Streamlining claims management

The CSU Collaborative has operated the Calculating Quality Reporting Service (CQRS) for NHS England since October 2020. The system facilitates payments in support of the GP contract for Directed Enhanced Services (DES), which are nationally agreed and offered to all GP practices in England (source: British Medical Association).

Local enhanced services (LESs) are developed by local commissioners and offered to GP practices to supplement the services offered in the core practice contract. Local Incentive Schemes (LIS) are also available and include services such as, extended hours access and other services designed to manage local health priorities.

In respect of this, it was recognised that these local services would also benefit from a streamlined claims management system. Following feedback and development of a new system with users and early adopters who represented both commissioners and providers, the CSU Collaborative launched CQRS Local in April 2021.

Benefits of CQRS Local

The web-based portal enables providers and commissioners to manage their local claims online. The new portal streamlines the process of provider claims against local schemes. It also reduces administrative time and ensures claims are visible within a secure platform.

Feedback from commissioners and providers who use the CQRS Local tool has been very positive. Some of the key benefits users have highlighted include:

• Provision of a standardised approach to claims management.
• More secure management of user access through NHS Mail single sign on for authentication.
• Instant notifications to providers when a claim has been approved.
• Practices can easily track the status of current claims within the approval process.
• Commissioners can access enhanced built-in reporting and auditing features.
• There has been a reduction in the number of inaccurate or incorrect claims being submitted.
• Built-in functionality enables commissioners to easily feedback the reasons for not authorising a claim.
• A reduction in claims administration for both providers and commissioners.
• Assurance for all users that claims will be paid promptly and accurately.

As further functionality is added to CQRS Local, the tool will continue to transform and streamline the management of financial claims for both commissioners and providers.

User feedback

3,773 registered and active users [December 2023] are accessing the online portal, benefiting from a streamlined approach to claims management; and over £9 million in claims has been processed through CQRS Local [October 2023].

Here’s what users say:

“CQRS Local is the answer that we have long hoped for, in dealing with practice claims and payments. It reduces the effort and improves the whole process for all involved.” South West London Integrated Care Board

“Some of the obstacles we encountered prior to using CQRS Local were having time to process claims and to run manual reports.” Bolton CCG

“Not only is it ideal for managing claims all in one place, that in the past have been collected individually using email and a form, but the status of those claims can now be reported on from CQRS Local.” NHS South, Central and West Commissioning Support Unit

“The reports generated will allow us to present more effectively the evidence for payment at the quarterly review panel and as the system calculates the values to be reimbursed, this will also support payments processing.” NHS North East and North Cumbria Integrated Care Board

To find out more about how you can benefit from using CQRS Local, browse our website.