These release notes describe the most important changes/fixes in version 6.5.0 of the CS R4+ software.
We have implemented a new option in the CS R4+ Clinical Administration application under the Tools section. This will allow an administrative type user to obfuscate a patient’s record who has requested and been granted the right to be forgotten.
Once completed the obfuscated record is archived as “GDPR Anonymised” and cannot be restored to an active state. An audit record is also created to indicate the user and the date that anonymisation took place on the specified Patient Code. This audit record only contains metadata which is not uniquely identifiable to any individual patient after obfuscation.
To anonymise enter the Patient Code number into the ‘Right to be Forgotten’ field and CS R4+ displays the patients name and Date of Birth so the user can confirm that the right patient has been selected. This is very useful for multi database customers to ensure the right database is being used by Clinical Administration so there is no accidental anonymisations. CS R4+ then applies checks on the Patient Record to make sure it meets the conditions to safely anonymise the patient. If these fail the user is displayed a message which explains why as follows.
The patient must not have had an accepted treatment plan in the last 10 years.
The patient must not have had any completed appointments in the last 10 years.
The patient must not have an outstanding balance.
The patient must not have any open courses of treatment.
The patient must not have any pending appointments.
The patient record must have been created more than 10 years ago.
The patient is not a group head
If treatment requires Prior Approval when the course is accepted they will be presented with a button to ‘Open Web Portal’. This button will launch the NHS Portal webpage to allow the user to login and undertake the required Prior Approval request within the NHS boards own system. The Prior Approval claim will also display the ‘Open Web Portal’ button in case the user wants to progress it later.
Once approved and the user has completed the course and is ready to submit the Final Payment claim from CS R4+. The user will need to then open the relevant Prior Approval claim window and delete it to remove the prior approval block on the Final Payment claim. The final payment claim can then be updated and readied for transmission.
Once a prior approval has been granted and the request has been deleted a user will be able to add the approval details and submit the claim as normal. A new tab called ‘Prior Approvals’ is displayed on the Final Payment claim window where an approval is required. This should be filled in as required based on the type of approval granted.
Paper Based: only the Date of Approval must be completed, this will be supplied on the paper approval itself.
Portal Based: The Date of Approval & Reference must be completed, these are supplied on the web portal for the approved request.
In the Users window under each clinical user list tab a new section has been added containing the Prior Approval limit for that list number, this will initially remain as £390 for all users. If changed the user will receive a letter from the NHS board confirming the limit adjustment and the date that it takes effect.
Administrators are then able to enter the new limit and specify the date for the limit change, this is very important to correctly maintain otherwise the wrong limits could be applied to courses of treatment. There is a table displayed below the current limit field allowing the user to track the history of any prior approval limit changes.
We have updated the recently added item 14 tooth surface treatment codes based on the SDR 2018-2019 final revision from the NHS board, this required additional changes since the previous draft received. The descriptions have been updated, applied surfaces have been adjusted, treatment code 1471 added, the Occasional scheme equivalents have also been approved by the board & the DPB charges have now been specified on all affected codes:
1405 / 5815: Composite, glass ionomer or resin fillings in permanent or retained deciduous teeth in patients aged Under 15 (only on occlusal surface).
1406 / 5816: Composite, glass ionomer or resin fillings in permanent or retained deciduous teeth in patients aged Under 15 (only where 2 or more surfaces involve occlusal).
1407 / 5817: Composite, glass ionomer or resin fillings in permanent or retained deciduous teeth in patients aged Under 15 (2 or more surfaces involving MO or DO).
1408 / 5818: Composite, glass ionomer or resin fillings in permanent or retained deciduous teeth in patients aged Under 15 (3 or more Surfaces involving MO or DO).
1471 / 5837: Treatment of any surface using Composite, glass ionomer or resin fillings for women who are pregnant or breast-feeding (Tooth Specific Code).
The 2018-2019 SDR also implemented further changes to existing Treatment Proviso rules effective immediately, these changes are as follows:
Proviso 14.3 has now moved to 14.7: Adding a 1401 to the where a fee is payable in respect to the same tooth.
Proviso 14.2 has now moved to 14.4: Increasing the two-applicable maximum fees to £32.69 and £36.40 respectively.
Proviso 14.5 has now moved to 14.10: Adding 1471 as a no fee payable code and codes 1405, 1406, 1407 & 1508 where a fee is payable in respect to the same tooth.
The 2018-2019 SDR has also introduced new Treatment Proviso rules effective immediately, these are as follows:
New Proviso 14.6 added: No fee payable under items 1401, 1402, 1403, 1404, 1411, 1421, 1422, 1423, 1424, 1425, 1426, 1441, 1451, 1461 or 1471 where a 1405, 1406, 1407 or 1408 fee is payable on the same tooth.
New Proviso 14.7 added: no fee payable under 1441 where a 1401, 1402, 1403 or 1404 fee is on the same tooth.
The 2018-2019 SDR also implemented further changes to existing Occasional Treatment Proviso rules effective immediately, these changes are as follows:
Proviso 58.2 has now moved to 58.4: Adding 5815, 5816, 5817 & 5818 to the no fee payable for more than 2 permanent or deciduous teeth in the same course of treatment.
Proviso 58.4 has now moved to 58.8: Adding 5837 to the no fee payable condition and adding 5815, 5816, 5817 & 5818 to the unless a fee is payable on the same tooth condition.
