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Wales FP17 Assurance

In March 2017 we wrote to all providers in Wales regarding analysis of the 2015/16 claims data which identified some Band 3 treatment types where either the rates or volumes of specific claiming exceeded expected levels.

The Wales FP17 Assurance pilot (run in collaboration with Health Boards), is a two year programme of reviews seeking to understand the circumstances in which these claims are submitted.

It will be delivered by the NHSBSA Provider Assurance Dental Activity Review (DAR) team across four 6 monthly exercises as follows:

  • Band 3 claims where the only Band 3 item included on the claim submission is ‘Other Treatment’
  • Band 3 claims associated with a course of treatment which starts and ends on the same day
  • Band 3 claims where a Band 1 or 2 item / treatment is included on the FP17 claim submission but no Band 3 item / treatment is indicated
  • Band 3 claims where it is recorded that the patient failed to attend to complete the course of treatment

Each review exercise will include 35 contracts, Providers will be asked to submit patient records for review and where appropriate complete a self-assessment of the claims submitted.

The DAR team will review the claims with our Clinicians and work collaboratively with the provider to advise of the outcomes of the review.  Providers will have the opportunity to review and feedback on our findings.

 Depending on the number of claims identified for the period, Providers may also be required to conduct a self-audit, collaborative measures are in place to complete this. Please see our Self Audit page for further information.

Where anomalies in claiming are identified financial recovery and refunds of patient charges may be sought.

Timeline of activity:

Band 3 claim type

Start

No. contracts Wales

Other

Apr-17

35

Same Day

Oct-17

35

No band 3 CDS item

Apr-18

35

Incomplete

Oct-18

35