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Understanding your payment reports

Published on 01 July 2021

An ophthalmic monthly payment schedule consists of the following pre-defined reports.

  • remittance reports - consisting of remittance advice and remittance breakdown (account 14)
  • itemised patient payments
  • adjustments to claims
  • adjusted claims
  • additional payments and recoveries
  • items summary
  • patient information

See guidance on each report.

Remittance advice

This report provides creditors with the amount payable per payment location code that a schedule has been created for.

It also highlights the total amount to be paid to the creditor for the schedule month.

It can be broken down as follows:

  • schedule month
  • shop name and address
  • creditor reference number and bank account details
  • the sum payable to your practice

Remittance breakdown (account 14)

This report details what payments and deductions have been made in this schedule.

Payment details of sight tests, Hospital Eye Service (HES) claims and other items of service can be viewed through this report for any given month.

You'll be able to view seven years of reports, including the current financial year.

The remittance breakdown also shows payments for adjustments, the Pre-registration Training Grant and other local NHS board payments.

COVID-19 update

We've amended the remittance breakdown (account 14) report to show a breakdown of the COVID-19 related financial support payments.

The breakdown shows the “top-up” and any payment for emergency treatment on top of that separately on line 13 of this report.

Information can be broken down as follows in the report:

Sums due

  • line one, Eye Exam – the total paid this schedule for GOS eye exams
  • line two, Hospital Eye Service – total paid this schedule for HES claims
  • line three, Other IOS – total paid this schedule for GOS3, GOS4 and adjustments to claims
  • line four, Total Payment Authorised – sum of lines one to three
  • line five, Local Superannuable Payment (HCH) – special schools payment (Lothian only)
  • line nine, Training Grant – Pre-registration Training Grant payment
  • line 10, Local Payments (HCH) – total of local NHS board payments, can include Teach & Treat, LVA, contact lens payments, diabetic retinal screening and optometry medication supplied
  • line 13, Miscellaneous Adjustments – payment of eOphthalmic Practice Grant
  • line 15, Gross Sum Due – sum of lines four to 13.

Deductions from gross sum due

  • lines 16 - 23 are only applicable to ophthalmic medical practitioners and refer to the details of superannuation contributions
  • line 27, Eye Care Information Services Levy – deduction of contribution to the Eyecare Trust
  • line 28, Local Ophthalmic Committee Levy – not in use
  • line 29, Recovery of Advance – recovery of advance payment(s) paid out with the payment system
  • line 30, Gross Deductions – sum of lines 16 - 29
  • line 33, Sum Payable to Practitioner – net amount payable to creditor's account.

Itemised patient payment report

This report provides details of all claims that have been paid in full, with no adjustments for the payment month.

The list is in alphabetical order by patient surname.

It details the following for each claim:

  • case ID (the identification number for the selected claim. It's required when submitting an Oph24 adjustment form)
  • patient name and date of birth
  • patient Community Health Index (CHI) number (please note some patients may not have been allocated a CHI number at this time)
  • form type – details of the type of claim, GOS or HES eye examination or voucher.
  • date of test/supply (date eye exam is completed or voucher accepted)
  • patient contributions – the payment patients have made when they are in receipt of an HC3 certificate, which entitles them to partial help with health costs (the contribution they should make is detailed on the certificate)
  • sum authorised (payment amount authorised for the selected claim)
  • Sum of item of service payments (total amount paid for item of service claims)

Adjustments to claims report

This report details all adjustments to claims for the payment month.

The information outlines all claims where the amount claimed and authorised are different.

To make amendments to these claims, submit an ophthalmic 24 claim adjustment form, stating the Case ID from this report.

Breakdown of adjustments to claims report

  • case ID (the identification number for the selected claim. This is required when submitting an Oph24 adjustment form)
  • sequence number 0 shows this is the first payment of a claim. Where the sequence number is greater than 0, a claim adjustment has been completed
  • patient name and date of birth
  • date eye examination is completed or voucher accepted
  • total amount claimed
  • total amount authorised for payment
  • total patient contribution detailed on claim
  • total patient contribution authorised for claim.

Adjusted claims report

This report details adjusted claims based on a claim being paid in a previous month’s schedule.

Breakdown of adjusted claims report

  • case ID (identification number for the selected claim. This is required when submitting an Oph24 adjustment form)
  • patient name and date of birth
  • details of the type of claim, GOS or HES eye examination or voucher
  • schedule month of this payment
  • amount paid by the patient if applicable
  • amount paid/deducted for the selected claim in this schedule. Please check first submission of this claim to ascertain full payment details
  • total amount paid/deducted in this report.

Additional payments and recoveries report

This report provides details of any payment adjustments due to bulk recoveries or underpayments.

Breakdown of the additional payments and recoveries report:

  • reason for the adjustment
  • total amount paid due to item of service updates or payment recoveries.

Items summary report

This report provides a breakdown of the different items of treatment and their monetary value.

Breakdown of items summary report:

  • number of items
  • breakdown of different items of treatment excluding “pay on claim total” claims.

An example of pay on claim total is where the retail cost claimed for a dispensed pair of glasses is less than the voucher value.

Patient information report

This report details patient matching anomalies. These occur where we've matched the patient on the claim to an existing patient in our system, but the details are slightly different.

The information we have on our system is called the 'master details' and the information submitted on the claim is the 'claim details'.

If any master details are incorrect, please complete an ophthalmic 26 patient detail amendment form and we'll action any corrections.

Breakdown of the patient information report:

  • master details we hold for patient’s surname and forename
  • master details we hold for patient’s sex and date of birth
  • master details we hold for patient’s CHI number (please note some patients may not have been allocated a CHI number at this time)
  • linked details from most recent claims submitted for patient’s surname and forename
  • linked details from most recent claim submitted for patient’s sex and date of birth
  • linked details from most recent claim submitted for CHI number.