How to Work with NHS Orthodontic Claims

Related Training
NHS Ortho Contracts Recorded Class

In addition to NHS dental claims, Sensei Cloud enables you to create, manage, and send claims for a patient's orthodontic treatment.

Orthodontic Contracts

(Administration > Contracts)

Before creating a treatment plan and adding procedures to it, an orthodontic contract must be created. 

Under Actions, select Create New Contract. Within the Create New Contract window, you can set the target number of points for the Units of Ortho Activity (UOA), enter the contract start and end dates, add performers, and manage performer targets. 

Note: Select the contract in the left side panel, and click Edit Selected Contract to make changes to the contract. You can also filter the list of contracts to Dental or Ortho.

See How to Add an NHS Contract for more information.

Treatment Planning

(Patient > Treatment Plans or Clinical > Dental Chart > Planning Mode)

When an orthodontic contract has been set up, you can create an orthodontic treatment plan.

From the Dental Chart

To create an orthodontic treatment plan from the patient's dental chart:

1. Select Planning Mode, and then click the + icon. The Create New Treatment Plan window is displayed, with Treatment Under the NHS selected by default.
2. Enter a unique name for the new plan and click OK, or accept the default name (Plan number and date created). 
3. If applicable, select Replacement Appliance, Two Replacement Appliances, or Repair To An Appliance Fitted By Another Dentist.
   Note: If the patient is just starting their orthodontic treatment, leave these options deselected.
4. Select Orthodontic as the Treatment Type.
   
5. Select a performer from the drop-down list.
6. Select a contract from the drop-down list. 
   Note: When Orthodontic is selected as the treatment type, only orthodontic contracts are available for selection. 
7. Click OK. You are returned to the patient chart in Planning mode.
   Note: The UOAs for the selected orthodontic treatment plan are displayed in the banner.
8. Begin charting by selecting Tooth, Surface, or Region.
9. Click Add Code in the Tools section. The Add Code window is displayed.
10. Select a procedure code to add. 
    Tip: Use the search field to quickly find specific codes.
11. Continue adding procedures to the plan. Each proposed procedure is added as a note in the Clinical Notes section of the left panel and saved automatically with the plan.
    Note: Click the Pencil icon to edit the treatment plan as needed.

From the Treatment Plans Window

To create an orthodontic treatment plan from the Treatment Plans window:

1. Under Actions, click Create New Plan. The Create New Treatment Plan window is displayed, with Treatment Under the NHS selected by default.
2. Enter a unique name for the new plan or accept the default name (Plan number and date created). 
3. If applicable, select Replacement Appliance, Two Replacement Appliances, or Repair To An Appliance Fitted By Another Dentist.
   Note: If the patient is just starting their orthodontic treatment, leave these options deselected.
4. Select Orthodontic as the Treatment Type.
5. Select a performer from the drop-down list.
6. Select a contract from the drop-down list. 
   Note: When Orthodontic is selected as the treatment type, only orthodontic contracts are available for selection. 
7. Click OK. The Manage Treatment Plan window is displayed.
8. Add procedures or groups of procedures to the plan.
9. Add information to the Patient Notes to be included in the printed treatment plan, if needed.
10. Click Save Changes.
    
11. Click Close.
    Note: Items from the treatment plan cannot be completed until the NHS treatment plan is accepted. 

See NHS Treatment Planning for more information.

NHS Orthodontic Claims

A treatment plan must first be accepted, and then you can select and schedule procedures and groups, complete procedures, complete the entire plan, and edit the claim details.

Note: Certain items must be entered in the patient's record in order to accept a treatment plan, such as a valid address. 

Start of Treatment Claim

The first orthodontic claim to send is the Start of Treatment claim.

To update and prepare the Start of Treatment claim to be sent:

1. From the Viewing Treatment Plan window, click the View Claim icon. The Update NHS Orthodontic Claim - Start of Treatment window is displayed. 
2. Click the menus in the right sidebar to expand them, and enter information as needed.
   
   Note: Most of the items in the Start of Treatment section are required and must be filled out before marking the claim as Ready to Send, including:
   --Treatment on Referral: Enter a date.
   --Dental Health: Select an option from the drop-down list.
   --Assessment Complete: Select Assessment Complete, and then enter the Assessment Date and select a Result. Note: Depending on the selected result, additional required fields might be displayed. For example, if Appliance Fitted is the selected result, you must enter the Fitting Date.
   --Commissioner Approval: When the assessment Result has been selected, you can then select this option.
3. Click Update to save the changes.
4. When you are ready to send the claim, click Mark as Ready To Send.
   Note: A message is displayed if there is any missing information that is required to send the claim.

End of Treatment Claim

When you complete the orthodontic treatment plan, you can then submit the End of Treatment claim.

To update and prepare an End of Treatment claim to be sent:

1. From the Viewing Treatment Plan window, click Complete Plan. The Update NHS Orthodontic Claim - End of Treatment window is displayed.
   Note: You can also click the View Claim icon to access the End of Treatment claim.
2. Click the menus in the right sidebar to expand them, and enter information as needed.
   Note: Most of the items in the Completed Treatment section are required and must be filled out before marking the claim as Ready to Send, including:
   --Treatment Finished: Select the Orthodontic Treatment End option, select an End Date, and select an option from the Treatment Finished drop-down list (e.g., Completed, Discontinued, etc.)
   --Dental Health: Select an option from the drop-down list.
3. Click Update to save the changes.
   Note: You can click View Start of Treatment to view the Start of Treatment claim.
4. When you are ready to send the claim, click Mark as Ready To Send.
   Note: If the treatment plan has not been completed, a message is displayed informing you that you need to complete a course or mark it as FTR (i.e., the patient failed to return and complete treatment).

Claims Management

(Location > NHS Claims > Claims Management or Patient > NHS Claims)

You can view or send/receive claims from the Claims Management list.

This list includes information about the claims such as the claim status, acceptance and completion dates, and UOAs.

Note: You can filter the claims by type: Dental, Ortho - Start, and Ortho - End.

See How to View NHS EDI Claims and How to Update an NHS Claim for more information.