Prior Approval

Prior Approval must be sought for all treatment claims where the cost, or likely cost, will exceed £350.00 and for discretionary items listed in the Statement of Dental Remuneration with an asterisk. In the case of orthodontic treatment, the calculation of £350.00 does not include diagnosis, study models, retention and extraction of teeth for orthodontic purposes.

In cases where Prior Approval is required, only emergency treatment can be carried out before approval is granted.

Prior Approval is not available through Electronic Data Interchange (EDI), at present, and must be submitted manually.

If you need to amend a claim that has already been approved, you must seek re-approval. You must submit the original GP17 form for re-approval. Re-approval can sometimes be given over the telephone for minor amendments to treatment plans.  Examples of this may be:

i) a tooth has broken and an extra filling (not crown) is required;
ii) a tooth loses vitality and requires root treatment;
iii) a tooth requires to be extracted. 

Prior Approval must be sought immediately if a course of treatment will exceed the Prior Approval limit when additional work is required to be carried out.

To allow us to approve cases submitted for Prior Approval we require relevant supporting information.

Regulation 9

Regulation 9 applies to the replacement of lost or broken dentures, splints, bridges and orthodontic appliances, due to an act or omission by the patient. In Regulation 9 cases you may take a deposit of up to the whole cost of the replacement. You must obtain a decision from your NHS Board before submitting the GP17 form for processing. It must include the amount confirmed by the NHS Board as appropriate to be claimed from public funds. Any deposit taken should be returned to the patient, as appropriate. In cases where Prior Approval is involved, as the total value is over £350.00, approval must still be obtained irrespective of the Regulation 9 claim. However, if the appliance/prosthesis is the only item claimed on the form and is under £350.00, Prior Approval is not required.

Forms

When extensive observations are required to support the case for Prior Approval, and these cannot fit in the observations field of the GP17 form, the DPD 285 form for Supporting Information should be completed and attached to the claim form. These should be addressed to Prior Approval Department, PO Box 23082, Edinburgh, EH12 9WY.

The PSD 284 form is for Periodontal Charting. This is required when claiming items 1c and 10c on the same GP17 form. Parts 7, 8 and 9 must be completed and the form should be submitted to us along with your payment forms.

Interim payments may be claimed by completing the PSD 264 form, once the appliances have been fitted. The form should be submitted to us along with your payment forms. We will recover the payment at the end of the treatment.

The PSD 103 form is for Discontinued Orthodontic Appliance Therapy. This form must be completed to evidence the stage reached for the orthodontic appliances. The form should be submitted to us along with your GP17(O) form.