How we verify claims and payments

We verify payments to ophthalmic practitioners in Scotland.

The programme of payment verification operates at the pre-and post-payment stages.

Levels of Verification

There are four levels of verification:

Level one

Payments staff and/or automated payment systems carry out all checks at the pre-payment stage

Level two

Post-payment checks involve trend analysis and random sample testing where:

• the results of level one checks show that this would be beneficial
• the results of statistical trend analysis indicate a need for further investigation
• the formal assessment of the level of risk associated with a particular claim type highlights a need for further testing.

Level three

Post payment checks involve extended sample testing. These checks may also involve sending patient letters or carrying out a targeted practice visit to investigate further the claims identified at level one and/or two.

Level four

These post-payment checks involve the random assessment of claims as part of a practice visit. Inspection of clinical records may also prompt practice visits.

What to expect at a practice visit

Pre-arranged practice visits may be part of the verification process. They will follow discussions with your NHS board about prescribing levels.

During practice visits, we check that glasses provided to patients match what’s claimed on the appropriate General Ophthalmic Service (GOS) voucher.

We will look at patient record cards and take copies of a sample of them, as well as discuss processes and check a sample of glasses awaiting collection.