When Denture modification or band 3 treatment is required

If the patient requires denture repairs, the provider should leave the pathway COT open and create a new COT, ticking it as a concurrent claim for a care pathway.

This will set the UDA value to band 2 and the patient charge to 0 as the patient only ever pays a band 2 value for band 2 treatment.

Should a provider forget to tick the concurrent claim checkbox, EXACT will attempt to warn the provider when a COT is created while a pathway is open (or closed within 3 months). Both qualifying as "concurrent" periods.

Ticking the checkbox on the warning, will set the concurrent claim checkbox on the exemption window.

Band 3 Treatment (excluding ortho and appliances)

If the patient requires band 3 treatment the provider should leave the pathway COT open and create a new COT, ticking it as a concurrent claim for a care pathway, as mentioned above.

If the denture repairs and band 3 treatment are going to be completed together at the same time, only 1 COT is required. If the are going to occur at different intervals, a new COT will need to be created for each.

EXACT will attempt to warn the provider if they haven't ticked the concurrent checkbox themselves.

Band 3 Charges

Providers are only able to claim up to a maximum of 12 UDA's for additional concurrent treatment alongside a pathway. Patients are also only subject to a maximum band 3 patient charge for their pathway and any additional treatment required.

EXACT will therefore adjust the UDA value on concurrent COTs to match this maximum, including only charging the patient the difference between a band 3 and band 2 charge, due to them already having paid a band 2 fee when signing up for the pathway.

The concurrent COT is then TC'd on completion as normal.

Acceptance date on concurrent COTs

The acceptance date on any concurrent COT's must match those of the pathway. EXACT will ensure this is true if the concurrent checkbox is ticked.
 

TCing a Pathway COT after a Concurrent COT

Providers must ensure they select the correct declarations when sending a pathway COT directly after a concurrent COT has been claimed. EXACT will attempt to automatically default these correctly, but they must be checked for accuracy.

This only needs to be declared on a pathway COT submitted directly after denture repair/modification or band 3 treatment is completed. If no further concurrent work is due, these declarations would not be ticked for pathway claims 4, 5 and 6.

Concurrent Claim Restrictions

The NHS will pay for one of each type of concurrent claim. for example, one denture repair, one denture modification and one band 3 claim. EXACT will automatically adjust the UDA's assigned if more than one of each type is charted.
 

Concurrent COTs within 3 months of a pathway completion

It is possible that band 3 treatment might extend beyond the timeline of a pathway. On the completion of the pathway, the provider will have the option of declaring band 3 treatment beyond the pathway.

Providers must create a separate COT for this treatment, as mentioned for additional band 3 treatment above, and tick it as concurrent. EXACT will then apply the maximum of 12 UDA rules to this COT as required for all concurrent pathway COT's.

Failure to declare a concurrent COT within 3 months of a pathway completion

If a provider does not tick the "within 3 months" declaration on the final pathway COT, a band 3 COT created after pathway completion will be treated as a normal band 3 COT (not associated with the pathway) and full UDA's and patient charges will be applied.

The NHS will monitor these occurrences as they do not expect many instances of unrelated band 3 treatment being necessary within 3 months of pathway completion.