Exam Pass Notes

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Use these notes to review the key points before the assessment.

Memory spine: Check, Explain, Record, Claim truthfully, Correct, Escalate

• Check: confirm the patient identity, claim type, eligibility route, current guidance, supporting evidence and local procedure.
• Explain: give clear information on declarations, voucher limits, charges, top-ups and the patient’s financial responsibilities before any commitment.
• Record: enter accurate names, dates, codes, voucher details, signatures and evidence notes, and keep a visible correction trail for changes.
• Claim truthfully: submit only for services, appliances, dates, values and evidence that are accurate and genuine.
• Correct: report errors promptly and follow the approved amendment, repayment, refund or query procedure.
• Escalate: seek help when uncertain, under pressure, when you suspect misuse, or when audits reveal repeated errors.

Common claim risks

• Wrong patient record, duplicated record or incorrect demographic details.
• Incorrect service date, collection date, claim type, code, voucher category or value.
• Missing declaration, signature, evidence note, collection record or representative details.
• Assuming entitlement because the patient was previously eligible.
• Confusing sight-test entitlement with voucher, repair, replacement or refund entitlement.
• Unclear pricing, undisclosed top-ups or pressure to accept optional extras.
• Backdating, inventing evidence, claiming for services not provided or claiming NHS payment in addition to private payment.

Role boundaries

Support staff may explain the process, request information, record facts and escalate concerns. They must not decide entitlement, override national rules, sign on behalf of patients without authority, alter records without a clear trail, make clinical justifications alone, or submit claims they believe are false.

Managers must keep SOPs up to date, provide training, supervise claim tasks, audit samples, review rejected claims, correct errors and maintain a culture where staff can raise concerns without fear of reprisal.

Before submitting or completing a claim

• Is this the correct patient?
• Is this the correct claim or voucher route?
• Is eligibility current and recorded as required by local procedure?
• Has the patient understood and completed any required declaration?
• Are the dates, codes, performer details, voucher details and charges accurate?
• Is there any uncertainty, pressure or lack of support that needs escalation?