Explore the NHS Orthodontic Workflow

Orthodontic treatments usually span a longer period, ranging from a few months to several years. Therefore, orthodontic claims are submitted in two stages: an Assessment claim and a Completion claim.

UOA (Units of Orthodontic Activity) is the orthodontic equivalent of UDA (Units of Dental Activity). They represent the level of activity or effort involved in orthodontic treatments.

Each orthodontic treatment involves two sets of claims:

• Assessment claim: This covers the orthodontic assessment or appliance fitting that has been done. 
• Completion claim: This is submitted at the end of treatment, which could take anywhere from a few months to a few years.

To set up a practice to work with UOA, the process starts with contracts. To learn more click here.

Set Up Treatment Plan as Orthodontic

• Search for the intended patient using the Global Search Bar.
• Click the Chart quick link.

• Search for the desired orthodontic treatment code and apply it to the treatment plan.

To learn how to configure an NHS treatment code in the system, click here.

Note: The system will only consider the Treatment Plan as Orthodontic if at least one code from the NHS category of Orthodontic Treatments is added and charged.

• Once the treatment code is marked as completed, click Submit Claim to bring up the claim submission form.

Note: You can identify whether a treatment plan has been classified as orthodontic by clicking the Submit Claim button. Two options will be displayed: Assessment Claim and Completion Claim.

Assessment Claim Form

• Click Assessment Claim (NHS Ortho) to submit the claim.

• When you choose Completion Claim (NHS Ortho) instead of Assessment Claim (NHS Ortho) you will find a warning in the claim submission form stating, 'This is an Ortho Completion Claim' to alert the users. 

• Selecting the assessment claim opens the Ortho Assessment [FP17O] modal (which is slightly different from the normal FP17 or UDA claim).
• In the Claim Details, a UOA Contract must be selected along with a Clinician.

• Within the Treatment Plan section, the Referral Date, is mandated by NHS. (orthodontic treatments are generally assumed to be the result of a referral)

• An Assessment Date must be chosen from the date picker. The assessment date must be on or after the referral date. Selecting an invalid date displays an error message.

• The Assessment field indicates the specific orthodontic assessment performed. It can be one of four options. Based on the selected Assessment, the UOA value will be updated dynamically at the top of the Claim form.
• If the Assessment selected is,
  • Assess & review only, and the patient does not require orthodontic treatment, the system dynamically updates the UOA value to one.
  • If the patient refuses orthodontic treatment after assessment, the Assess & refuse option can be selected and one UOA is awarded for the assessment effort.
  • If the assessment determines that orthodontic treatment is required and the patient agrees to proceed, an appliance is fitted. In this case, select Assess & Appliance Fitted, and the UOA value will update to the prescribed higher value. You must also enter the appliance fitting date, ensuring that it is on or after the assessment date.
  • If the assessment determines that orthodontic treatment is required, the patient agrees, and an appliance is fitted, select Assess & appliance fitted the UOA value updates to the prescribed higher value. In this case, the appliance fitting date must also be entered, and it must be on or after the assessment date.
  • Another option applies when a patient already has braces and they need to be removed or debonded. Selecting Assess & debond (overseas patient) option assigns the corresponding UOA value. All UOA calculations are performed according to NHS-prescribed values, and the UOA total updates live based on the selected activity.
  • Orthodontic treatments are typically done for patients under 18 years of age. For such patients, the NHS-prescribed patient charge is £0. For patients over 18, a patient charge may apply, and the system automatically calculates it based on the patient’s age.

• The Commissioner Approved field is optional. 
  • For patients above 18, permission approval may be required. This information can be captured using the checkbox and passed through in the claim form.
• The IOTN Score (Index of Orthodontic Treatment Need) indicates how severe the patient’s orthodontic condition is.
  • A lower score indicates good alignment, while a higher score indicates a greater need for orthodontic treatment. 
  • The score ranges from one to five.
  • This value justifies the orthodontic treatment and is mandated by NHS.
  • The rule states that IOTN must be four or five for the claim to be accepted. 
  • If the IOTN score is three, then the Aesthetic Component score must be six or above. 

  • The eligibility requirement is shown as a tooltip in the system. Hover over the to view the following

    

  • The system allows users to submit claims with non-qualifying values, but displays a warning message. The risk of rejection lies with the user.
• In the Patient Contact Information section, consent for the phone number and email address is set to No by default. If the patient provides consent to share their contact details, this can be updated, and the information will be included in the claim.
• Click Submit Claim, once all the details are added to the form.

• The submitted claim appears in the Assessments Claims grid (under NHS Centre > Claims > Ortho Claims).
• On submission of the assessment claim, the UOAs are awarded upfront (and are not dependent on the submission of the Completion Claim). Even though assessment and completion claims exist as pairs, UOAs are awarded only on the assessment claim.
• The completion claim is used purely for auditing and to inform NHS that the course of treatment has been completed. No additional UOAs are awarded, and no UOA values are modified based on completion outcomes.

Completion Claim Form

To submit the Completion Claim,

• Visit the same Treatment Claim (i.e., the Treatment Plan where the Assessment claim was originally submitted) and click Submit Claim.

• Click Completion Claim.

Note: The completion claim is used for auditing and to inform NHS that the course of treatment has been completed. 

• No additional UOAs are awarded, and no UOA values are modified based on completion outcomes.
• When submitting a completion claim, the Contract and Clinician are pre-selected (based on the values chosen in the Assessment Claim). 

• The form includes the Final Assessment Date and the IOTN Score after treatment. 
• Enter the PAR score (Peer Assessment Review) pre & post treatment.
  • This is a scoring metric used to assess how well the orthodontic treatment has progressed.
  • Values range from 0 to 100. 
  • Higher scores typically indicate worse pre-treatment conditions, while lower scores indicate better post-treatment outcomes.
  • These fields are optional. 

• The Completion Claim represents the treatment outcome. The Completion Claim represents the treatment outcome. There are three possible outcomes:
  • Treatment Completed, which requires a completion date.
  • Treatment Discontinued by the practice, which requires the last visit date.
  • Treatment Abandoned by the patient, which requires a reason such as failure to return or patient request.

• Enter all the other mandatory fields and click Submit Claim.

• The submitted claim appears in the Assessments Claims grid (under NHS Centre > Claims > Ortho Claims).

• You will find a icon. Hovering over it shows 'Completion Claim linked. Click to view'.
• Clicking it will take you to the Completion Claims tab.

• On the Completion Claims tab, you will find a icon, click it to return to the Assessment Claims tab.

Practices can use this comprehensive guide to understand the NHS Orthodontic workflow in CareStack.