E-Claim (NHSO) claims

Why

Every claim page (including the claim form) checks the add-on first, and sending closures/claims uses the shop’s NHSO connection — without it you can save but nothing reaches NHSO

How

1. 1Open the E-Claim menu — E-Claim add-on required means the shop does not have the add-on yet
2. 2The owner opens the account centre (User menu › Shop settings) and buys the E-Claim add-on on the packages page (See packages & add-ons below)
3. 3Shop settings › Integrations (API): pick the NHSO entry, fill in the connection values NHSO gave you and press Save
4. 4Make sure the shop has a facility code (HCODE) — if not, the closure window says The shop has no facility code (HCODE) set; contact the APSTH team
5. 5Back in the E-Claim menu, refresh — you should see the summary cards and the Receipts to claim tab
6. 6Owner: on Shop package, Buy for = this shop
7. 7Add-ons: tick E-Claim, then Place order and pay
8. 8Shop settings › API integration: pick the NHSO entry, fill in the values you received, save

Why

The 13-file claim pulls from the receipt, the OPD queue and the customer record — missing source data means the receipt never shows up, or the form says "Must fix" and cannot be sent

How

1. 1Always record ICD-10 diagnoses in the OPD queue, with one principal diagnosis — only receipts of OPD queues with ICD-10 appear in Receipts to claim
2. 2In the customer record, fill in the citizen ID, phone and treatment right (the closure form starts from the customer’s right)
3. 3Whoever records closures opens Profile › Profile Setting tab › License Information
4. 4Fill ID Card Number and press Save — otherwise the closure window says The recorder has no national ID

Why

A receipt without a claim is money not yet claimed from NHSO — check daily so nothing is missed

How

1. 1E-Claim menu — the page opens on Receipts to claim (the number beside the tab is how many are waiting)
2. 2Payment date: choose This month, Last month or Custom (up to 1 year at a time) — shared by all three tabs
3. 3Claim step: choose Waiting / Has claim / All
4. 4Type the receipt no., invoice no., HN or customer name and press Search
5. 5Check Paid / bill total and each status — receipts without a claim have a Create claim button at the row end

Why

A closure tells NHSO the patient’s service is complete, with identity and service location — NHSO uses it before reviewing the claim

How

1. 1In Receipts to claim press ⋯ (More actions) at the end of the receipt rowReceipt menu
2. 2Choose Close service (only for receipts without a claim)Close service window
3. 3Facility and Patient come from the shop and customer record — fix any red field at the source and reopen
4. 4Treatment rights type: check or pick the scheme (prefilled from the customer)
5. 5Check Tel. and in Service the Service date and Service code
6. 6Service location: allow the browser to use your location until it says Location found — if blocked, allow it and press Get location again
7. 7Press Save — the entry moves to the Service closure tab as Waiting to send

Why

Entries "saved, not sent" have not reached NHSO — send them to get an Authen code and continue to the claim

How

1. 1Open the Service closure tab
2. 2Tap the Waiting to send chip to see only entries Saved, not sent
3. 3Tick the entries to send (or the header box to select all)
4. 4Press Send n service closures in the bottom barSend confirmation
5. 5In the confirmation, tick Create the 13-file claim right after a successful send if you want
6. 6Press Send service closure — successful entries show Closed with an Authen code and a Create claim button

Why

A claim is the 13 NHSO standard files; the system fills most from the receipt, you only check missing files and save the version to send

How

1. 1In Receipts to claim press Create claim on the receipt row (or on a closed entry in the Service closure tab)13-file claim page
2. 213-file claim page: the file menu on the left shows Complete or Missing n per file — tap a file to jump to it
3. 3Diagnosis: exactly one principal diagnosis (DIAGTYPE=1) — edit rows or press Add row
4. 4Charge details (CHAD): every row needs a bill group (BILLGRCS) and standard code (STDCODE)
5. 5Charge summary (CHA) empty? Press Summarize from CHAD to total it
6. 6Tick Extra files in the left menu (e.g. procedure, prenatal, newborn) only when they have data
7. 7Press Save in the bottom bar

Why

Claims that break NHSO rules get rejected and paid late, so only saved claims that pass "Validate before sending" can be sent

How

1. 1On a saved claim press Validate before sending in the bottom bar (save first — the check uses the saved version)
2. 2The Validate before sending panel lists Must fix (red) and Warning items — fix them in the named files
3. 3Press Save, then Validate before sending again until the panel says Passed the pre-send check
4. 4Press Send to NHSO (enabled when nothing must be fixed)Send to NHSO confirmation
5. 5Press Send to NHSO in the confirmation — sent claims can’t be edited unless cancelled first
6. 6To send many: in the E-Claim claims tab tick several, press Validate before sending in the bottom bar, then Send n to NHSO

Why

NHSO reviews in stages (reviewing → passed → payment report → transferred). Rejected claims must be fixed and resent — without tracking, money gets stuck

How

1. 1Open the E-Claim claims tab
2. 2The Step chips filter e.g. Waiting to send · Sent · in review · Rejected · Approved · awaiting payment · Paid
3. 3NHSO’s message appears under each status — for Rejected, read the reason and fix as in the previous step
4. 4Press Edit or View on the claim row13-file claim page
5. 5Check the NHSO tracking box on the right for the current stage (created → sent → review → payment report → paid)
6. 6Claims sent via NHSO Digital Platform have NHSO status tracking — press Refresh status, then View payment details for the amount actually paid