Reducing GMS reclaims

Panara has long had the ability to check the validity of a Medical card online.

In the last update this was extended. Now if a PPS number is known, the relevant Medical card number can be retrieved as well as eligibility for an examination and for fillings.

This information was then stored in Panara for reference purposes in the following format :

Check Date : 21/02/2011 12:16:35
PPS Number : 1234567Y
Status : Completed. 21/02/2011 12:17:20
Med card Number : 7654321A
Med card Expiry date : 30/04/2011

Examination cannot be carried out

11 : Tooth is recorded as missing
12 : Tooth is recorded as missing
13 : Tooth is recorded as missing
14 : Tooth is recorded as missing
15 : Filling will be reimbursed
16 : Filling will be reimbursed
17 : Tooth is recorded as filled within the last 5 years
18 : Tooth is recorded as missing
….

As was pointed out by several users, this information would be more useful if it was directly integrated with charting in Panara

In the update scheduled to be released in the next couple of weeks this enhancement has been implemented.

Now as you chart treatment in the normal way, the program will check it against the information downloaded from the PCRS database and flag any issues that arise.

So, for example, if you attempt to chart a cavity/filling on the GMS for UR7 you will be warned about the fact that the PCRS database has a filling less than 5 years old, recorded for this tooth.

Being aware of this when making a claim and providing a clinical necessity can hopefully help to prevent a reclaim

If a person has only 1 premolar present in a quadrant, some people will chart it as a second premolar, others as a first premolar

Now if you wish you can directly incorporate the PCRS’ chart of missing teeth into the patient’s chart in Panara.

This should be especially useful for new patients.

This will then help you to chart the premolar present as a 5 rather than a 4 so it won’t appear to the PCRS that you are restoring a missing tooth if you later need to fill this tooth.