NHS Northern Ireland requires prior approval for treatments exceeding £380 in value as well as any discretionary items as per the latest SDR.
- Applying for a prior approval in EXACT
- Transmitting prior approvals to the NHS
- Viewing prior approvals
- Changing the status of a prior approval
- Prior approval status icons
- Approval limit configuration
Applying for a prior approval in EXACT
- Open a course of treatment (cot) for the patient, charting all services as required.
- EXACT will display a prior approval symbol next to the charted items if it determines a prior approval is required, this is a yellow icon with a tick inside.
- When you are ready to apply for the prior approval, click the prior approval icon at the bottom of the cot.
- If there are any details missing from the patient information, you will be prompted to enter these prior to sending the prior approval as you may receive a rejection without these details. Select the option you wish.
- Once the patient record has been updated or the prompt has been dismissed you will be presented with the NHS HS45 window. All NHS relevant details to the cot will be displayed, check through these to ensure everything is correct.
- Enter your observations by selecting the Observations tab.
- When you are happy everything is correct, click Send Approval.
- You can choose if you wish to print the prior approval at this point.
- The prior approval is now awaiting transmission to the NHS.
Transmitting prior approvals to the NHS
All prior approvals will be transmitted at the same time as transmitting your NHS claims.
Viewing prior approvals
All prior approvals for the practice can be viewed by navigating to Approvals via the NHS workspace icon or Administration - NHS - Approvals.
This will display a list of prior approvals with COT details.
Changing the status of a prior approval
You must manually update the status of approvals EXACT, to change the status of an approval, to change an approval status,
- Navigate to Administration - NHS - Approvals or selecting Approvals via the NHS workspace icon.
- Select the COT you wish to edit.
- Click Edit Appr. Status in the lower menu bar.
- Choosing the appropriate status from the options.
- The colour of the approval icon will change depending on the status selected.
- This will also update on the COT.
- After the approval has been granted by the NHS, you can proceed with the COT as normal.
Prior approval status icons
Once the status of an approval has been changed the icon colour will update in both the approvals list and on the COT's themselves.
- Yellow = Approval pending
- Green = Approval granted
- Red = Approval refused
The approval icon in the payor banner on the COT will also display this information, for increased visibility in surgery.
If prior approval has not been requested, no approval icon will be displayed.
Approval limit configuration
EXACT determines if a COT requires prior approval via the Payor Approval Limit, this is set in the NHS payor configuration.
- This can be found by navigating to File - Payors - NHS.
- The window in the lower right shows the values.
To change the limit.
- File - Payors.
- Then select NHS.
- Prior Approval limit is displayed in the lower right window.
- Select +1.
- Enter up to date details, pressing OK when complete.
Course of treatment will not send
Confirm that the providers PIN has an NHS activation date prior to that of the date of acceptance.
- A providers activation date can be checked by navigating to File - Providers - select the provider then the NHS Details tab. The date is displayed with the providers NHS details.
- The acceptance date can be found with the exemptions on the COT. Open the COT for the patient, click the Exemption button below the charting, the acceptance date is displayed to the right.