We've added specific functionality to handle incomplete treatments within the NHS England/Wales claim flow, typically used when the patient fails to return for a course of treatment.
There are two reasons for submitting incomplete claims;
Scenario 1 - Either the patient fails to return for treatment, eg, you have planned the treatment but have not carried it out and therefore you wish to claim for the work you have completed.
Scenario 2 - Or, you may have started higher UDA Band work, such as a denture or a bridge, but the patient fails to return for fitting and so you now need to abandon the treatment. This means you are entitled to the UDAs for the work you have carried out, but the patient charge remains at the band for the treatment they received.
NEW Process to Sending an Incomplete NHS Claim
This new procedure will start rolling out across NHS practice in England and Wales from Monday, 16th October 2023. Prior to this date please follow the old procedure below.
How to process a claim with the new workflow.
Firstly, it's important to note that the practitioner/user should make no changes to the treatment plan when abandoning a course of treatment and choosing to send this as an incomplete treatment plan.
You should simply leave any incomplete items on the treatment plan without the "completed" checkbox ticked. In the example below, we have completed the initial exam (Band 1) but not the recommended fillings (Band 2)
Then click "Submit Claim". The form will then automatically detect that there is an incomplete item of a higher band than the highest complete item on the course of treatment.
Look for the new field labelled "Band claimed for incomplete treatment"
Where there are two possible options for example Band 2 and Band 3, the field will not default to either because we need the practitioner to make a decision as to which band they wish to claim.
If there is only one possible option (e.g. the highest complete treatment and the incomplete treatment are both Band 2) then it will select the value for you automatically.
It's important to note that for an incomplete treatment, you cannot proceed to submit the claim until a Band has been selected.
Once you have selected a band this will update the claim form to show the correct band that is being claimed.
Continue to complete the claim form as usual, then submit and complete your claim when you are ready. This will raise a fee against the patient if needed.
Full gif of the new procedure...
OLD PROCEDURE - How to claim incomplete NHS treatment?
When claiming for incomplete work you MUST have some incomplete work charted on the plan of the appropriate banding.
If you wish to claim the higher band, simply leave all of the proposed work on the plan and leave the incomplete work unticked and click Submit claim as normal.
Video example GIF below 👇
If you are NOT claiming the higher band, but still want to send it as incomplete, you MUST not have any items charted that exceed the band you are claiming for, but you still need to have an item of the band you are claiming left unticked on your plan for Dentally to trigger an incomplete treatment claim. We also recommend adding the originally offered treatment to a general note to ensure you retain an historical record of the treatment you recommended
Video example GIF below 👇
As you can see in the video above we are using an incomplete treatment item to ensure we are only claiming for the band of the work we have carried out rather than the higher band. If you do not have these codes available and you wish to add them you can do so by following the guidelines below👇
OLD PROCEDURE - Adding incomplete treatment codes
When sending an incomplete claim we recommend that a new treatment item is created;,
Go to settings
Go to Treatment & Plans
Click New
Add a treatment code to make it easy to find and name it so you can identify easily which band this is for.
Ensure you add an NHS band as appropriate and you MUST set the treatment category to Other Treatment.
Save your new code and its ready to use.
Example video GIF below 👇
OLD PROCEDURE - Let's take a look at some examples of claiming incomplete NHS work👇
OLD PROCEDURE - Incomplete Band 1 claim - Claim 1 UDA
If a patient fails to return for planned treatment and you wish to only claim for the original band 1 examination you can;
Remove the Band 2 treatment from the treatment plan
You can either move them onto another treatment plan and complete this so the treatments are retained in notes.
Or you can add a general note to the patient's treatment plan to ensure a record of this recommended treatment remains.
On the original treatment plan, add an Incomplete Treatment Band 1 code to the plan and Leave this UNTICKED!
This then means that the claim will show Band 1 completed work and Band 1 incomplete work, and will inform the BSA that the plan is incomplete without claiming for the Band 2 UDAs.
Submit the original Treatment Plan with the completion date being the last date you saw the patient.
This date does NOT need to be within the last 2 months for incomplete treatment, even though Dentally will still give you a warning about this.
OLD PROCEDURE - Incomplete Band 2 claim - Claim 2 UDA's
The same scenario works for Band 2 claims going off as incomplete where the dentist does not want to claim Band 3.
In this case, you would use your Incomplete Treatment Band 2 item code and remove any Band 3 treatment before submitting your claim.
You would use this, for example, if you have not completed any moulding, lab work or denture and the patient fails to attend for any reason and the treatment is now abandoned.
OLD PROCEDURE - Incomplete Band 3 claim - Claim 3 UDA's
In the scenario where you have planned and started a Band 3 treatment but the patient abandoned this at the Band 1 stage. You may still wish to request the full band 3 UDA's.
Leave the treatment as is, Tick what has been done, and leave all other items unticked on the treatment plan.
Submit the claim as normal, Dentally will automatically pick this up as a Band 3 incomplete claim. The claims screen will show the Band 3 UDA's you are claiming, the Band 2 patient fee and the items marked as incomplete👇
Charging the Patient
As highlighted in the last example above the patient will only be charged for the band of treatment that has been ticked as complete on the treatment plan.
🚨 Please note 🚨
That any incomplete treatment left on a plan when submitted will register the band of UDAs you wish to claim. If you have not started or incurred any costs for the higher band of treatment, then it should be removed from the plan and an incomplete treatment left on the plan of the band you do wish to claim.
Additional NHS England and Wales Support web pages