Ophthalmic PaymentsNational User Group Meeting16th January 2014Presented byMark Green & Mark Hillman

Ophthalmic Payments ServiceCentral Ophthalmic Payments system continues to use old PCTs as the organisational structure within England

Local Code to indentify a Contractor

Constrained by Organisation Code to provide unique code per contractor

No changes

Ophthalmic Payments ServiceNo longer doing a full PCT migration:Minimise riskContinuity of serviceeGOS practices remain operationalLarge effortSmall benefit

Focus will be on reconfiguring the organisation hierarchy within the central Ophthalmic Payments system

Current Organisation Hierarchy

Possible Organisation Hierarchy

Ophthalmic Payments ServicePCSS offices can decide to re-structureSupport log will be requiredProvide new structure for organisationsChange to be implemented by HSCIC between payment cycles

You will be able to log into all responsible organisations using one Open Exeter account

Ophthalmic Payments ServiceGrouping of organisations for payments can be changed or remain the same as today

Local Contractor codes remain unchanged

No additional work required for PCSS staffBut update your organisations from PCTs

Electronic StatementsBackground

Setup

Sending electronic statements

Available downloadsNHS Ophthalmic Decrypt Utility

Electronic StatementsBackground

Payment system makes over 81,000 paymentsCovers 9,849 contractorseStatements has been identified to help reduce costs1,400 enabled to use eStatementsNew report to list eStatements details

Print Optician Email Statement Settings Report

Electronic StatementsSetupSending email addressSet email address for your Payment AuthorityPractice email address & passwordPractitioner electronic claims settings

Sending payment statementsAll statement reports (email option)

Electronic StatementsSending email address

Electronic StatementPractice email & password

Electronic StatementsSending emails

Electronic StatementsNHS Ophthalmic Encryption Utility (Version 1.5)

All electronic statements are encrypted for non NHS.NET email accountsA practice can use our decrypt utility for free but mustAgree to terms & conditions of use

Electronic StatementsAvailable downloads

Data File Formats for Electronic Submission of Contractor Claims User guide & FAQsNHS Ophthalmic Payments Decrypt Utility Overview & file (Version 1.5)NHS Ophthalmic Payments Decrypt Utility terms & conditions of use

Electronic Links (eGOS)Activity Details 399 active stores261 Specsavers stores93 practices using the Optix system24 Vision Express stores use Ocuco21 Independents125 PCT/LHBs over 54 payment agencies

Electronic Links (eGOS)Claim Volumes from May 2007

9,289,327 GOS 18,705 GOS 31,581 GOS 43 GOS 584 GOS 6

Non CR deliverablesISFE / regulation workPerformance improvementsRe-platforming Ophthalmic Payments systemOptions for Organisation Migration

Completed Change Requests

5183Add details (apart from password) from the Contractor Payment information/Electronic Claims Settings page to theopticians list report or create a separate report.

Released on 29/10/2013. Functionality is provided via: System Administrator Setup -> Opticians Details Reports -> Print Optician Email Statement Settings List5433Enhance the current reports to collect the ethnicity data that is entered into the system

This CR has been closed and the additional ethnic information will be available within the EHEW statistical report fromthe 29th August 2013.

Open Change Requests

4796HoldSystem to amalgamate statements based on email addresses.5032Facility be introduced on GOS3/4 at the 3 month after collection stage, to prevent old claims going through.5108Allow duplicate statements for those performers on a list outside of Essex to be available once the monthly cleardown hasoccurred.Requirement needs to be clarified as the system should be able to produce Duplicate Performer Statements for all PCT areas outside of Essex. It may be that this functionality is already provided.5140Block claims for a small glasses supplement if the patient is a child NOT Under 7 years.5143Batched Enhanced Service Information to be included within the General Purpose Audit ReportRequirement needs to be clarified. Would batched data be considered for the General Fraud Audit as there is no patient details data to check for fraud on Batched claims?

