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Ophthalmic Payments

Ophthalmic Payments. National User Group Meeting 21 st January 2010. Electronic Links. Activity Details 201 activation requests processed 192 active stores 182 Specsavers 8 Optix practices 1 Vision Express 1 Independent 109 stores using automatic process

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Ophthalmic Payments

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  1. Ophthalmic Payments National User Group Meeting 21st January 2010

  2. Electronic Links • Activity Details • 201 activation requests processed • 192 active stores • 182 Specsavers • 8 Optix practices • 1 Vision Express • 1 Independent • 109 stores using automatic process • 83 PCTs over 42 payment agencies

  3. Electronic Links • Claims Volumes • Period May 2007 – Jan 2010 • 919,581 manual approvals • 1,055,749 automatic approvals • 1,975,330 total claims

  4. Electronic Links • GOS 6 claims • Pilot expected with Healthcall • Early in 2010 • Pilot site within West Yorkshire CSA

  5. Electronic Links • GOS 3, GOS 4 & GOS 5 • NHS development completed for April 2009 • Ocuco have sent test GOS 3, GOS 4 & GOS 5 claims for processing • No supplier asked to be accredited to submit GOS 3, GOS 4 or GOS 5 claims to live payment system

  6. Electronic Links • Processing Possible Duplicates • More individual GOS 1 claims stored • More possible duplicate claims identified • Raised questions regarding the GOS Regulations when a patient is tested and advised otherwise on their previous sight test date

  7. Electronic Links • Processing Possible Duplicates • DoH response: • providing that the sight test is done in good faith, claim should be paid • a matter of judgement locally as to whether the PCT thinks the patient was deceptive or mistaken and then whether they want to pursue

  8. Electronic Links • Processing Possible Duplicates • Electronic processing changes for possible duplicates: • validation checks updated to enable PCT to control how to proceed on each possible duplicate claim indentified • Check Possible Duplicate Electronic Claims menu to list possible duplicate claims

  9. Check Possible Duplicate Electronic Claims

  10. Check Possible Duplicate Electronic Claims

  11. Electronic Links • Processing Possible Duplicates • Manual approval changes for possible duplicates: • extended duplicate check automatically enabled on approval • all patients previous claims available for viewing

  12. Check Possible Duplicate Electronic Claims

  13. Closed Change Requests

  14. Closed Change Requests

  15. Closed Change Requests

  16. Closed Change Requests

  17. Closed Change Requests

  18. Open Change Requests

  19. Open Change Requests

  20. Open Change Requests

  21. Open Change Requests

  22. Open Change Requests

  23. Open Change Requests

  24. Import Pre-notification detailsCR 2851 • Pilot at Hampshire • Started on 13th February 2009 • Completed on 3rd November 2009 • Released Nationally on 4th December 2009 • Refer to online help prior to use

  25. Import Pre-notification detailsCR 2851

  26. Import Pre-notification detailsCR 2851

  27. Import Pre-notification detailsCR 2851

  28. Import Pre-notification detailsCR 2851

  29. Import Pre-notification detailsCR 2851

  30. Import Pre-notification detailsCR 2851

  31. Import Pre-notification detailsCR 2851

  32. Import Pre-notification detailsCR 2851

  33. Import Pre-notification detailsCR 2851 • Excel form approved by Domi Eye Care Committee, FODO, AOP and OPUG • New form available from import screen & online help • Encryption to protect patient details • NHS Ophthalmic Encryption Utility

  34. NHS Ophthalmic Encryption Utility • Practice responsible for protecting patient data • Practice can use this utility for free • Utility has ability to:- • encrypt a data file for transmission • decrypt files with .ecf extension

  35. NHS Ophthalmic Encryption Utility • Available to NHS personnel only at https://nww.openexeter.nhs.uk/nhsia/opthelp/Ophthalmics/eng/indexElectronic.html • Pass the utility to the practice • Terms & conditions for use apply • FAQ’s available

  36. NHS Ophthalmic Encryption Utility

  37. English GOS Fees 2010/2011 • Voucher values and sight test values will be available on 1st April 2010 • No back pay for 2010/2011

  38. Welsh GOS Fees 2010/2011 • Voucher values and sight test values should be available on 1st April 2010 • Possibly no back pay for 2010/2011 • Waiting for confirmation from the Welsh Assembly

  39. LHB Restructuring & Ophthalmic Payments • Completed during October 2009 • No outstanding issues

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