Articles in this section

See more

Claim Forms in CCP

Aishwarya Nair
  • Updated
Follow

Topics Covered

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.
  • When a CCP status transitions to In-Progress, the system will scan all other open (unsubmitted) NHS plans of the patient and recalculate fees as per the NHS fee logic regarding Treatment Plans concurrent with CCP.

  • Only Band 1 and Band 2 codes are billable inside a CCP, attempting to add Band 3 or denture modification codes triggers a warning, allowing users to move those treatments to a new NHS treatment plan with auto-calculated fees.

  • When adding Band 1 or Band 2 codes to a non-CCP plan while the patient has an active CCP (In-Progress or Suspended), the system prompts the user to move the codes into the active CCP plan and submit the next interim claim, ensuring NHS compliance.

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.

Related Articles

 

 

Related articles