Open Change Requests

5274Facility required to upload a batch total for GOS 1's per premise from a spread sheet into OE each month.Consideration needs to be given - as we are trying to move away from non-descript batches and encourage more use of Electronic Links to provide more richer data for better fraud checking and more accurate control over payments to Opticians.5323Is it possible to have asterix's marked as mandatory fields5552Enhance the report on the General Purpose Audit Reporting screen for Additional Services to include the clinical data5553amend the Fraud Officer access to enable Post Verification Teams to view the Statistics menu5563PPV adjustments as separate items to any other adjustments

Service Performance - targets98% of reported support calls to be responded to within target90% of reported support calls to be resolved within the target

PriorityMaximum Response TargetMaximum Resolution TargetExamples130 minutes1 dayUnavailability of the entire system, a key module or major function, causing significant business impact.21 hour1 dayUnavailability of the entire system, a key module or major function, causing limited business impact.32 hours5 daysProblems causing inconvenience, minor disruption or restricting performance.44 hoursAs agreedNon urgent problems causing slight irritation but where workarounds are available; cosmetic or general enquiries for information.

Service Performance - achievement

2013/14AprMayJunJulAugSepOctNovNo. Calls6034253019211418Response % - (98% target)100100100100100100100100

Resolution % - (90% target)95889697100959394Availability (%)100100100100100100100100

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When you select the Email option on the statement report, no other Contractor statements will be generated EXCEPT the ones set up for emailing. However, if you select the Report or BOTH option then you can decide whether to exclude the Email Statement Contractors from the printed report using the Exclude Email Opticians from printed report box. The default is NO, so that when you generate the PDF Report it includes all Contractors.

**This address will be used as the sender and it could be an active account to enable communications between the ophthalmic team and the contractor.*Enter the practice email address & password , set the Email Statements flag to YES.

Electronic StatementsSome of the statement reports have the ability to email payment statements directly to the optician. To fully facilitate this option, you must enter a valid email address for your Payment Authority on the Payment Authority Organisation screen. Your responsible Payment Authority is identified on each of your NHS organisation records by the value found within the field Responsible Organisation Code. To use the electronic statements, please set Email Statements to Yes, enter the opticians email address which will receive emails containing their electronic statements and then enter a password for this optician. Then click Create/Update to save the record. You must keep a note of the Optician's password and pass this onto them, as the Optician will need to know it to view their electronic statements.

To fully facilitate the electronic statements option, you must enter a valid email address for your Payment Authority on the Payment Authority Organisation screen. To do this, you must go to the System Administrator Setup menu, then Setup Details, then Enter Organisation Details. On this screen, change the Type field to Payment Authority and then select your Payment Authority from the list of organisations. The system will allow you to view all Payment Authority records, but you can only update your own record. Using your Payment Authority organisation, update the field called Email Address to hold a valid email address and then click Update. This allows the Ophthalmic Payments System to send the Electronic Statement emails with your nominated email address as the Sending email address. Any emails which were not delivered to an optician will be reported back to this nominated account and show if any Opticians did not receive any of their Electronic Statement emails.

Sending Electronic Statements to Multiple Email AddressesTo send Electronic Statements to multiple email addresses for the selected Contractor, enter all the required Email Addresses into the Statements Email Address field separated by either a comma or a semi-colon. A space can also be used in conjunction with the comma or semi-colon to separate the Email Addresses.

You will need to ensure the password is strong enough to protect the contractor payment statements. *

When you select the Email option on the statement report, no other Contractor statements will be generated EXCEPT the ones set up for emailing. However, if you select the Report or BOTH option then you can decide whether to exclude the Email Statement Contractors from the printed report using the Exclude Email Opticians from printed report box. The default is NO, so that when you generate the PDF Report it includes all Contractors.

*The decrypt utility runs in under a windows operating system, (or emulator). It is an available download for PCTs and Agencies from https://nww.openexeter.nhs.uk/nhsia/opthelp/Ophthalmics/eng/indexElectronic.html.

If the Contractor has problems decrypting a file then they should ask the PCT to send them the latest version from the website, as it may have been upgraded. Or use nhs.net if both parties have nhs mail email addresses. (Or https://nww.sft.nhs.uk if both parties have nhs mail email addresses.)*Web site: https://nww.openexeter.nhs.uk/nhsia/opthelp/Ophthalmics/eng/indexElectronic.html

Choose Available Downloads from left-hand menu.***1554 English contractors now setup to use eStatements increase of 146*