This describes the possible processes for checking eGOS claim status and rejected claims.

Checking the status of an individual claim

The status of a claim can be checked from an individual's claim module, however this is not a recommended process for daily checking of all the submitted claim statuses.

Open the patient record of the claim you would like to check the status of.

Click on the ‘Px Claims’ button.

The patient claim will open.

In the bottom right corner click on a button called ‘Get Status’.

An eGOS Claim Status box will open, please wait while i-Clarity checks the PCSE website for the claim status.

Once the status of the claim has been received it will be displayed in the box.

Once the claim status has been retrieved, a button will appear on the claim form called ‘Show Last Status’. This allows you to check the last status received from the PCSE website at any time. i-Clarity will also show the status of the claim next to the claim number at the top of the form.

It is advised that you check the status of your submitted eGOS Claims daily so that any rejections can be dealt with as they occur.

Checking the status of multiple claims

Open the Deferred Payments module.

Whilst on the status ‘Not yet submitted’ and the payment type ‘NHS Payment’ check there are no old unsubmitted claims. You should aim for the status ‘Not yet submitted’ to be clear of GOS1 claims at the end of every day.

Now check the claims that have been submitted that day for rejections. (This could either be done at the end of the day or it could be done the next day for yesterday’s claims).

Select the payment status ‘Not yet paid, submitted between…’ and the payment type ‘NHS Fee’. 

Either enter today’s date in both the to and from date fields (if you are checking claims submitted today) or yesterday’s date (if you are checking the claims submitted yesterday).

Click ‘Retrieve Records’.

At the bottom of the page click on the button, ‘Update Claim Statuses’.

Please wait while i-Clarity checks the PCSE website for the claim status. Once received the status of the claims will be listed in the box.

Click 'Close'.

The Status of each claim will also be listed against each payment line.

Use the scroll bar along the bottom of the grid of payments to scroll to the right and display the claim status.

Rejected Claims

Rejected claims will also display a status message with the PCSE rejected reason code.

Double click on the patient’s name to open the rejected patient claim.

On the claim click the ‘Retract' button.

This will allow you to edit the claim information.

Once the claim has been retracted the payment in deferred payments will be unsubmitted and it will reappear in the deferred payment list as 'not yet submitted'.

On the claim you will be able to click on the ‘Show Last Status’ button to show the error code from the PCSE. The meanings of the error codes are listed in i-Clarity. To view the error codes, click on the button ‘Error Codes’.

This will open the ‘Business and Validation Error Codes’ form.

You can either scroll through the list of codes or enter the code in the ‘Search by code:’ box and then click refresh.

This will then change the display to show the relevant code reason.

Once you are aware of the reason for the rejection you can close the 'Business and Validation Error Codes' box.

Make the necessary changes to the claim or refer the rejected claim to the optometrist for correction.

Once you have made the correction, click the 'Submit' button on the claim. You can either then wait and check the status from the patient's claim (this may take a few moments) or you can return to the deferred payments module and check the status with any other resubmitted claims.

Repeat the above process for the GOS3 and GOS4 payment types.