This describes a possible process for the journey of English electronic GOS1 claim forms within a practice using i-Clarity. There is now no clinic preparation required for the NHS forms.

 

Part 1: The Patient Attends Their Appointment

Open the appointment diary.

Double click on the patient’s appointment and when the Edit Appointment screen opens, change the appointment status to attended.

The Edit Appointment screen will automatically close. i-Clarity will have registered the last appointment that was selected so you can now click on the ‘View Patient’ button at the bottom of the screen to view the patient record.

Check the patient’s details and confirm they are entitled to an NHS sight test. If the patient is entitled to an NHS sight test, then click on the ‘Px Claims’ button.

This will open the GOS1 Claim form:

If this is the first time a claim has been created for this patient, it will open on a new form. If it is not, you will need to click the New button at the top of the page.

New unsaved forms will be coloured green and will not have a claim reference at the top of the form. Saved claims will be white and will have a claim reference.

It is advised that you complete the first two columns of the GOS1 form before the patient’s appointment.

The patient’s Name, Address and DOB will be carried through from the main record to the claim form.

Depending on the patient’s age, some of the entitlement reasons may be automatically completed, e.g. over 60 or under 16.

The NHS reason that is selected on the front screen will also be automatically completed on the claim form.

Check these automatic selections and make any additions or amendments.

If it is not the patient that receives the benefit selected in the blue box, then complete the section under the title ‘BENEFIT RECIPIENT’.

If you have selected an entitlement reason that is prisoner on leave, full time education, or medical entitlement that requires doctors’ details, we would advise that you complete the establishment name and town field like you would on a paper GOS1. (i-Clarity will automatically populate these fields where possible).

If the patient has had an appointment with you before, i-Clarity will populate the last eye exam field. You can over type this if it is a first exam with you or they have been elsewhere since the last exam with you. If the patient does not know when their last sight test was, you can select the ‘Unknown’ tick box. If it the patient’s first ever sight test, then tick the ‘First Test’ tick box.

Once you have completed these details, the patient now needs to sign the form.

Double click on the signature date in the first column. This will enter today’s date and will open the signature box.

Ask the patient to sign in the black outlined box.

Click 'Save' under the signature.

You can now exit the form.

This partially complete form will now sit in the Claims module ready for the optometrist to pick up after they have completed the sight test.

 

Parent/Carer/Guardian Signatures

Clicking on one of the bullet points for a parent, carer/guardian will cause a blue box to appear that you can enter the name and address details of the parent/carer/guardian in.

If the parent/carer/guardian are a patient, then you can click on the ‘Find’ button. This will bring up a patient search facility.

Or you can populate the address fields by ticking the box next to the postcode, typing the postcode in the box and clicking enter on the keyboard.

New future claims will automatically bring through the previous parent/carer/guardian details, but these can be overtyped if needed.

 

Part 2: The End of the Eye Examination, Optometrist Signature

The optometrist would now complete the eye examination.

At the end of the examination, double check the NHS fee has been assigned in the selected fees box, then click ‘Confirm Details and Load Claims’.

(From the Rx form, click 'Save Record and Load Claims'.

The NHS sight test fee will automatically be entered on to the patient till and listed in deferred payments. It will also be automatically linked to the started claim.

After clicking the ‘Confirm Details and Load Claims’ button, the partially completed claim form that the patient signed before the sight test will be loaded. The optometrist should now complete the top section of the last column.

If an early recall code was selected on the clinical record, it will automatically populate the claim. The exam date will be automatically populated with the exam date.

The optometrist should complete the following:

The optometrist's title, forname, surname and list number should have been automatically populated.

If the exam date, early recall code, optometrist title, forename, surname, and list number have not been automatically completed, click the ‘Load Exam Details’ button.

These details will not be automatically completed if there is no partially completed claim waiting for the exam and optometrist details to become available. They may arise when it does not become apparent that the patient is entitled to an NHS sight test until after the examination has been started.

(The optom forename, surname, and list number details are taken from fields in the Users tab in Maintenance. Please ensure these fields are completed correctly before starting to use eGOS claims).

