eOrtho Treatment Claims
Please select the relevant section depending on your eOrtho treatment claim query.
For Approval or Prior Approval information, please see eOrtho Approval and Prior Approvals.
- Regulation 9
- Claiming for retainers after final payment
- Interim payments
- Final Payment
- Retention
- Transfer case
- Transmitting requested attachments
Regulation 9
Regulation 9 applies to the replacement of lost or broken dentures, splints, bridges and orthodontic appliances, due to an act or omission by the patient |
If you are requesting a replacement appliance you will need to follow the steps below:
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Create a new NHS Orthodontic Course of Treatment (COT).
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Chart the services required.
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Click the Ortho button at the bottom of the COT.
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In soeConnect select More Actions followed by Select claim type and select the REG 9 claim type, entering the mandatory data, when complete click send.
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TC the COT and the Regulation 9 claim will be paid in a schedule.
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You will need to process this payment as normal.
Note: If the NHS respond with errors in Connect. The COT only needs to be resubmitted in EXACT if corrections to treatment are required. Otherwise, re-claiming can be done in Connect alone. |
Claiming for retainers after final payment
Note: If you are claiming for retainers after you have already TC’d your orthodontic course you will need to do this on a separate course of treatment. The original COT should not be resubmitted. |
- Create a new NHS Orthodontic Course of Treatment (COT).
- Chart the services required.
- Click the Ortho button at the bottom of the COT.
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In soeConnect select More Actions followed by Select claim type and select the RETAINERS claim type, entering the mandatory data, when complete click send.
- TC the COT and the retainers will be paid in a schedule; you will need to process this payment as normal.
Note: If the NHS respond with errors in Connect. The COT only needs to be resubmitted in EXACT if corrections to treatment are required. Otherwise, re-claiming can be done in Connect alone. |
Interim payments
In order to claim for an interim payment, the Course of Treatment (COT) must have already been created with the treatment plan charted and, if required, Prior Approval (PA) approved.
To claim for an interim payment follow the steps below:
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In EXACT tick, complete and charge the appliance once fitted.
DO NOT TC the COT. -
Click the Ortho button.
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In soeConnect select More Actions followed by Select claim type and select the INTERIM PAYMENT claim type, entering the mandatory data, when complete click send.
- DO NOT TC the COT.
The Interim payment will be paid in a schedule and you can process this payment as normal.
Final Payment
To claim for a final payment the course of treatment (COT) must have been created with the treatment plan charted and Prior Approval (PA) approved (if required) and interim payment possibly requested.
- If you want to claim retainers at the same time, chart the appropriate services.
- Click the Ortho button.
- In soeConnect select More Actions followed by Select claim type and select the FINAL PAYMENT claim type, entering the mandatory data, when complete click send.
- TC the COT. The final payment and any claimed retainers will be paid in a schedule. You will need to process this payment as normal.
Note: If the NHS respond with errors in Connect. If corrections to treatment are required, the COT only needs to be resubmitted in EXACT. Otherwise, re-claiming can be done in Connect alone. |
Retention
To claim for a retention treatment you will need to follow the steps below:
- Create a new NHS Orthodontic Course of Treatment (COT).
- Chart the services required.
- Click the Ortho button at the bottom of the COT.
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In soeConnect select More Actions followed by Select claim type and select the RETENTION claim type, entering the mandatory data, when complete click send.
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Finally, TC the COT and the retention will be paid in a schedule; you will need to process this payment as normal.
Note: If the NHS respond with errors in Connect. The COT only needs to be resubmitted in EXACT if corrections to treatment are required. Otherwise, re-claiming can be done in Connect alone. |
Transfer case
This occurs when a practice is completing a Course of Treatment (COT) started at a different practice. To chart a transfer case in EXACT,
- The completing dentist will need to open a new Orthodontic COT, charting all treatment to be completed.
If the original dentist (who started the treatment) partially completed treatment you will need to chart the Discretionary service '3861'. This is required for the NHS to pay the completing dentist. - When the service is charting, click the Ortho button.
- In soeConnect select More Actions followed by Select claim type and select the PRIOR APPROVAL claim type, entering the mandatory data, when complete click send.
The NHS will respond with a payment amount, this will likely include a fee code for 3861, if applicable. - The completing dentist can continue with interim payment/final payment as normal.
Note: Please ensure the approved fee code 3861 is entered against this service in EXACT (if relevant) so that is it correctly claimed at final payment time. |
Transmitting requested attachments
On occassion the NHS will request an attachment, when this is requested, they will provide an attachement link. You must be working on a computer that is SWAN connected to perform this.
- In soeConnect you can view all of your Orthodontics claims by selecting NHS then Orthodontics from the left-hand side menu.
- If the board have requested an attachment you will see this represented in the status column of the claim details.
- Open the claim where you can, then click on the link shown at the top of the page to upload your attachments.
- Once the appropriate images are uploaded, you must specify what was uploaded (or sent physically) in the reply section and then send the claim again using the Send button.
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