EXACT may still display payor codes for a quick way to find certain English/Welsh NHS service codes, however, the NHS no longer require these specific payor coded services to be used.
|Please Note: As and when the NHS update datasets, you will need to assign/update these to your NHS services as you see fit. If you seek guidance as to the most appropriate dataset for a service, please contact your NHS team.|
NHS perform validation on bands matching data set categories in a claim, as such a warning message will appear in EXACT to warn if there is a mismatch. This warning is to prevent claims being rejected. View the clinical dataset and treatment banding section for full information on the appropriate banding per dataset.
- Configuring Services, Datasets & Categories
- Clinical Datasets and the Treatment Banding
- Advanced Perio RSD
- Service and Banding Mismatch (V13.729)
Configuring Services, Datasets & Categories
Note: Some of the steps mentioned in this article may be hidden, depending on your level of security access. If you are unable to follow any of the steps in this article due to security access, please refer to your practice administrator.
Any service within EXACT can be used for NHS treatment and those services used with a clinical dataset assigned will get included in the FP17 data that is transmitted to the NHS.
There are two ways to change or assign a data set to a service,
- Open the chart screen on a patient file, select the service list tab, locate the service and edit the service via the e|d button in the lower right.
- Navigate to Configure - Services, locate the service and edit the service via the e|d button in the lower right of the screen.
Once in this window you can choose the relevant data set from the FP17/O Data Set dropdown menu, select OK, the data set will then be included when you chart and TC a claim including the selected service.
Keeping your NHS service codes within service categories like “Favourites” or “NHS Favourites” is the best way to make sure you use the correct codes that are already mapped to the correct Clinical Datasets.
Example of an incorrect dataset claim:
The following claim contains both an exam and a denture
The Exam has the dataset 'Examinations' assigned to it and Denture has the dataset 'Other' rather than a Denture dataset.
Because of this the datasets transmitted with the claim to the NHS contains no data about a denture so the board will only pay 1 UDA for the Examination.
To correct this, the dataset on the Denture needs to be changed to the correct dataset by following the instructions here.
Clinical Datasets and the Treatment Banding
For NHS England clinical data set validation rules as of 1st April 2022, click here.
For NHS Wales clinical data set validation rules as of 1st April 2022, click here.
Advanced Perio RSD
For the dataset 'Advanced Perio RSD' to appear on the Clinical Data Set tab, the Chart Graphic must be set to 'Tooth Frame', if this is not currently set on the desired service you will need to contact our support team to set this.
Note: The graphic must be set in order to fulfill the NHS requirement of sextant data being transmitted along with any claims utilising an Advanced Perio RSD dataset.
NHS rules state 'If present, the code must be accompanied by a quantity of 1-6 (number of sextants)'. EXACT automatically adds sextant data to a claim through the use of the relevant dataset and charting information.
Service and Banding Mismatch
Checks have been introduced to prevent claims being rejected if there is a banding and/or dataset category mismatch, this coincides with the recent validation changes being made by the NHS.
The following popup will appear if one of the scenarios listed below, is met.
The warning will appear in the following scenarios.
- If a replacement is ticked for a service without a band 2 or 3 data set assigned.
- If a COT has a total band of 1, 2 or 3, but none of the services in the COT have been assigned a category to match.
- If any service in the COT has been assigned a data set category higher than the total band of the COT.
To correct these, review the steps below to assign datasets, for more information view Clinical Datasets and the Treatment Banding.