Payment Verification

As the accountable bodies for Family Health Services (FHS) spend, NHS Boards are required to ensure that the payments made to contractors on their behalf are timely, accurate and valid.

With respect to the validity of the payments made by Practitioner Services, as far as possible, claims will be verified by pre-payment checks. The checking process will be enhanced by a programme of post-payment verification, across all contractor groups – Community Pharmacists, Dentists, GP’s and Optometrists.

Whilst accountability for carrying out payment verification (PV) ultimately rests with the NHS Boards, there is an onus on Practitioner Services, as paying agents, to implement appropriate arrangements for a programme of overall PV at both the pre and post payment stages. This is outlined in, and forms a central part of the Partnership Agreement between Practitioner Services and the NHS Boards.

It is vital that a consistent approach is taken to PV across the contractor streams and the approach has been produced following consultation with representatives from NHS Boards, Practitioner Services and Audit Scotland and reflects the outcome of a comprehensive risk assessment process. The PV processes will be subject to regular review in respect of performance and contractual changes.

PV of the exemption/remission status of patients (Patient Checking) is dealt with within a Partnership Agreement between National Services Scotland (NSS), Counter Fraud Services (CFS) and the NHS Boards.