Ophthalmic Payments

Ophthalmic Payments National User Group Meeting 8th July 2010

Electronic Links • Activity Details • 222 active stores • 189 Specsavers • 30 practices using the Optix system • 2 Vision Express (Winchester 29/06) • 1 Independent • 18 activation requests outstanding • 125 stores using automatic process • 88 PCTs over 44 payment agencies

Electronic Links • Claim Volumes • Period May 2007 – Jul 2010 • 1,238,683 manual approvals • 1,406,723 automatic approvals • 2,645,406 total claims

Electronic Links • GOS 6 Claims • Pilot expected with Healthcall • During 2010 • Pilot site within West Yorkshire CSA

Electronic Links • GOS 3, GOS 4 & GOS 5 • NHS development completed for April 2009 • Ocuco have sent test GOS 3, GOS 4 & GOS 5 claims for processing • No supplier asked to be accredited to submit GOS 3, GOS 4 or GOS 5 claims to live payment system

Closed Change Requests

Open Change Requests

Early Re-Test Codes • 1. Patient is at risk of frequent changes of prescription for reasons not requiring medical referral or for reasons already known to a medical practitioner; • 2. Patient has pathology likely to worsen, for example age-related macular degeneration, cataract, corneal dystrophy, or congenital anomalies;

Early Re-Test Codes • 3.Patient has presented with symptoms or concerns requiring ophthalmic investigation: • 3.1 resulting in referral to a medical practitioner; • 3.2 resulting in issue of a changed prescription; • 3.3 resulting in either no change or no referral (the patient's record should indicate any symptoms shown to support this category of claim, if necessary).

Early Re-Test Codes • 4.Patient: • 4.1 needing complex lenses; • 4.2 with corrected vision of less than 6/60 in one eye.

Early Re-Test Codes • 5. Patient: • 5.1 has presented for a sight test at the request of a medical practitioner; • 5.2 is being managed by an optometrist under the GOC referral rules, for example suspect visual fields on one occasion which is not confirmed on repeat, or abnormal IOP with no other significant signs of glaucoma; • 5.3 is identified in protocols as needing to be seen more frequently because of risk factors.

Early Re-Test Codes • 6. Other unusual circumstances requiring clinical investigation.

Early Re-Test Codes • Summary of valid early re-test codes: • 1 • 2 • 3.1 • 3.2 • 3.3 • 4.1 • 4.2 • 5.1 • 5.2 • 5.3 • 6

Standby Service • Please use the stand by service during unplanned interruptions of the Open Exeter service and it’s associated applications • https://nww.standby1.openexeter.nhs.uk/nhsia/index.jsp

General Purpose Audit Report • Change Request Enhancements • More flexibility within searches • More capacity within searches • All payment cycles are now listed • Multiple payment cycles can now be selected • Archived claims are now included automatically, depending on selection

General Purpose Audit Report

General Purpose Audit Report • Viewing Results • Screen shows claim details • Further searches on results available

General Purpose Audit Report • Report screen shows available options: • Order options are: • Optician code, month of claim, patient’s date of birth, patient’s surname, patient’s forenames and patient’s postcode • Output options are: • Report, File (CSV) or Both

Ophthalmic Payments