DSfC - NHS South West Lincolnshire CCG IV

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

Invoice Validation INVOICE VALIDATION: [2 paragraphs unchanged] Invoice Validation with be conducted by Optum Health Solutions (UK) Ltd The CCG are advised by the appointed CEfF whether payment for invoices can be made or not. The CCG are advised by Optum Health Solutions (UK) Ltd whether payment for invoices can be made or not. Invoice Validation will be conducted by Liaison Financial Services. Liaison Financial Services conduct an independent ad-hoc review on retrospective payments made. Investing resource, skills and experience into deeper reconciliation, this identifies overcharges already paid and recovers savings for the CCG that would otherwise be lost.

Processing activities

PROCESSING CONDITIONS: [6 paragraphs unchanged] Onward Sharing ONWARD SHARING: [2 paragraphs unchanged] Segregation SEGREGATION: [3 paragraphs unchanged] Data Minimisation DATA MINIMISATION: [3 paragraphs unchanged] Invoice Validation Microsoft UK supply provide Cloud Services for Liaison Financial Services Ltd and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data. INVOICE VALIDATION - Liaison Financial Services Ltd [1 paragraph unchanged] 2. The DSCRO pushes a one-way data flow of SUS+ data into the Controlled Environment for Finance (CEfF) in the Optum Health Solutions (UK) Liaison Financial Services Ltd. 3. Optum Health Solutions (UK) Ltd carry out the following processing activities within the CEfF for invoice validation purposes: 3. The CEfF also receive backing data from the provider. a. Validating that the Clinical Commissioning Group is responsible for payment for the care of the individual by using SUS+ and/or backing flow data. 4. Liaison Financial Services Ltd carry out the following processing activities within the CEfF for invoice validation purposes: b. Once the backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: a. Validating that the Clinical Commissioning Group are responsible for payment for the care of the individual by using SUS+ and/or provider backing flow data. b. Once the provider backing information is received, this will be checked against national NHS and local commissioning policies as well as being checked against system access and reports provided by NHS Digital to confirm the payments are: [1 paragraph unchanged] ii. are in relation to a patient registered with a CCG GP or resident within the CCG area. iii. The health care provided should be paid by the CCG in line with CCG guidance. CCG area. 4. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Optum Health Solutions (UK) Ltd CEfF team and the provider meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc. iii. The health care provided should be paid by the CCG in line with CCG guidance. 5. The CCG are notified that the invoice has been validated and can be paid. Any discrepancies or non-validated invoices are investigated and resolved between Liaison Financial Services Ltd CEfF team and the provider, meaning that no identifiable data needs to be sent to the CCG. The CCG only receives notification to pay and management reporting detailing the total quantum of invoices received pending, processed etc.

Expected output

Invoice Validation INVOICE VALIDATION - Liaison Financial Services 1. The Controlled Environment for Finance (CEfF) will enable the CCG to challenge invoices and raise discrepancies and disputes. 1. Validation of Continuing Healthcare related invoices and payments 2. Outputs from the CEfF will enable accurate production of budget reports, which will: 2. Independent Identification of potential overpayments made by the CCG through invoice validation a. Assist in addressing poor quality data issues 3. Liaising with providers with a view to recouping these monies b. Assist in business intelligence 4. Review is completed for the retrospective period from date of contract with Liaison Financial Services back to 01/04/2013. 3. Validation of invoices for non-contracted events where a service delivered to a patient by a provider that does not have a written contract with the patient’s responsible commissioner, but does have a written contract with another NHS commissioner/s. 5. Reviews take 3-9 months depending on number of claims to investigate and resolve 4. Budget control of the CCG. 6. Liaison Financial Services would repeat the exercise 2-3 years later 7. CCGs could request reviews to be done more frequently 8. SUS+ would only be requested each time a review was completed, and could be requested at different times as independent reviews

Expected measurable benefits

Invoice Validation INVOICE VALIDATION - Liaison Financial Services The invoice validation process supports the ongoing delivery of patient care across the NHS and the CCG region by: 1. Financial validation of activity 1. Ensuring that activity is fully financially validated. 2. CCG Budget control 2. Ensuring that service providers are accurately paid for the patients treatment. 3. Assurances over the robustness of internal control mechanisms relating to the payment of invoices and/or suggested improvements 3. Enabling services to be planned, commissioned, managed, and subjected to financial control. 4. Identification and recovery of monies which would otherwise be lost 4. Enabling commissioners to confirm that they are paying appropriately for treatment of patients for whom they are responsible. 5. Meeting commissioning objectives without compromising patient confidentiality 5. Fulfilling commissioners duties to fiscal probity and scrutiny. 6. The avoidance of misappropriation of public funds to ensure the ongoing delivery of patient care 6. Ensuring full financial accountability for relevant organisations. 7. Benefit delivered 3-9 months from receiving data, depending on number of claims to investigate and resolve 7. Ensuring robust commissioning and performance management. 8. Ensuring commissioning objectives do not compromise patient confidentiality. 9. Ensuring the avoidance of misappropriation of public funds.

Benefits reported

Stated in the previous version and removed here.

The CCG has achieved all of the expected benefits. This is a very important and worthwhile function and supports correct appropriation of funding.