With the change to indici claiming for some services, the eligibililty criteria is automated wherever possible, to streamline the claiming process for practices.
As a result of this, there may be occasions (due to eligibility rules) where the option to claim for a service may not appear for a specific patient.
This may be due to the patient not being eligible for that service, which could be for a number of reasons e.g their age band, gender or enrolment status.
We have found that patients may not be recognised as eligible because they do not have their domicile DHB recorded in their enrolment form.
The patient needs to be e-SAM validated in order for the DHB field to be populated.
We recommend that you run a ‘validate patient address report’ to see which patients in your practice do not currently have e-SAM validation. Running this report will avoid this eligibility issue in the future. Further information on how to validate bulk e-SAM patient addresses is available online, see the link below.
On a case by case basis you can go to the patient’s enrolment page and validate the e-SAM for that patient, see the link below.
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