When a practice arranges for a patient to be 'treated on referral', a number of Commissioners now use a central service to allocate these 'treatment on referral' cases.
This is commonly known as a 'triage service'.
Where a 'treatment on referral' case is managed by a triage service, the referring dental practice will not initially know if the patient is to be treated under Additional Services, Advanced Mandatory or Secondary Care hospital arrangements.
The referring practice has 2 options in regards to the management of the patient's dental charges.
How you deal with the situation as a practice is a matter for the contracts provider to decide. The contract provider is advised to have a practice policy in place to cover this type of referral issue.
Option 1
Take the full patient charge for the planned treatment before the triage centre decides where the patient is going to go.
If the patient ends up being treated on a Advanced Mandatory Referral or in secondary care hospital, the practice must refund the appropriate amount overpaid by the patient and either:
- withdraw the original claim
- resubmit the claim with the correct details if they had already submitted a claim before the true referral outcome was known
Option 2
Delay submitting a claim or taking the patient charge until the referral outcome is known.
If the Date of Completion (DoC) was more than 2 months before this outcome is known, there would be no UDA activity processed in respect of the care provided by the practice as the claim would be regarded as 'late submitted'.