Once a patient has been placed onto a Complex Care Pathway, claims must be submitted at each stage of the pathway to ensure the practice receives the appropriate NHS remuneration.

Completing the First Appointment

At the end of the first appointment, the provider must Treatment Complete (TC) the Course of Treatment (COT) to submit the initial pathway claim. 

This applies even if there is unfinished treatment remaining on the COT.

When completing the COT, a new Pathway Declarations button will be available within the TC window. 

This displays the declarations associated with the pathway claim being submitted.
Please note that the declarations presented will vary depending on:

• The pathway type selected.
• The stage of the pathway being claimed.

The Pathway Declarations window displays the declarations associated with the current pathway claim.
 

Automatic Creation of the Next Pathway Claim

After the first pathway claim has been submitted, EXACT will automatically:

• Create the next pathway COT in the sequence.
• Move any incomplete treatment from the previous COT to the newly created pathway COT.
• Clearly identify the pathway stage within the COT description.

This allows treatment to continue without requiring the practice to manually create subsequent pathway claims.

EXACT automatically creates the next pathway COT and transfers any outstanding treatment.

Patient Record (PR) Forms

Where a PR form has been completed for the initial pathway COT, it will automatically be linked to all subsequent pathway COTs within the same pathway.

As the pathway is treated as a single overall course of treatment, patients are not required to sign multiple PR forms for each pathway claim.

Date of Acceptance

The Date of Acceptance remains the same throughout the entire pathway.
EXACT automatically carries the original Date of Acceptance forward to all subsequent pathway COTs.

No manual intervention is required.

The original Date of Acceptance is automatically retained throughout the pathway.

Patient Charges on Subsequent Claims

The patient charge is only collected on the initial pathway claim.
For all subsequent pathway COTs:

• No additional patient charge is applied.
• The patient continues treatment under the existing pathway.
• The remaining pathway treatment is covered under the original Band 2 charge.

As previously described, UDA values will be automatically updated once the NHS returns the practice-specific pathway values.

Monthly Pathway Claims

A NHS CCPATHWAY service is automatically added to each pathway COT.
This service supports the requirement for pathway claims to be submitted regularly throughout the duration of the pathway.

Why is this important?
Pathway claims must continue to be submitted even if the patient does not attend the practice every month.

Where no clinical treatment has been provided during a particular month, the provider can:

1. Open the current pathway COT.
2. Tick the NHS CCPATHWAY service.
3. Treatment Complete (TC) the COT.

This allows the required pathway claim to be submitted without the need for additional treatment entries.

Continuing Through the Pathway

Each time a pathway COT is Treatment Completed:

• The pathway claim is submitted.
• The next pathway COT is automatically created.
• Any incomplete treatment is transferred forward.
• The pathway progresses to the next claim stage.

For example, once Claim 2 is completed, EXACT will automatically generate Claim 3 and transfer any remaining treatment.

Following submission of a pathway claim, EXACT automatically creates the next pathway stage and carries forward any outstanding treatment.

Key Points

• The first pathway COT must be Treatment Completed, even if treatment remains unfinished.
• The Pathway Declarations window displays the declarations associated with the current claim.
• EXACT automatically creates subsequent pathway COTs.
• Incomplete treatment is automatically transferred to the next pathway COT.
• Patients only pay the Band 2 charge once, at the start of the pathway.
• PR forms and Date of Acceptance are automatically carried forward.
• The NHS CCPATHWAY service can be used to submit monthly pathway claims where no treatment has been provided.
• Each completed pathway claim automatically generates the next pathway stage.