lower Denture - Acrylic

     • Upper Denture - Metal

     • Lower Denture - Metal

     • Veneer(s) applied

     • Inlay(s)

     • Bridge(s) fitted (number of bridges not teeth)

     • Referral for advanced mandatory services (AMS)

     • Examination

     • Antibiotic items prescribed (number of prescriptions not teeth)

     • Best practice prevention according to Delivering Better Oral Health offered

     • Other treatment

   • DMF - Decayed, Missing and Filled Teeth - In the corresponding boxes, enter the number of decayed, missing, and filled teeth that the patient has.

     

     Note: Dentrix Ascend determines which standard procedures and conditions represent decayed teeth (such as caries), missing teeth (such as extractions), and filled teeth (such as amalgams).

     Dentrix Ascend checks for all existing work, conditions, and completed treatment that have been charted in the patient's record for permanent and deciduous teeth throughout the entire mouth. Then, Dentrix Ascend populates the following boxes with the calculated counts of decayed, missing, and filled teeth as applicable:

     • Decayed teeth - permanent

     • Decayed teeth - deciduous

     • Missing teeth - permanent

     • Missing teeth - deciduous

     • Filled teeth - permanent

     • Filled teeth - deciduous

   • Other Services - Indicate any other applicable service information.

     

     Select any of the following options:

     • Treatment on referral

     • Free repair/replacement

     • Further treatment within 2 months

     • Domiciliary services

     • Sedation services

   • NICE Guidelines - Enter the recommended recall interval.

     

     In the Number of months box, enter the recall interval that you recommended to the patient, according to the NICE (National Institute for Health and Care Excellence) guidelines. By default, if an NHS claim was created for the patient previously, and a recall interval was entered for that claim, that interval is used for this claim.

   • AGP Appointment Count - Enter the number of appointments that had aerosol generating procedures

     From the NHS: "With effect from 1 July 2020, NHSE&I are introducing a change to include an additional CDS data item provided as an additional number box. The new AGP field is to record the number of AGP appointments provided as part of the course of treatment.  For example, a patient has 3 fillings and a crown and AGP is used at two of the appointments so the value submitted will be 2."

     Note that this input box is optional and should be manually entered by practice staff. If no appointments contained aerosol generating procedures, it can be left blank.

     

1. • NHS Contact Preference - Specify the patient's preferred contact method as an alternative to the patient's postal address.

     

     Select any of the following options:

     • None specified - This option indicates that the patient has not provided an alternative contact preference.

     • Email - With this option selected, enter the patient's email address in the box that appears.

     • Mobile - With this option selected, enter the patient's mobile phone number in the box that appears.

     Note: By providing an email address or mobile phone number, the NHSBSA may use that method to contact the patient to survey his or her NHS dentistry experience.

   • Declarations - Select the applicable declarations.

     

     To select all the declarations, click (or tap) Select All. Also, you can select and clear the check boxes of each declaration as applicable. The first declaration may be applicable if the course of treatment is incomplete. The second declaration may be applicable for completed treatment. The last declaration needs to be selected.

   • Incomplete Treatment and Treatment Dates - Enter the dates of the acceptance of treatment and the completion of treatment (or the most recent visit) , and indicate if there is incomplete treatment.

     

     Specify the following dates:

     • Date of acceptance - Click (or tap) in the box to select a date from the calendar that appears. This is the date when the patient accepted the course of treatment.

     • Date of completion or last visit - Click (or tap) in the box to select a date from the calendar that appears. This is the date when the course of treatment was completed, or the date of the patient's most recent visit if the course of treatment was not completed.

     Tip: You can click (or tap) Calculate Dates to insert the date of oldest procedure on the claim in the Date of acceptance box and the date of the latest completed procedure on the claim in the Date of completion date or last visit box.

     If the course of treatment was not completed, under Status, select the Incomplete treatment check box. For a banded course of treatment that was commenced but not completed, select the band of treatment (Band 1, Band 2, or Band 3) that was completed from the list. The selected band will be used to determine the NHS Patient Charge. The selected Treatment Category must be the same as, or higher than, the selected band.

2. Click (or tap) Save.

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