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How we check claims

Pharmacies and dental practices send their NHS prescriptions and NHS dental treatment claim forms to us at the end of each month.

We then calculate how much each pharmacy or dental practice needs to be reimbursed by the NHS.

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

If your entitlement to free NHS prescriptions or dental treatment cannot be confirmed, you will be sent an enquiry letter. If you do not respond to this letter, you may receive 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, an enquiry letter will be issued.

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

After an enquiry letter has been sent

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, your case will be closed.

If you do not respond to your enquiry letter, you may receive a Penalty Charge Notice.

If you receive a Penalty Charge Notice, and have an exceptional reason not to pay, the 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.