When a practice arranges for a patient to be 'treated on referral', a number of Commissioners (Sustainability and Transformation Partnerships) now use a central service to allocate these 'treatment on referral' cases. This is commonly known as a 'triage service'.
Where a 'treatment on referral' case is managed by a triage service, the referring dental practice won't initially know if the patient is to be treated under Additional Services, Advanced Mandatory or Secondary Care (Hospital) arrangements.
In regards to the management of the patients dental charges, the referring practice has two options:
- Take the full patient charge for the planned treatment before the triage centre decides where the patient is going to go. If the patient ends up being treated on a Advanced Mandatory Referral or in secondary care (hospital) then the practice will have to refund the appropriate amount overpaid by the patient and withdraw the original claim / resubmit it with the correct details if they had already submitted a claim before the true referral outcome was known.
or
- Delay submitting a claim / taking the patient charge until the referral outcome is known. However, if the Date of Completion (DoC) was more than two months before this outcome is known, there would be no UDA activity processed in respect of the care provided by the practice as the claim would be regarded as 'late submitted'.
How you deal with this situation as a practice is a matter for the contracts provider to decide. The contract provider is advised to have a practice policy in place to cover this type of referral issue.