NHS England Claim Responses

Responses to claims are sent by the NHS when there is a query relating to a claim or course of treatment. The NHS are best equipped to answer any queries you may have regarding these responses.

We have compiled a list of information and questions to ask the NHS if you are to contact them regarding any responses you may have received.

1. Contract number
2. Performer number
3. CRN/COT number
4. Response

Questions to ask:

1. Provide the background of the claim (eg. what type of claim this relates to such as a continuation/rejection etc.
2. What is incorrect in the claim?
3. What is required to get the claim accepted and processed?
4. More clinical information can be requested if required.

Common Responses

A list of common responses, their meanings and resolutions can be viewed as a PDF on the NHS Guidance for eDental website or a list of common responses can be found as a PDF here.

All of this information can be found by logging into Compass, navigate to Activity - Error Code List.

• No responses received
• Response code @330: SQ Ind claim where the original cannot be found
• Invalid location ID
• Invalid pin
• Contract not valid

No responses received

EXACT will only pull responses in from NHS when transmissions have been sent.

1. Transmit claims by navigating to File - Payors - select NHS/PDS (depending on your practice set up) and click Transmit Claims.
2. Any responses waiting to be received in EXACT will be displayed under Administration - NHS - Claim Bundles.
3. Email NHS, if no new claims are received, requesting for any responses to be re-sent. Your email should be sent to EDISupport@dpb.nhs.uk contain your NHS site number/full practice address and the claim bundles you require responses for.
   Support use only: If the XMIT folder has no files in folders, the responses have not been re-sent.

It can take up to 5 days for responses to be received by EXACT once they have been re-sent, please contact the NHS to confirm they have re-sent the claims. If they confirm this has been actioned and you have not received these claims please contact our support desk, EXACT Live Chat.

Response code @330: SQ Ind claim where the original cannot be found

This response is sent due to the NHS being unable to locate the original claim. This is due to an SQ Indicator of '1' against the claim, for more information on this please view NHS England - Re-sending claims with a Schedule Query SQ Indicator or sending a claim as a deletion.

This would only occur if a claim has been transmitted, resubmitted and transmitted again.

To resolve this,

1. Resubmit the original course of treatment.
2. Copy the treatment, click on the COT then press CTRL+A then CTRL+C on your keyboard to highlight all the treatment and copy this.

Paste the treatment on the new COT, CTRL+V

Invalid location ID

1. Confirm your practice NHS location number with the DPB/PCT.
2. Open Configure - Practice Information, in the NHS Location Number field enter the number the NHS provided and select OK.
   Note: If you using a version of EXACT before V13.000, follow the steps noted below step 6.
3. Go to Administration - NHS - Claim Bundles.
4. Confirm with the DPB/PCT the claim numbers needed to resend.
5. Delete the claim bundles. (this does not delete the courses of treatment inside the claim bundle).
6. Go to Transmit Claims and Claim/Transmit as normal. It will include the items that were inside the deleted claim bundle.

For V13.000 or below.

1. Go to Administration - NHS - Responses.
2. Highlight a response with the invalid location ID.
3. Click Resubmit and Yes to the subsequent message.
4. Click on the patient icon - this will take you directly to the patient file.
5. On the chart tab and you will see the COT you have just resubmitted on the chart.
6. TC treatment as normal.

Invalid pin

The first step upon receiving an invalid PIN response is to contact the NHS or log onto Compass and confirm or reset your provider PIN number.

Once you know your PIN is correct, log into EXACT as a user with access to File - Providers and proceed with the following steps.

1. Go to File - Providers.
2. Find the provider with the invalid pin (click the lined icon at the top of the screen to the right of sort by code, highlight the provider and click OK).
3. Click on NHS Details tab - you will see a small box at the top and a large box at the bottom of the screen).
4. In the top box highlight the most recent performer number (this will be the one with the most recent activation date) and click the e|d button (under the small box on the right-hand side) or double-click the details.
5. This will bring up the performer and pin number and the activation date - ensure that all the details are correct and ensure the activation date matches the earliest COT with the invalid pin response.
   

   Note: When transmitting claims EXACT will pick up the pin number based on the course of treatment with the earliest date, if the activation date for the valid pin is after a course of treatment date it will pick up the incorrect pin.

6. Click OK.

Once everything has been corrected, the claims with the invalid pin response will need to be resent, to do this,

1. Log in as SUPER/ADMIN.

2. Go to Administration - NHS - Claim Bundles.

3. Highlight the bundle/s you need to resend for the affected provider and click the delete button (bin icon, bottom right-hand corner of screen).

4. You can now Claim again to re-bundle these claims and then transmit using the normal process you would normally follow when sending NHS claims to the Dental Board.

Contract not valid

There are a number of reasons why you may be getting a similar Response stating The contract number is invalid. Please amend and re-transmit.

Call DSD EDI support to check if the contract (performer number) is valid/provider is registered to it.

If you have a new Dentist that's started. It is possible that the performer number entered on the provider file is incorrect. You can find this by going to,

1. File - Providers, select the provider.
2. Click on the NHS details tab.
3. The Performer will be present here (view the GIF in the previous section for visual steps to view this).
4. If this is incorrect follow the steps to correct an invalid pin.