Proviso 58.3 has now moved to 58.6: Increasing the two-applicable maximum fees to £32.69 and £36.40 respectively.
The 2018-2019 SDR has also introduced new Treatment Proviso rules effective immediately, these are as follows:
New Proviso 58.3 added: where more than 1 claim made under 5815, 5816, 5817, 5818 for the same tooth in the same course of treatment, the higher fee only shall be paid.
New Proviso 58.7 added: no fee shall be payable under 5811, 5812, 5813, 5814, 5821, 5822, 5823, 5824, 5825, 5826, 5836 & 5837; when a fee is payable under 5815, 5816, 5817 or5818 in respect of the same tooth.
Several codes have been identified as not allowing suffixes to be applied on the payment claim in comparison to the current SDR document. We have corrected these and the following treatment codes will now allow Suffixes to be set against them in the claim:
1041, 1815, 2841, 2926, 3239, 3240, 5541 & 5591
Previously CS R4+ would use a patient’s exemption field to specify if a patient was being seen as a Non-GDS patient. This was problematic as it proved difficult for users to know when to set and unset depending on what ongoing courses of treatment a patient had. Additionally, patients could not have an exemption set at the same time.
We have now changed this to a tick box option called ‘Non GDS (PDS) Activity’ on the Create Course windows in Clinical Chart and the Treatment Tab. This has the benefit of allowing the option to also be edited if needed on concurrent courses independently and allows an exemption to also be set on the patient at the same time.
The CS R4+ upgrade will detect existing Patients where this has been previously set via the exemption panel and set the course tick box automatically on all open and ongoing courses of treatment. These patients will now also initially show an exemption status of either ‘Not Exempt’ or ‘Exempt’ if under 18 allowing for real exemptions moving forwards.
Previously CS R4+ would apply the same conditions for triggering a Prior Approval to Non-GDS PDS courses and GDS courses based on either treatment codes or course value. However, the NHS board has indicated this was incorrect. We have changed this based on their feedback so that
If Treatment is PDS GDS activity, then Prior Approvals still applies.
If Treatment is Non-GDS (PDS) Activity, then Prior Approvals are not applied.
An issue was identified where Patients with an active HC2 or HC3 Exemption were being rejected where the record had no reference number present, working with the board we have identified the cause and the issue has been addressed. Any claims previously rejected on this basis should be moved back to ‘Not Ready’ and resubmitted.
It has been reported that users are unable to access the DPDE service from within CS R4+ recent releases, after investigation we have identified the root cause and addressed the issue.
An issue was identified where treatment added to a course could trigger proviso 28.3 and then proviso 28.4 to apply a maximum fee, but then a miscalculation would then re-apply a treatment charge relating to 28.3 causing the course total to breach the fee maximum defined in proviso 28.4. This has now been addressed so the fees are correct where both provisos are active.
An issue was identified where invalid characters would be transmitted as part of either the Patients name or the Clinical Users name. This would result in a failed response when attempting either a Patient CHI Search or submitting a payment claim.
A warning has been added that is displayed if invalid characters are detected in either name when a user transmits to allow the user to correct themselves. But CS R4+ in the meantime will also strip out the invalid characters when transmitting to allow the Patient Search or Claim Request to remain valid. It will go through successfully to minimise the impact on the user, It is then important to correct the affected name or else CS R4+ will continue to warn in future when transmitting.
From the EDI Claim search window if a user clicks the ‘View Responses’ button the user can monitor the state of all received Reconciliation files which are used for settling sent claims. This is split in to two views which have been improved.
Responses – Users can now see any errors returned in a reconciliation settlement file by selection in the ‘For’ dropdown filter, changing the filter will immediately update the displayed results.
Schedules – The received file result will now filter to the logged-in clinic to make it easier to find settlement schedules. When viewing the details within the file, claims are now shown by their DSR number, this makes it easier to locate in the EDI Search grid using the DSR and owning Dentist, as the responses are always based on DSR number and not the EDI Claim reference.
It has been reported that some customers were getting payment claims that were unable to move forward to being transmitted. After investigation it was found in certain circumstances invalid values could be saved to the Survey Consent Mobile Number field which was then failing validation stopping the claim from sending. This has now been fixed so if any invalid values are detected we will strip them out of the claim transmission.
After investigation it turned out several issues affected the value being recorded for mobility. When charting using a keyboard, scores would move between the upper and lower grids as well as being changed to an invalid score for this type of examination. Additionally, historical invalid scores would be hidden by the ½ symbol that was shown on the grid.
We have addressed these issues so for all new exams the value entered is the value saved without moving on the grid. If an invalid ½ value is entered, we will round it to its nearest valid value and display its true decimal figure on screen.
Our customers requested that we change the order that the Periodontal exam pocket depth results are listed on this report, they now display from the Oldest to Newest to make the report more logical to read.
It has been reported by Multi Clinic sites that recent versions of CS R4+ were returning less provider results in the provider drop down on the NHS New Plan window. After investigation this was found to be due to a previous performance enhancement, this enhancement has now been reworked so it returns the full list of providers without losing performance
An issue was identified that affected the ability to undertake a fresh server installation of CS R4+ in Scotland, where an error would occur during the database upgrade, this has now been addressed.
An issue was recently highlighted that affects the update mechanism that deploys regulatory fee updates. This meant Scottish & Northern Irish updates would not automatically deploy for importing to any databases other than the primary database, this has been addressed for all future upgrades.