Ophthalmic Payments

1
Ophthalmic Payments

• National User Group Meeting
• 20th September 2007

2
Electronic Links Pilot Project

• Pilot Site Activations
• 1st Specsavers store Winchester activated on 31st
  May 07
• 2nd Specsavers store Andover activated on 10th
  July 07
• 3rd Specsavers store Exeter activated on 31st
  July 07

3
Electronic Links Pilot Project

• Pilot Site Activations
• Specsavers Leeds on 29th Aug 07
• Specsavers Hull on 30th Aug 07
• Specsavers Bedford on 30th Aug 07 installed.
  Not active.
• Specsavers Camborne on 3rd Sept 07
• Specsavers Stourbridge on 3rd Sept 07

4
Electronic Links Pilot Project

• Automatic Approval switch ON at
• Specsavers Winchester, 22nd June 07
• Specsavers Andover, 27th July 07
• Specsavers Exeter, 14th August 07

5
Electronic Links Pilot Project

• Claims Volumes
• Entered in Aug 2007 / Sept 2007
• 638 manual approvals
• 2211 automatic approvals
• Paid during May 2007 / Sept 2007
• 1627 manual approvals
• 1860 automatic approvals

6
Electronic Links Pilot Project

• Sub-group meeting 11th Sept 07
• Successful pilot
• All sites delighted with pilot
• National Implementation
• Post Implementation Report

7
Processing Electronic Claims

• Valid GOS claims ready for payment, these are
  REQUESTED claims
• Requested claims can not be paid
• Requested claims can be entered into an open
  payment cycle for payment-
• Automatically
• Manually

8
Processing Electronic Claims

• Invalid GOS claims are assigned rejection codes
  and have their status set to REJECTED
• An automatic response (e-mail) is sent to the
  sender when the claim status is changed

9
Viewing Requested Claims
10
Viewing Requested Claims
11
To Approve or Reject a Requested Claim
12
Health Act Regulation Changes

• Implementation Date 1st April 2008
• Contracts
• Performers
• Mobile Services

13
Closed Change Requests
14
Closed Change Requests
15
Open Change Requests
16
Open Change Requests
17
Usage of Old GOS forms

• During August 13,672 GOS forms were entered for
  payment using the old input screens
• There is no legitimate reason for these to be
  used within any English PCTs
• Same will apply in Wales from February 2008

18
Patient Reason Age Checks

• All individual input screens now have fields to
  record the Beneficiary details.
• Beneficiary Name
• Beneficiary Date of Birth
• Beneficiary NI Number

19
Patient Reason Age Checks

• Reasons their age checks
• Income Support (16 59)
• Pension Credit (60 or over)
• Tax Credit (16 or over)
• JSA (16 65)
• Glaucoma (40 or over) ACTIVE
• Electronic Links
• Above checks are active in validation process

20
Patient Reason Age Checks

• Do you wish for these checks to be activated on
  input screens ?
• Impact of activation
• Invalid claims will not be permitted for payment
• Increase in returned GOS claims to practitioners
• Practitioners will need guidance from DoH, PCTs
  etc
• Co-ordination of enforcement of the Regulations

21
Activity

• 785,767 GOS1 claims processed in August 2007
• 14,919,624 for GOS1 in August 2007
• 67,599 Schedule D searches in August 2007
• 14.61 GOS1 claims were individually entered
  during August 2007