Submitting EPS messages within time

Submitting EPS messages within time

Key information on EPS and timing is at Claiming for EPS prescriptions on time Factsheet and Understanding the EPS payment schedule.

SSPs timing information is set out within FAQs below.

When to Send dispense and claim messages?

There are two key EPS notifications which can be sent to the central NHS Spine using your local PMR system:

(1) dispense notification; and

(2) claim notification – includes endorsement information and information on the charge status of the prescription

Checking exemption status and endorsement prior to claim: Some pharmacy contractors may prefer that staff, for example locums, do not submit the ‘claim’ message at the same time as the ‘dispensed notification’ message to allow the contractor time to check that a prescription has been endorsed fully and appropriately before submission.

Sorting by dispensed prescriptions to be claimed: Pharmacy systems will provide pharmacy staff with a list of electronic prescriptions which have not been submitted for reimbursement so that these can be completed and submitted when appropriate.

Amending after a claim: From August 2014, suppliers can introduce functionality so that prescriptions can be amended before the pricing agency ‘locks’ them for pricing. If your supplier has not added this feature you may wish to discuss this matter with them.

Submitting paper: Pharmacies will have to continue submitting paper prescriptions (and tokens where required) to the pricing agency on a monthly basis.

Payment Window

For paper prescriptions, the pricing agency process all prescriptions included in the physical bundle for each given month.

For electronic prescriptions, for each given month, the pricing agency consider all electronic prescriptions with a dispensing notification during that month where the claim message was then received by them by the end of the 5th day of the following month.* For example:

A form and item sent to the Pricing Authority on the 5th November but dispensed in October (e.g. dispensing notification date = 30th October) would be included with October prescriptions. See examples below:

*Drug Tariff Part II Clause 5A explains pharmacies should submit prescriptions by the 5th day of the month following that in which the supply was made.

5daypaymentwindow

First ‘dispense’, then ‘claim’: A claim message cannot be sent to the pricing agency until a dispense notification message has been sent for every item on the form. If the product is not going to be dispensed or is only going to be part dispensed, the dispense notification message can be sent carrying this information.

EPS 6 month (180 day) script time limits

You will need to ensure that prescriptions are submitted in a timely way to prevent them reaching the six month time limit. This takes place six months after the most recent ‘dispense notification’ is applied to a prescription, or after 6 months where the prescription is neither marked as dispensed nor claimed.
The NHS Digital dispensing system specification explains EPS prescription time limit takes place to ensure that the size of the prescription database on the Spine remains manageable.

Further information. Examples of what might occur if all or part of an EPS prescription remains unclaimed:

Scenario 1 – Fully dispensed. No claim for 6 months

Prescription fully dispensed, but no ‘claim’ made within 180 days (six months) after the final dispense notification for an item. The prescription will pass its time limit, but should remain visible on the local pharmacy system. Payment will not be made at the Pricing Authority (see Reimbursement for prescriptions passed deadlines below).

Scenario 2 – Partially dispensed. No claim for 6 months

Some items are marked as dispensed, but one item is left as partially dispensed and no claim is made within six months:
A prescription which has been left marked as partially-dispensed or owing will have its status changed to passing deadlines 6 months after the last dispensing event (see Reimbursement for prescriptions passing deadlines below).

It is recommended you claim for what was dispensed rather than allowing a prescription to reach its time limit because part of it was not dispensed. Where needed mark an item or part of an item with “not dispensed” and submit your prescription

Scenario 3 – No items dispensed (and therefore no claim made) for 6 months

A prescription which is held on the Spine with no items dispensed for its 180 EPS time limit cannot have its dispense message sent. If dispensing is required, the patient should be referred back to the prescriber for a new prescription.

Patient requires further dispensing episodes against a script passed the 180-day EPS deadline

The patient should be referred to the prescriber so that a new prescription can be issued. (NB: The RPS issued guidance on the legal validity period for owing slips which depends on whether the prescription is for a Controlled Drug or not. Guidance on the legal validity period for owings differs from the 180-day EPS technical time limit caused by the Spine’s housekeeping rules to keep data on the spine manageable.)

Prescriptions will be held on the Spine for three months after 180 days with no processing allowed on these items. If an attempt is made to ‘pull down’ the item for dispensing, the pharmacy will be sent a rejection message informing the pharmacy staff that the prescription has passed its 180-day EPS time limit.

