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Ophthalmic Payments API

Submit General Ophthalmic Service (GOS) payment claim forms to Primary Care Support England (PCSE).

This specification is a work in progress

This specification is a work in progress

We'll be adding the missing details over time.


Overview

Use this API to submit the General Ophthalmic Service (GOS) payment claims to Primary Care Support England (PCSE). Electronic claims are submitted via Practice Management Systems (PMS) and paper based claims are submitted via a bulk scanning facility, provided by Capita Intelligent Communications (CIC).

Activity data about NHS sight tests, optical vouchers, repairs and replacement are collected via a series of GOS payment claim forms.

  • GOS1 – Application for an NHS funded sight test
  • GOS3 – NHS optical vouchers and patient statement
  • GOS4 – NHS optical repair/replacement vouchers application form
  • GOS5 – Private sight tests with partial help towards the full costs
  • GOS6 – Application for a mobile NHS funded sight test

You can electronically:

  • submit GOS1 claims from PMS and bulk scanning facility to PCSE
  • submit GOS3 claims from PMS and bulk scanning facility to PCSE
  • submit GOS4 claims from PMS and bulk scanning facility to PCSE
  • submit GOS5 claims from PMS and bulk scanning facility to PCSE
  • submit GOS6 claims from PMS and bulk scanning facility to PCSE
  • submit GOS6 pre-visit notifications from PMS to PCSE
  • submit and retrieve GOS3 voucher only between PMS and PCSE
  • submit a status request to PCSE

You cannot submit:

  • GOS2 claims

  • health cost 5 (HC5) refund claims 
  • pre-registration training (PRT) grant claims
  • continuing education and training (CET) claims

A single GOS message can contain multiple claims for payment of a single GOS claim type, i.e. batch submission is allowed. A message cannot contain a mix of different GOS claim types.

You can also submit GOS payment claims via PCSE Online. For further information, see Ophthalmic payments.


Who can use this API

This API can only be used where there is a legal basis to do so. Make sure you have an ophthalmic contract before you go too far with your development.

You must do this before you can go live (see ‘Onboarding’ below).



API status

This API is in production.


Service level

To be supplied.


Technology

This API is RESTful.


Network access

This API is available on the internet and, indirectly, on the Health and Social Care Network (HSCN).

For more details, see Network access for APIs.


Security and authorisation

This API is application-restricted, meaning:

  • the calling application is authenticated - we do care who it is

  • the end user is not authenticated - we do not verify who it is or whether they are present

In particular, it uses TLS Mutual Authentication (TLS-MA).

This API is only for use when the end user is a healthcare worker, not a patient.

In addition, we require calling applications to:

  • authenticate end users locally with a minimum of user ID and password

  • use role-based access control (RBAC) locally to control end user access to the patient data

  • keep an audit trail locally of all accesses to patient data by end users


Environments and testing

To be supplied.


Onboarding

PMS providers need to register with PCSE to onboard for this API. For further information, contact [email protected].


Interactions

For details of interactions, you need the Ophthalmic Payments Interface Specification. For further details, contact [email protected].

Last edited: 14 September 2023 6:02 pm