NHAIS Finance Development News - NHS Connecting for Health

Issue 40 – April 2011CR 1279 requested that download of paid claims also include total amount payable followingthe count of claims at pay rate. This now will supply an account of how much has been paid forhow many claims at each individual rate within the Paycode. So the new /DOWNLOAD UnixFile Layout will be:Paycode, PCT Code, Practice Code, Rate, Payment Date, Number of Claims, Amount paidFor example:NIGHT,5JJ,E12345,A,01.04.2010,100,751.00NIGHT,5JJ,E12345,B,01.04.2010,200,3004.00This additional field only holds paid amounts. Records of unpaid EM claims will contain zeroesin the amount field – indicating that these records have yet to be processed.The FJ-DESE process is also being modified to provide an analysis of payments down toPayband within Paycode level.CR1279 changes were issued to commence pilot at South Staffordshire, the site responsible forraising the initial CR on 8 February. Full National Release will depend on pilot signoffachievement, but is anticipated for later this month (April 2011).2.2.4 CR 1284 – To provide flexible NHS Number Duplicate checking on EMand FJ-DESE by including the option of extended validation checkingto identify claims for the same Paycode and NHS Number withinspecified defined time periods (e.g. Duplicate Claim within year ormonth or quarter – or within a defined elapsed time)Work is progressing to build the new EM PAYCODE/*DUP screen for initialising NHS NumberDuplicate checking parameters. A layout of the new EM PAYCODE/*DUP screen is shownbelow:EM]Direct/Local Enhanced Services Qualifier[GSWINE/*DUP ]SWINE FLU (GMS) – Claims BasedPermit Duplicates (Y) . . . . . . . . . . . . . . . . . . . . . . . . . . . .[ ]Reject Same Day Duplicates only, otherwise permit entry . . . . . . . . . . .[ ]Reject all Duplicates (Y) . . . . . . . . . . . . . . . . . . . . . . . . . .[ ]Reject Duplicate entries within a time period . . . . . . . . . . . . . . . .[Y]Minimum days between Duplicates (else REJECT) . . . . . . . . . . . [9999]Reject Duplicate entries within a date range from . [ ] to [ ]Reject Dupl entries within same (M)onth, (Y)ear or (Q)tr (M, Y or Q). . . . .[ ]Only one type of duplicate check can be applied from the above selection. Min.Time Period selection requires ‘Y’ to select minimum period plus entry of mindays in range 1 to 9999.Figure 12: EM PAYCODE/*DUP ScreenThis facility enables the NHS Number Duplicate Checking function performed on Open Exeterinput of DES/LES claims to be tailored to specifically match the requirements of each claim type(as designated by Paycode). For example it is appropriate to permit a qualifying (aged over 65)patient to receive one Flu vaccination every year so validation for the Flu Paycode can be set toinhibit duplicate claims against the same patient within the same Flu year. Other interventions© Crown Copyright 13