If you are experiencing difficulties submitting continuation of treatment claims with NHS Scotland, here is the process that we have seen to work with our customers.
Possible Reasons for needing a Continuation
Possible reasons for needing to send a continuation claim include:
the dentists list number might have changed.
Or the dentist who was carrying out the treatment has changed during the course of treatment
Continuation Part 1
If you are continuing treatment where the patient has had a change of practitioner:
FIRST check that the original practitioner is set as the patient's practitioner in the patient details
Click on Submit Claim
Set Continuation to YES
Set Continuation part number to 1
Set List Number of dentist for part... to the OLD Practitioner's List number
Set PIN to the PIN of the OLD Practitioner.
Continuation Part 2
Allow at least 24 hours between sending Part 1 and Part 2 of a Continuation claim.
Send the claim with the following:
Set Continuation to Yes
To locate the Continuation Claim number -
Go to the NHS Tab
Under NHS ID, locate the first claim
The claim number is listed under NHS ID
Set Continuation Part Number to 2
Set List number for dentist for Part 1 of the claim to the original Practitioner List number
To set Original Claim submission count
Go to the NHS Tab
Under the Claims tab
Locate the first claim
Under Retries, is the count number
Performer should be the new practitioner details
PIN will be the PIN for the new practitioner
ENSURE that the start date of Part 2 is the SAME DATE as the start date on Part 1
If the claim has previously been submitted for prior approval and been approved, the prior approval date and prior approval reference number must also be entered in this section.
Do NOT add anything into the Observations field.
Other things to note:
The SAME DATE of acceptance must be used on all parts, to reflect that it is one course of treatment.
For part 2 and above, the claim type must be ‘I am registered with another dentist at this practice’.
Separate parts must be submitted in the correct sequence and it is advisable to allow at least 1 day between submitting the different parts, otherwise there is a risk the claim may be rejected.
Do not enter any of this information in observations, only in the Continuation Details section.
Orthodontic continuation - Prior Approvals and Transfers
There is a special continuation case with Orthodontic cases, where the patient transfers between dentists after Prior Approval has been granted.
The original Dentist has already submitted an Ortho Prior Approval claim. The Dentist has had the Prior Approval granted and a Prior Approval number.
This is a case where a Dentist has started some work on a patient, but has not completed all of it. The Dentist would like to be paid for the work that has been done, before the transfer.
The original Dentist sends a Final Payment Claim and is paid for the work they have done.
The original Dentist then transfers the patient to an orthodontist to complete the work.
The new Dentist submits a Prior Approval Request including feecode 386101 (Discretionary fee code for 'eOrtho Transfer Case') and submits any evidence as required.
This code tells the NHS Board that this is a patient transfer to this Practitioner who is now taking over the work previously claimed for by the first Dentist.
The new Dentist can now submit the ortho claim as normal.