Complex Care Pathways Workflow in CareStack

CareStack supports NHS Complex Care Pathways (CCP), enabling practices to create, manage, and submit CCP treatment plans.

To get started,

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

On the desired NHS Patient's treatment plan,

Always ensure to add any exemptions to the plan, if any, before marking them as CCP.
Select Mark as Complex Care Pathway from the gear () icon to the right of the NHS (payor) label.

Note:

Ensure the patient is eligible for signing up into a CCP. To learn more about the clinical criteria click here.
At this time, the NHS does not perform clinical eligibility validation for pathway entry. The clinician is responsible for determining the appropriate pathway based on the patient's condition and clinical assessment.
Once NHS starts pathway entry validation, changes would be made to the CCP workflow in a future release to support such validations.

When a pathway is selected, the Entry Criteria and the following are displayed:
- Number of required submissions
- Total NHS payment for the pathway
- Payment per submission
- Patient payable amount
Click Confirm to proceed.

Add and charge out any treatment code to the plan, if required.
A light purple banner and the patient charge will be computed and displayed in the chart.
Click on the View Declaration button to open the Complex Care Pathway claim popup.

This popup comprises of all the claims pertaining to that CCP.
- Once the sign up claim is accepted by the NHS, the clinician can submit the succeeding ‘Interim’ claims after reviewing the applicable declarations.

Sign Up Claim (First Claim of the CCP)

On the Claims Submission modal,

Complete the Signup form.
- Claim Details
- Claim Submission Details
- Treatment Details
- Patient Contact Details
- Deductions
- Clinical Details
- Declaration
Once all the mandatory fields are filled, click Submit Signup and proceed.

If there are any errors in the data, the system will flag it:

You will find an alert message prompting right ways to submit the claim.
You can also Edit Patient Details as needed.

Note:

Pathways 1 and 3 consist of a total of six claims: one Signup claim, four Interim claims, and one Completion claim.
Pathway 2 consists of a total of twelve claims: one Signup claim, ten Interim claims, and one Completion claim.
It is always recommended to submit the claims monthly.
A claim can be submitted only after the previous claim has reached at least the Received status from the NHS, ensuring the claim is eligible to proceed.

Interim Claim

Clinicians can submit interim claim stages as long as the patient is on a Complex Care Pathway even though there is no active treatment carried out during the month.

Note:

The two-month rule is applicable for the Signup and Completion claim submission stages.
Interim claims in a pathway can be submitted in sequence any time between Signup and Completion subject to the following conditions:
1. The next Interim claim becomes available for submission only after the previous claim in the pathway is accepted by the NHS.
2. For interim claim submissions in July 2026, the first interim claim submission should be no earlier than July 15th.
3. Subsequent interim claim submission should be no earlier than the 1st of the applicable month.
Each interim claim submission would be eligible for UDAs equivalent to the NHS payment for each pathway submission. This will be paid in the payment processing cycle in which the interim claim was received.
The patient payable would be deducted from NHS payout associated with the Completion claim.

The total value of each interim covered so far by the total value of the CCP is displayed here.

When a particular CCP Claim attains a Received or Completed status, the system automatically directs you to the next available claim in the pathway whenever View Declarations is selected.
Use the left and right arrows to navigate between the different claims in the pathway.
Data within Interim claims is read-only and cannot be edited, except for the Declaration section.
- Use the collapsible arrows to expand or collapse sections and review the claim details.
- The information is collapsed by default to reduce scrolling, as it was already captured during the Signup claim submission.
Review the information and sign the declarations to proceed.
The 'Potential UDA' is computed based on the Notional Value set against the Contract selected. Once the claim is accepted by NHS, this label gets renamed to 'Confirmed UDA'.
The Signup Claim declaration differs from the declarations used for Interim Claims.
If the patient has any parallel treatment plans and is currently undergoing treatment under them, select the applicable 'concurrent' declarations in the Interim claim in CCP, as well as in the concurrent plan's claims as well.

You cannot submit the next claim until the current claim reaches a Received or Completed status.

Suspend or Mark As Incomplete

Choose Suspend to pause the treatment temporarily and Mark as Incomplete for a permanent closure.

Note:

A CCP can be suspended only once during its lifetime for a maximum period of 3 months.
After 3 months, a suspended CCP automatically becomes incomplete.
Mark as Incomplete to close the CCP before Completion.

Practices can use this guide to learn about complex care pathways.