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How we check claims

At the end of each month, pharmacies and dental practices send their NHS prescriptions and NHS dental treatment claim forms to us. These forms are scanned into our processing system.

After scanning, we calculate how much each pharmacy or dental practice needs to be reimbursed by the NHS.

Every day more than four million prescription items are scanned.

We carry out monthly randomised checks on the prescription forms and dental treatment claim forms to check for fraud.

If your entitlement to free NHS prescriptions or dental treatment cannot be confirmed, you will be sent a Penalty Charge Notice.

Matching your details

During the automated checking process, your personal details on the prescription or dental form will be checked against our records using ‘matching’ criteria. These personal details include:

  • first name
  • surname
  • date of birth
  • first line of address
  • postcode 

Where they do not match our database, a Penalty Charge Notice will be issued.

You can reduce the risk of getting sent a Penalty Charge Notice by keeping your personal details up to date with us, your GP surgery, dental practice and benefits organisations.

After a Penalty Charge Notice has been issued

If you can show us that there has been a mistake and you were exempt from NHS prescription or NHS dental charges at the time, the Penalty Charge Notice will be cancelled.

If you have an exceptional reason not to pay, the penalty charge could be eased or removed, but you will still have to pay the original NHS prescription charge or NHS dental treatment charge.

If you cannot challenge the Penalty Charge Notice, you must start paying the charges listed on the letter as soon as possible.