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Reimbursement model guidance

This guidance seeks to support API consumers with populating prescriptions with the necessary details needed for reimbursement.

SCAL notice for suppliers

Please refer to the Supplier Conformance Assessment List (SCAL) as the definitive source of supplier information and guidance for EPS development. You will receive the SCAL when you begin the EPS onboarding process.

Cost centre models

Prescribing cost centre model

Where your site is configured to use a 'Prescribing Cost Centre' model, then the site might use identifiers to identify medical prescribers at the site.

These include a:

  1. DIN number to identify the responsible practitioner
  2. spurious code to identify that the requester is acting as a locum at a given site 
  3. spurious code used by medical prescribers at the site

Prescribing cost centre model (6 digit code)

This model is typically for primary and community care. There are 3 key fields which must be completed: Responsible Practitioner, Requester, and Prescription Type.

Flow chart diagram showing the prescribing cost centre model for the electronic prescription service.
Responsible Practitioner

The responsible practitioner is the person or service responsible for the prescription. The responsible practitioner field must include the responsible practitioner's name, the name of the cost centre (typically primary or community care) and the 6-digit ODS code of the cost centre in the ‘ANNNNN’ format.

The final piece is the prescriber code. For medical prescribers this will be the 6-digit DIN ‘NNNNNN’ or the 6-digit spurious code ‘6NNNNN'. For non-medical prescribers, the prescriber code is their professional registration or personal identification number, which may include additional zeroes as shown in the full list of prescriber code formats with examples.

Requester

The requester is the person creating and signing the prescription. The requester field must include the requester's name, the name of the cost centre (typically primary or community care) and the 6-digit ODS code of the cost centre in the ‘ANNNNN format’. The final piece is the Professional Code. For medical prescribers this is the GMC registration number. For non-medical prescribers this is the PIN or registration number.

Prescription Type

For medical prescribers, the prescription type must include the ‘0101’ code. For non-medical prescribers, this will be a ‘01NN’ code. The full list of accepted codes can be found in the Overprint specification for FP10SS forms v2.1 section 5.3. An exception for this is dental prescribers, where the prescription type will be ‘0607’.

Trust site model

Where your site is configured to use a 10nn model, then the site will not have any prescriber specific identifiers as costs in this model are charged back to the site itself. Therefore, there are no specific identifiers beyond the professional identifier to identify prescribers at the site.

Trust site code or ePACT model (5 digit code)

This model is typically for secondary care for 'HP' equivalent prescriptions. There are 3 key fields which must be completed: Responsible Practitioner, Requester, and Prescription Type.

Flow chart diagram showing the trust site code or ePACT model for the electronic prescription service.
Responsible Practitioner

The responsible practitioner is the person or service responsible for the prescription. The responsible practitioner field must include the responsible practitioner's name, the name of the cost centre (typically primary or community care) and the 5-digit ODS code of the cost centre in the ‘RXXXX’ or ‘ANANA’ format. The final piece is the prescriber code. For medical and non-medical prescribers this is the PIN or registration number.

Requester

The requester is the person creating and signing the prescription. The requester field must include the requester's name, the name of the cost centre (typically primary or community care) and the 5-digit ODS code of the cost centre in the ‘RXXXX’ or ‘ANANA’ format. The final piece is the Professional Code. For medical prescribers this is the GMC registration number. For medical and non-medical prescribers this is the PIN or registration number.

Prescription Type

For medical and non-medical prescribers, the prescription type must include the ‘10nn’ code. The full list of accepted codes can be found in the Overprint specification for FP10SS forms v2.1 section 5.3. An exception for this is dental prescribers, where the prescription type will be ‘0607’.


Field mapping

Entity FHIR mapping
Requester

MedicationRequest.requester: PractitionerRole

→ PractitionerRole.Practitioner

Responsible Practitioner

MedicationRequest.extension: DM-ResponsiblePractitioner

→ PractitionerRole.Practitioner


Prescribing cost centre model message examples

The requester (DR C BOIN) is prescribing at a site where the responsible practitioner (DR A BOIN) is identified using their DIN number.

The requester (DR C BOIN) is acting as a prescriber at a site where the service as a whole (DR NHS 111 OOH) is identified as the 'responsible practitioner' for the site.    

The requester (DR C BOIN) is acting as a locum at another site, where they are identified as a 'responsible practitioner' using their spurious code.


Trust site model message example

The requester (DR C BOIN) is a medical practitioner prescribing at the Trust Site RH5E4.

Last edited: 3 September 2024 3:10 pm