The National Health Service (Ophthalmic Services) (Wales) Regulations 2023

Payment claims

22.—(1) Any claim by a contractor for fees for the provision of primary ophthalmic services under these Regulations must be made by completing a primary ophthalmic services form and sending it to the Local Health Board in whose area the primary ophthalmic services were provided within 3 months beginning with the date of completion of the provision of those services.

(2) Any such claim—

(a) may be submitted electronically or on paper, and

(b) must be—

(i) signed by the optometrist or ophthalmic medical practitioner whose name is included in a combined list and who provided or assisted in the provision of the primary ophthalmic services in respect of which the claim is made (“the practitioner”), and

(ii) in a case where the practitioner is not on the ophthalmic list of that Local Health Board, counter-signed on behalf of the contractor by a person (who may be the contractor) duly authorised by the contractor to counter-sign, whom the contractor has previously notified the Local Health Board as being so authorised.

(3) In the case of a claim signed under sub-paragraph (2)(b)(i), the practitioner must supply with their signature, their professional registration number with the prefix and suffix given to that number in the combined list in which the qualified practitioner’s name is included.

(4) In the case of a claim counter-signed under sub-paragraph (2)(b)(ii), the person authorised to counter-sign must supply, with that person’s counter-signature, the professional registration number of the contractor.

(5) A signatory or counter-signatory is to sign any electronic claim or paper claim in digital ink or in ink, in the signatory or counter-signatory’s own handwriting and not by means of a stamp or reproduced image, with the signatory or counter-signatory’s—

(a) initials or forename, and

(b) surname.

(6) Except as provided in these Regulations, in the Statement or in sub-paragraph (7), a contractor must not demand or accept from any patient or from other persons the payment of any fee or other remuneration in respect of the provision of primary ophthalmic services.

(7) A contractor is entitled to demand and recover from a patient, or person having charge of a patient, a sum in respect of loss of remunerative time resulting from that patient’s failure to keep an appointment.

(8) A contractor must not demand or accept from the Local Health Board the payment of any fee or other remuneration in respect of any item of service—

(a) which has not been provided under primary ophthalmic services, or

(b) for which another claim has already been submitted to the Local Health Board.