Then double click on the optom signature date. This will enter today’s date and open the signature box.

Sign your name in the signature box and click ‘Save’ under the signature.

If the Optometrist completing the test is the authorised signature, then they have the option of completing the next step. However, if the authorised signature is going to be completed by another member of staff, you can now exit the form.

 

Part 3: Authorised Signatory and Submitting the Form

Practice list no, contractor forename and contractor surname are stored in the Maintenance module and will be automatically submitted with each claim.

To enter an authorised signature, click on the 'Authorise Signature' box.

Clicking on this button will open a password box.

Enter your i-Clarity password and click ‘OK’.

Your name will be entered in the name fields and a signature box will open. Enter your signature and click ‘Save’.

(Only users that have been marked as registered, authorised signatures will have their details entered into the claim after entering their password. This is set up in the Users tab of maintenance).

Underneath the authorised signature date there is a pink button called ‘Validation Errors’.

Once you have clicked ‘Save’ after entering your authorised signature, this box may disappear. If this box disappears, then the claim has passed the validation checks.

If this box remains on screen, then you can click on this box and a list of information that is missing from the claim will be displayed.

Once the ‘Validation Errors’ box disappears, the claim can now be submitted. Double check the claim information and then click the ‘Submit’ button.

i-Clarity will now submit the claim. Please wait while i-Clarity captures all the signatures, submits the data to the PCSE website and waits for a reply message to say the PCSE have successfully received the data. Once complete, a confirmation message will appear on the screen.

You can now ‘Exit’ the claim.

For the confirmation of submission message to appear, the PCSE website must return a message to i-Clarity within a set time window. If no response is received within the time window, i-Clarity will not mark the claim as submitted and instead will display the following warning message.

If this happens, a new button will appear on the claim 'Submit without web call'.

Do not try to resubmit the form.

Wait until the end of the day and check the PCSE website to see if the claim has been received.

If the claim was received by the PCSE website, click the button ‘Submit without web call’. This will mark the claim as submitted in i-Clarity and move it to the deferred payment list ‘not yet paid, submitted between’, without resending the claim data to the PCSE website.

If the claim has not appeared on the PCSE website, click the standard ‘Submit’ button. This will resubmit the claim data to the PCSE website. 

 

Part 4: Checking Claim Submission for the Day

For many practices, it may be more appropriate to complete Part 3 (above) as a separate daily task rather than throughout the day on a patient-by-patient basis.

If this is the case, you can use the list of ‘yet to be submitted’ payments in Deferred payments as a checklist. Claims that have been completed using the method described in steps 1 and 2 are automatically linked to NHS payments. These payments are listed in Deferred Payments.

Open the Deferred Payments module.

Payments linked to unsubmitted claims will be listed under the payment status 'not yet submitted' and under the payment type 'NHS'.

Green deferred payments are unlinked e.g. Patient NHS fees are not linked to an electronic claim form.

Once you start using electronic GOS claims rather than paper forms, you should have very few green payments. They will only occur if you have used a paper form or the PCSE website directly. It will also happen if a claim is started after the fee has been assigned to the patient’s till. For example, if it was during the eye examination that it became apparent that the patient was entitled to an NHS examination.

Orange payments are linked to a claim but are missing an authorised signature.

White deferred payments lines are linked to claims and have an authorised signature.

You will also notice that linked claims will have a claim reference number and if you double click on the payment line, it will open the patient’s claim form.

 

Checking Claim Submissions

Double clicking on a patient name from the list in Deferred Payments, will open the patient’s claim.

Once the claim is open, you can check the claim has all the required information and signatures, as well as that the ‘Validation Errors’ button has disappeared or shows no errors.

Once completed, you can click the ‘Submit’ button and exit the claim.

Submitted claims will automatically be moved to the status ‘not yet paid, submitted between’.

 

Correcting Unlinked Claims (Green Payments)

If you have any green payments, close the Deferred Payments module and open the patient record in the normal way. Then open the claim form, because the claim form is not linked to a payment, there will be a ‘Link Payment’ button in the top right corner next to the exam date.

