Prior Approval is only required for NHS Scotland.
Creating a Prior Approval
PRIOR APPROVAL LIMIT
When you submit a Prior Approval, you will see a summary of the claim with a list of the items charted.
If the items charged is near or over the Prior Approval limit, Dentally gives you a warning. It does not prevent you from sending the Prior Approval claim.
Unlike a claim, a Prior Approval doesn’t need the items on the Treatment Plan to be completed.
To submit, click on Submit, then on Submit Prior Approval.
As with all claims, you must either have a CHI number or a search reference before you can proceed. Please see the CHI Number web page for more information.
You should see a screen like this:
NOTE the following in this example:
- The CHI search has been done and a search reference has been set. If there is no CHI number or search reference, you will NOT be able to proceed.
- The patient has no exemptions but you can set one on this screen, if you need to.
- You can also add a new BPE from this screen.
From here the Next button takes you to the Prior Approval details & evidence screen.
Without a PIN the Prior Approval cannot proceed.
Ensure the Location is set.
From this screen, you can make sure that the Prior Approval has all of the information it needs.
This is also where you note external mouth trauma.
Check all the treatment options are correct and that there is no additional information that you can add. Click on Show to expand each of the 5 sections to add more information.
When you are satisfied with your submission, click on Next.
You will be prompted to confirm you want to send the Prior Approval, click on Submit and it will be sent. You will see a notification telling you that the Prior Approval has been sent to Practitioner Services, with a code - VAR in this instance.
Other Dentally web pages to help you with Prior Approvals include: