NHS Claims covers both the Refer-Out and Refer-In processes. In this article, let's walk you through how to configure a treatment code as an NHS code with Referral for Advanced Mandatory Services and how to use it in the patient’s chart to refer the patient out.
Topics Covered
Let's get started!
Configure Procedure Code
To configure a treatment code,
- Navigate to the System Menu > select Practice Settings > Treatments > Procedures.
- Click + Add New Procedure.
On the Add Procedure Code slide-out,
- Input the Code Details and Chart preferences.
Under the NHS Setup,
- Available for NHS: Select Yes to set up the code as NHS and enable the NHS Tx Category.
- SNOMED Code: Choose the desired SNOMED (Systematised Nomenclature of Medicine) Code from the dropdown.
- NHS UDA Band: Select the desired UDA Band.
- NHS Tx Category: Choose the desired NHS Tx Category. Here, for the referral code setup, use Referral for Advanced Mandatory Services under General Treatments.
- Treatment is a filling: Choose Yes or No as desired.
- Click Save.
- A toast notification will appear on the top-right stating, 'Procedure Code added successfully'.
Add Treatment to the Patient's Chart
- Search for the patient using the Global Search Bar.
- Click the Chart quick link for the intended patient.
- Search for and choose the treatment code from the right.
- Once the treatment is added to the chart, it will be visible in the plan.
- Adding a code setup as 'Referral for Advanced Mandatory Services' can be used to refer out a patient.
| Note: The Patient Payable for the plan will include the payable amount for the referral treatment, but the UDA for that treatment will not be included in the claim. |
Referring In
When a referred-out patient attends their appointment, the receiving practice can mark the case as an NHS Referral. To do this, on the treatment plan, Either
- Select Mark as NHS Referral from the three-dot menu.
Or,
- Select Mark as NHS Referral from the gear (
) icon.
- Once marked as an NHS referral, the Patient Payable automatically becomes £0.
- On the left side of the treatment plan, you will see the plan Name, Status, Location, Payor, UDA, and the Referral pill (if the treatment has been accepted from another practice).
- Click Submit Claim to open the Claim Submission form.
On the Claim Submission form,
- You will find the Band, UDA allocated for the treatment done, and the Patient Payable on the top-right.
- For the treatment that has been referred out, the status will be shown as Referred Out.
Practices can use this simple guide to gain a clear understanding of how to configure a treatment code as an NHS code with Referral for Advanced Mandatory Services, apply it in the patient’s chart, and refer the treatment out when needed.