Scenarios

What if a patient who qualifies for a pathway is already in treatment?

Treatment should be completed normally. A patient should not be transferred to a pathway mid treatment. Patients should be assigned to pathways as part of their initial assessment.

What if a user deletes a pathway COT by mistake?

Users can select the pathway claim manually, but will need to set the date of assessment to the same as the original pathway claim. 

This can be done by manually charting the NHS CCPATHWAY service and setting its acceptance and completion date to that value. Once a pathway COT exists, EXACT will continue auto creating the COT's after TC.

What if the patient requires two sets of band 3 treatment during a pathway?

It is possible that a patient may have denture repairs in month 1, band 3 treatment in month 2 and then again in month 5. Assuming the treatment is not being completed together, separate COT's should be created alongside the open pathway COT, and the concurrent checkbox ticked.

EXACT will apply the max 12 UDA/band 3 patient charge in each case.

e.g. 1st Denture repair COT = 3 UDA's & 0 patient charge.

Next Band 3 COT = 9 UDA's as the provider has already received 3 UDA's from the previous denture repair COT. The patient charge is the difference between band 3 and band 2 (as they have already paid for band 2 in the first pathway claim).

Any subsequent band 3 COT = 0 UDA's and 0 patient charge due to the max 12 UDA and band 3 patient charge rules.

What if a patient becomes exempt part way through a pathway?

Please ensure the exemption is set correctly for all remaining pathway COT's after the patient became exempt.

What if a patient name changes?

If a patient's name changes during a pathway, their name should not be updated in EXACT until their pathway is completed. The NHS are not able to find patients with differing names and have specified that the patient name must remain the same for the duration of the pathway.