New GOS 4 Pre-Authorisation Process
On behalf of the Optical Confederation:
NHS Business Services Authority (NHSBSA) have been asked by NHS England to run a national pilot for the pre-authorisation of adult GOS 4 vouchers. It is expected that this pilot will begin in November 2018.
Under the new system when a patient asks for a repair or replacement, the GOS contractor will ring NHSBSA to explain the circumstances of the request. This will be checked against a standardised list of conditions (and escalated to a clinical advisor if the circumstances are not covered by the list). If the request is approved the contractor will be issued with a unique code, which can then be added to the GOS 4 form before submitting to PCSE for payment. Any claims that have been submitted inappropriately (i.e. with missing or incorrect codes) will be recovered via the PPV process.
Read the full Hot Brief here.