As you will be aware, we introduced new rules in April around the Clinical Data Set (CDS) items entered on a claim. As part of these rules, the CDS items reported need to match the treatment band claimed.
To ensure a smoother introduction of the validation rules, no claim will currently be rejected. Instead, for claims where we find inconsistencies, a comment code is generated on your summary of forms processed (part of the performer schedule).
We are seeing a significant number of claims with comment codes and therefore health boards have asked that providers review any comment codes on your summary of forms. The health boards have also asked for some examples of claims with comment codes. We'll share these with them to help review the validation rules.
A list of common comment codes is below, but please read our 'CDS items treatment bands - updated April 2022' guidance document for more information.
CDS and treatment band comment codes
|011||No treatment to justify band
This is advising a CDS item applicable to the band claimed is not present.
|012||Treatment entered higher than band
This is advising a CDS item higher than the band claimed is present.
|013||Reg 11 claim without appliance
This is advising an applicable appliance is missing from the claim.
|014||Free Repair without repair/replaceable item
This is advising a repairable/replaceable item is missing from the claim.