Reimbursement for a prescription passed 180-day time limit

After 180 days an electronic reimbursement claim to the NHSBSA could not be processed. A manual request (which may be based on an average) must be made to the local NHS England team who may speak with the Pricing Authority on the issue. PSNC is in discussion with NHS England on arrangements for the manual submission of reimbursement claim requests in these circumstances. Your Local Pharmaceutical Committee may be able to assist with making a claim to the local NHS England team, and the LPC itself may seek assistance from PSNC on this.

Ensuring your system prevents prescriptions reaching EPS 180-day deadline before claims have been made: Does your system do this adequately yet?

System suppliers have flexibility to introduce or improve the warnings and reports to alert pharmacies that prescriptions have gone unclaimed

This is a key area for contractors to discuss with their pharmacy system suppliers to ensure that systems meet the needs of pharmacy staff.

Example discussion points:
  • What reports and alerts will be in place in the system to alert pharmacy staff of the need to claim these outstanding prescriptions when these accidentally go unclaimed?
  • Will there be a regular warning when logging in, advising that there are x number of prescriptions which were marked as dispensed more than three months ago but have not yet been claimed?
For further advice on making your pharmacy system work for you see here.
 

Frequently asked questions

Q. I supplied a Serious Shortages Protocol (SSP) item within the SSP time period. Can I submit the SSP a bit late?

A. No, given that you should reduce the risk of non-reimbursement, by submitting SSPs both within SSP timeframes and within the relevant dispensing month bundle.

A scenario: If an SSP item was processed by you on the last day of the calendar month and this date also corresponded with the last day of the SSP arrangements being in place for this item, you should consider how to get your SSP item submitted within time. For paper prescriptions, you must submit it within the relevant dispensing month bundle. For an EPS prescription in this ‘late’ scenario, there are two options (EPS SSP method or EPS token SSP method) but the EPS token SSP method may be more suitable for you for taking into account points such as those covered below.

EPS Option 1 for scenario above: EPS token SSP method:  You may decide to use the EPS token method instead of the EPS SSP method in scenarios in which there is risk that use of the EPS SSP method may put timely submission at risk. The EPS token should be submitted with the relevant EPS bundle being posted to NHSBSA.

EPS Option 2 for scenario above: EPS SSP method and issues to consider:  If considering use of the EPS SSP method,  you should take into account the EPS 5 day window and EPS submission timing. If you were unable to get the EPS form dispense message submitted in time for the last day of the calendar month (e.g. because of a computer outage or for another reason) and therefore the EPS dispense message could only be submitted within the next dispensing month at the earliest (causing a late submission of the SSP item via the EPS SSP method) then the EPS token method will need to be used instead and the token submitted with the correct dispensing bundle posted to the NHSBSA.

Q. I have a prescription with both an SSP item plus a non-SSP item. What if an owing delays the submission of the prescription and this might impact me submitting the SSP in a timely way? How do I handle such prescriptions.

A. It is for the contractor taking into account and their chosen systems and processes to determine when to send EPS messages. However, note the FAQ above relating to late SSP submission. See also EPS and submitting on time.

If you have a prescription with both an SSP item as well as another item where you plan to process the non-SSP item at a later date, you may want to consider using the SSP EPS token method instead of the EPS SSP method, if this will make it easier for you to get the SSP submitted within time.

Q. I have dispensed two items on the prescription but have only partially dispensed the third item, how can I claim for the whole prescription?

A. Where a prescription has gone unclaimed for some time, you may choose to claim for what was dispensed rather than allowing a prescription to reach its 180-day time limit because part of the prescription was not dispensed. Where needed mark an item or part of an item with “not dispensed” and submit your prescription. Some contractors may choose to collect or use patient’s telephone numbers to inform patients about uncollected medicines.

Q. What happens if a price concession is announced after the date that I have sent my claim message to the Pricing Authority for an EPSR2 prescription?

A. Price concessions, once granted, apply for the whole ‘dispensing month’. For example a price concession announced on August 30th applies to the entirety of your August ‘prescription bundle’.

Your August prescription bundle is made up of all your paper prescriptions which are sent to the Pricing Authority by the 5th September and all the EPS prescriptions which fall into the August dispensing month (see below). Prescriptions for any one dispensing month are not priced until the Pricing Authority receives both the electronic and paper prescriptions as the FP34C submission document is needed from the paper bundle to calculate the advance payment for the contractor.

How a dispensing month is determined for electronic prescriptions is outlined below:

eps timing mini table

Related resources

eps arrow green-previous eps box green- home eps box green- Endorsing, submission& reconciliation eps arrow green-next

 

 



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