As an NHS Practice it is very important that you TC and transmit your claims to the Dental Board. It is recommended that you transmit your NHS claims on a daily basis or at least every other day. By doing this you it will ensure your claims are paid on a regular basis This information sheet is designed to help you ensure your NHS UDA figures are up to date, and will allow you to deal with situations that may arise as a result of claims and responses
1. Go to File – Payors or if you have one, the ‘Payors’ button along the top.
2. To the right of ‘Sort by name/Sort by code’, find NHS or PDS depending on which is used.
3. To the right of this screen, you will have a button that says ‘Claim’, left click this.
4. On the next screen, select the providers you wish to bundle claims for, leave blank for all providers, or select multiple to the right. The date field is set to today’s date, so it will bundle everything up to today. Click ‘OK’.
5. The system will bundle the claims, and once finished, will prompt you to print the list of claims, press print if you would like to print, or cancel to skip this.
6. If you get a message saying ‘No Claims Found’, nothing is ready to send, and if you get a message saying ‘There are too many claims for the bundle…’, once finished, you will need to press the ‘Claim’ button again to bundle these extra claims ready to transmit.
7. The ‘Transmit Claims’ screen will appear straight after you have bundled. The dates that appear will include as default anything bundled in the last month, as long as transmissions are kept up to date this should not need changing. Click ‘OK’ and the screen will show the transmission progress. Once finished, it will say how many claims have been sent and if any files such as responses, acknowledgements and schedules have been received.
8. Click ‘OK’, the transmission is complete.
If your transmissions are taking a long time, this usually means that the Software is importing the Schedules. UNDER NO CIRCUMSTANCES CANCEL THE TRANSMISSION AS THIS WILL CAUSE THE SCHEDULES TO IMPORT INCORRECTLY AND THIS COULD CAUSE ISSUES WITH YOUR UDA FIGURES.
Once you have transmitted your claims you need to check the claim bundles have been received by Web EDI.
Responses are received when you transmit your claims. On average, it can take a couple of days for the responses to be sent back from the Board
To view responses go to Administration > NHS > Responses
Any acknowledgements are automatically resolved (ticked off the list) as they are only for information
Any responses that may require your attention will show on the responses screen as unresolved. There are a number of responses that can be received. Below is a list of the most commonly received ones.
* Go to Administration > NHS > Claim Bundles The following information is displayed:
1. The date the claim bundle was transmitted
2. Response received - this is a black tick (this is when you have received a response from the board - this is normally a few days behind the last transmitted claims)
3. Transmitted - this is a telephone with a red tick; this means the claim has been transmitted successfully. If you have a telephone with no tick this indicates that the claim has been sent but has not been confirmed as successful. In this case you need to contact the board and check they have received the claim. You may also see a telephone with a red X, this indicates the claims have not been sent. In this instance delete the bundle and re-transmit
4. Number - this is the claim bundle number - you will need to quote this if speaking to the board about any claims
5. Provider - these are created per provider.
To view which courses of treatment have been sent you double click on the required claim bundle. This will bring up a list of all patients claims which have been sent to the board for processing.
1. Administration->NHS->Claim Bundles
2. Highlight the claim bundle that needs to be resent. If there is more than one to delete, you will need to do them one at a time.
3. Click on the delete (Bin symbol) in the bottom right. You may want to print these bundles as once it has gone you will not be able to find the contents easily.
4. Click 'Yes' (you will need super user privileges to do this):
5. Now go to File->Payors
6. Select NHS in Payor
7. Click on 'claim' button. Again you may wish to print the bundle to know what additional claims have been added.
8. Choose the provider and click 'Ok'
9. Click yes to transmit claims
If you receive any other responses please contact the Dental Board on 01323 433560 for further advice. If you require assistance regarding the use of your Exact Software, please contact Support on 01634 266800