Training type: User Guide

Single-Service Claim Submissions mean that your Commissioner has requested that all service claims can be submitted as one claim rather than being submitted individually.

IMPORTANT – Under no circumstances should you attach or reference any kind of Patient Identifiable Data (PID) when submitting your claim. Your Commissioning Organisation will never request this kind of information.

Please note that if you have not got a +New Claim button, it will mean one of three things:

1. The claim window has not yet opened. For further information, please refer to the section titled Viewing your Claims Windows (Schedules).
2. You have submitted all your services claims and have no more claims to process.
3. You have missed your claims window. If this is the case, please contact your Primary Care Team.

1. From your Claims page, click on the +New Claim button.

2. You will then be presented with your claims page. Each section will be explained below.

1 = Claim ID – this is automatically generated by the system once the +New Claim button has been clicked on.
2 = Services Pane – this lists the services that are currently available to claim. Each service shows the service name and how many components are part of that service.
3 = Add All button 1 – this will add all the services into the components pane.
4 = Components Pane – this section lists the components for the service(s) selected in the services section and lets you add the components to the claim.
5 = Add All button 2 – this will add all the services and their components into the components pane.
6 = Claim Pane – the claim section contains the components that have been added to the claim and is what will be submitted for approval. This section is where you complete the details of the claim such as unit values, add attachments, and if required, complete supplementary information.
7 = Remove All – this will remove all components from the claim.
8 = Delete – this will delete the claim as if it hadn’t been started in the first place.
9 = Submit – clicking this button will validate the claim and submit it for approval.

3. Your eligible services to claim for are listed under the Services pane. Use the grey bar to scroll further down the Services pane.

4 Click once on your first Add All button. This will add all services and all components into the Component pane.

5. All associated services and components will then appear in the Components pane. Click on the second Add All button. Please note that if you see individual Add+ buttons within the component box – these are for organisations who do not have claims windows. If this is the case, click on the component you wish to include into the claim.

6. All associated services and components will then appear in the Components pane. A green tick will indicate that the service is currently being processed.

7. You can now proceed with completing the claims. In this example, for the Quarter 1 period, there was a total of 12 Complex Care Plans created – this equates to £2,321.04.

8. Next, is to scroll down to see the second of the two components. You can use the scroll bar to move further down the page. This component is a Retainer and doesn’t require the inputting of information – it is asking to read the information icon. Please make sure that you read this and understand it.

9. Keep scrolling down the list of service components entering in the required information.

10. One of the components within the list is for the Ear Irrigation Service and requires the upload of a document. This is displayed with the following icon:

and is mandatory if you enter the number 1 or more into the Units box. If you haven’t achieved anything for any component which requires the upload of a document – enter a ‘0’ (zero) into the Units box – you will NOT be required to upload anything.

11. Under the Evidence Requirement Details, you will see what the requirements are. In this scenario there is a request to “Please could you provide the name of the registered practice the patient belongs to. Please do not include any PID. Thanks” It will also state which file types are accepted. Click on the Add Attachment button and navigate to the area on your computer where this document will be located.

12. Once you have located the file, highlight it once and click on the Open button.

13. We see that the file has been successfully uploaded into CQRS Local. On the right-hand side of the screen, there are two buttons; the Download button will allow you to download the file to ensure that it’s the correct file. The Delete button will remove the file from the system. If you do need to delete a file, use the Add Attachment button again to re-upload the correct file.

14. You may have a service which has Supplementary Information. Commissioners’ can attach questions to each component that need to be completed when creating a claim. This could be for example; to confirm Yes or No or it could be requesting the name of a clinician who undertook a certain procedure. The example below is for the Depot Antipsychotic Injections Service and requires confirmation that the administration of depot injections has been undertaken by a qualified member of staff. Once this information has been understood, switch the toggle button from No to Yes.

15. Continue moving down the page and enter all required information for each and every service components. Finally, when the claim is ready, check that all the information has been checked and then click on the green Submit button.

16. Confirm that you wish to submit the claim.

17. You will then be presented with a claims summary screen. This confirms the claim information that you have submitted.

18. To return to your claims page, click on the Claims link in the upper left-hand side of your screen.

Please note: if you have attached any documentation, you will temporarily see a status of Pending System Review. This means that it the documents are going through an anti-malware check to make sure the file(s) are free from malicious software. After approximately 60 seconds, the status will change to Pending Tier 1 Review.

19. The claim has now been submitted and the system has generated a Claim ID. The ID is 35929.