How to Update an NHS Claim

Sensei Cloud enables you to update existing NHS claims and to modify and resubmit an NHS claim that has already been settled.

To update a claim:

1. From the Patient tab, select NHS Claims. The patient's claims are displayed.
   Note: You can also access claims from the Location tab > NHS Claims > Claims Management.
2. Select the claim from the list. The Update NHS Claim window is displayed.
   
   Note:
   --The claim status must be Not Ready before you can update the details. Select Mark as Not Ready if you need to change it before continuing.
   --Click View Treatment Plan to navigate to the treatment plan. 
3. Select a category to display the values and entry fields.
   
   Note:
   -- You can set a Flexible Commissioning indicator from the Course of Treatment section. For more information, see How to Flag an NHS Claim with a Flexible Commissioning Indicator.
   -- NHS claims populate the highest BPE score (worst sextant) and number of untreated teeth with decay (if enabled in the practice settings) in the Clinical Data Set / DMF section. You can view or override the auto-filled values (Untreated Decayed Teeth is under Examination while the Highest BPE Sextant Score is under Oral Hygiene) during claim submission.
   See NHS Treatment Planning, How to Add Existing Conditions or Diseases on the Hard Tissue Chart or Dental Chart, and How to Create a Periodontal Screening and Recording (PSR) or Basic Periodontal Exam (BPE) for more information. 
   Note: For customers in Wales, effective for NHS claims on or after 1 April, 2025, three additional options display under the Other Services section to meet CCN75 compliance requirements:
   -- DAP New Patient: Patient has registered via DAP (Dental Access Portal) for non-urgent treatment.
   -- New Urgent Patient Referral: Patient has been referred via DAP (Dental Access Portal) for urgent treatment.
   -- Did Not Attend: Patient has been referred via DAP (Dental Access Portal) for urgent treatment but has not turned up for any appointments.
4. Make the necessary changes to the claim details.
   Note: See Changing the Performer and Contract in an NHS Claim for more information.
5. Click Update.

Changing the Performer and Contract in an NHS Claim

To update the Performer and/or Contract for a claim:

1. From the Patient tab, select NHS Claims. The patient's claims are displayed.
2. Select the claim from the list. The Update NHS Claim window is displayed.
   Note: The claim status must be Not Ready before you can update the details. Select Mark as Not Ready if you need to change it before continuing.
3. From the Performer drop-down list, select a different performer.
   
   Note:
   --NHS Claims ensure that Claim Reference Numbers (CRNs) are not duplicated when claims are updated and resubmitted. Logic checks validate the CRN when the claim's Performer has been updated.
   -- If you change the Performer for the claim, the following message is displayed. Click Proceed to continue. 
   
4. If applicable, from the Contract drop-down list, select a different contract.
5. Click Update.

Resubmitting a Previously Submitted NHS Claim

If you discover an issue with a claim that has already been submitted, or even paid, you can replace the previously submitted claim with a new one containing corrected data.

Note: You cannot access the resubmission options until you have received a response to a claim.

To resubmit a claim:

1. Select the claim, and then click Resubmission Options.
2. Select Create New Submission.
3. Select Replaces Scheduled Claim.
4. Make the necessary changes to the claim details.
5. Select Mark as Ready to Send.