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I have a question about NHS claims on the API.

There are several claim state but do you have a definition of these states by any chance? 

“The status of the claim new, queued, submitted, completed, error, invalid, received, queried, withdrawn” -  this is from the API docs do you have any definition by any chance?

 

In addition when I query the API for approval_date I always get null values is this normal?

Any advice is appreciated!

Hi ​@ac0569463👋

Sure! Here are all the definitions for the NHS claim status:

  • new: the claim has just been created in Dentally; it will almost immediately roll forward to queued
  • queued: Dentally has flagged the claim for transmission but hasn’t handed it off to the NHS gateway yet. (If the gateway is up, it usually leaves the queue in the next overnight batch.) 
  • submitted: the EDI file has left Dentally and has been accepted by the CSU / eDental gateway; Dentally is now waiting for the first reconciliation message. 
  • received: NHSBSA has acknowledged the batch (EDI 5). The claim is sitting in their queue for clinical validation. 
  • completed: the claim passed all NHS checks, was reconciled, and a schedule number has been assigned. You’ll see the UDAs in your next payment. 
  • queried: NHS has come back with a query (often a fee mismatch). Check the patient’s NHS tab for the message and respond as needed. 
  • invalid: Dentally’s own pre-submission validation failed (missing tooth chart, no signature, etc.). Fix the issue and resubmit; nothing was sent to NHSBSA. 
  • error: something went wrong in transport (timeout, malformed EDI). Dentally retries automatically; if it stays in error you’ll see the explanation on the claim. 
  • withdrawn: the practice withdrew the claim after submission; Dentally sends a withdrawal marker so NHS removes it from the schedule. 

 

EDITED OUT FOR CLARITY

 

Hope that clarifies things! 


Thanks for the clarification ​@Saymon! I just wanted to ask further on approval_date - I have queried for NHS claims with a completed status and they still have a null approval_date - so even my completed claims have a null approval date? Is this a bug potentially?


Hi again ​@ac0569463  👋 

So, the short version is that a claim can be “completed” in Dentally but still show approval_date = null 

EDITED OUT FOR CLARITY


Thanks for detailed response ​@Saymon

I’ve searched all my NHS claim records on the API since the beginning (about 17000 completed claims) and there isn’t one claim where the claim_status is completed and the approval_date is not null. Infact there are no claims regardless of status where the approval_date is not null?

In addition I believe that there is no nhs_claims webhook so I can’t listen for NHS claims update anyway?

Would you have any suggestion for this, I can’t seem to get any approval dates at all

 

 


Hi ​@ac0569463,

I checked all our internal documentation and even though we have the approval_date, I am not entirely sure when it should populate, I’m running some test to see if I also get the null result.

I’m going to check with our API team so we can get to the bottom of this! 
You’re also correct that the current public webhook catalogue does not include an nhs_claims topic. The only way to track a claim programmatically today is to poll the /nhs_claims endpoint. I’ll ask our team if we have any updates on this.

Thanks for your patience! I’ll update the threads above to avoid confusion and I’ll keep you posted 😊

 


Hi ​@ac0569463 👋

Quick update after speaking with our engineering team:

  • approval_date: they confirmed the field is populated, but only after NHS mark the claim as paid (i.e. when the schedule arrives). Historic claims won’t be back-filled, so anything that was already completed and paid before the feature was switched on will still show null. I’m checking to see if there’s any case where we do back-fill, for example with conversions and i’ll let you know.

  • Webhooks – unfortunately there’s no public nhs_claims webhook in the pipeline at the moment; polling the /nhs_claims endpoint (or parsing the monthly schedule CSV) is still the recommended route for now.

I’ve sent you a quick DM asking for your more details about the Dentally practice you’re working with so the eng team can look at those 17 000 claims directly and confirm whether payment data is being imported for your site. Once we have that we can give you a definitive answer on why you’re seeing only null values. 😊


Thanks for getting back ​@Saymon. I can see from the changelog the approvals feature was added to Dentally at the end of October 2021 but we joined Dentally in 2022 - do you know if there is something we need to enable on our instance to have the values come through? Or is there any additional setup usually needed on the NHS side?


Hi ​@ac0569463,

 

That’s correct, it was enabled in at the end of 2021. There shouldn’t be anything for you to do nor on the NHS side, however the best thing at this point is to have our engineering team check on your account so they can identify what went wrong. If you can answer my private message, we can go from there and get this sorted! 😊

You can find your private messages here: https://community.dentally.com/inbox/overview


I’ll report here any learnings for other users in case they have the same issue!


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