Click on this button.

This will open a pop up called Unlinked Payments. Tick the box next to the correct payment. Then click ‘Link’.

If the form has been completed and signed, you can now submit it.

 

Bulk Signatures and Submissions

A feature has been added to i-Clarity that allows you to sign and submit claims in bulk. We do not recommend this feature is used on a regular basis as it is advisable that each claim is individually checked before submitting.

This feature is in the Deferred Payments module (it cannot be used with unlinked/green claims/payments).

For white payments (claims that have been signed), tick the box next to the payments that you would like to submit.

Click the button at the bottom of the page 'Submit Selected Claims'.

The Submit Claims form will open.

Click the yellow ‘Submit Claims’ button.

This will open a password check box to ensure an authorised signatory is submitting the checked claims.

Enter your password and click ‘OK’.

Please wait while i-Clarity captures all the required signatures and data, submits it to the PCSE website and waits for a successful response message.

If any of the claims fail our validation and cannot be submitted, no claims will be submitted. A message will be displayed to tell you which claims need correcting. You can either remove this from your list of selected claims or correct the validation errors before resubmitting your selection.

Once the claims have been submitted successfully, they will be moved to the next status.

For orange payments that are missing an authorised signature, tick the box next to the payments that you would like to sign and submit.

Click the button at the bottom of the page 'Submit Selected Claims'.

The submit claims form will open.

Clicked on the orange ‘Authorised Signature’ box.

This will open a password check box to ensure a registered authorised signatory is signing the claims.

Enter your password and click ‘OK’.

This will open a signature box.

Sign in the yellow box surrounded by a black box and the click ‘Save’.

This will save your signature and name to the claims selected.

Now click on the yellow 'Submit Claims' button.

This will open a password check box to ensure an authorised signatory is submitting the checked claims.

Enter your password and click ‘OK’.

Please wait while i-Clarity captures all the required signatures and data, submits it to the PCSE website and waits for a successful response message.

For practices that need it, optometrists can also add their signatures to the claim forms in bulk.

Select the patients from this list that you have seen that day by ticking the box next to the payments.

Click the button at the bottom of the page 'Submit Selected Claims'.

The Submit Claims will open.

Click on the pink ‘Optom Signature’ box.

 

Double Checking All the NHS Sight Tests That Have Had A Claim Submitted

If you would like to double check all the NHS Sight Tests have had a claim submitted, we would recommend using the ‘Clinic Outcome’ report.

Open the Reports module.

Select the ‘Clinic Outcome’ report from the drop-down.

Enter the date range of examinations you would like to check.

Then click 'Run Report'.

A list of the clinical records created in this time frame will be displayed in a list.

Any NHS site test will have either a Y or N in the last column titled ‘Sub.’ (Submitted).

Clinical records with a ‘Y’ have had a claim submitted.

Clinical records with a ‘N’ have not had a claim submitted.

(Private Examinations will have a ‘N/A’ in this column).

 

Part 5: Checking Claim Status

The status of your submitted claims can either be checked on the PCSE website or through i-Clarity.

Checking the status of an individual claim.

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 the 'Get Status' button.

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 have 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.

 

Checking the status of multiple claims Open the deferred payments module.

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

Click ‘Retrieve Records’.

At the bottom of the page, click 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 reson code.

From the deferred payment module showing the payment status ‘Not yet paid, submitted between…’ and the list of the payment types ‘NHS Fee’, double click on the patient’s name to open the rejected patient claim.

On the claim click the 'Retract' button.

On the claim you will be able to click on the ‘Show Last Status’ button to show the error code from the PCSE website.

The meaning 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.

Because the claim has been retracted you can make the necessary amendments and then resubmit the claim.

 

Viewing Previous Claims

If you need to view a previous claim for a patient; open the patient record and click on the ‘Px Claims’ button.

At the top of the patient claim is a drop-down list titled ‘Claim Ref’.

Clicking on this drop-down will show you all the patients previous claims for that type of form. Selecting a claim ref from the drop-down list will display that claim below.