Invoice Validation (Secondary Care, PbR, Pathways, SCG, etc.)

This module processes secondary care activity data at patient level in SUS or SLAM format and applies it against a large number of validation rules. Locally agreed schemas e.g. SLAM columns are auto-detected in run-time allowing flexibility in data layout. The spell level output by provider contains details of why the spell failed. The default rules-set has the following categories:

� Data Quality (Poor quality, Duplicate Spell, missing fields, etc.)

� Low Priority Procedures or PPwT (verifies against prior approval list)

� Pathway (duplicate OPFAs, DCs within spell, contiguous spells, etc.)

� PbR (PbR variation, local tariffs if provided)

� Refundable Spells (e.g. Road Traffic Accident)

� Specialist Activity (SSNDS 3.4, HCD validation)

Each category has permutations of a rule e.g. Low Priority Procedures runs over 100 sub-rules and Specialist Activity runs over 16,000 sub-rules.