Payment by Results guidance

SUS PbR Guidance is a reference resource designed to support SUS users with regard to National Tariff/Payment by Results and it's implementation in SUS. For general SUS user guidance on sending and accessing data, set-up help and system support please refer to the SUS Guidance page.

General SUS PbR guidance

SUS PbR reference manual

Guidance on all aspects of SUS PbR, including concepts, functionality and policy implementation. This document has replaced release-specific technical guidance documents and consolidates applicable historical guidance.

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SUS+ PbR reference manual

Extract specification

Data item details for each extract available via the Portal.

SUS extract specification

xlsx 224 KB

Indicators, errors and data quality rules

Derived data items applied and output in scheduled extracts.

SUS indicators, errors and rules

xlsx 90 KB

NHS England guidance

CAM Interactive 1718 v1.0

xlsx 260 KB

Organisation code guidance

docx 32 KB

Readmissions

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Readmissions

This guidance was originally published on 13 December 2017 as Appendix A in SUS+ readmissions which also included instructions to obtain the now discontinued monthly readmissions extracts.

Submission timetables

Submissions must be received by SUS+ before 5pm on the inclusion date.

SUS+ will endeavour to publish ahead of the delivery date.

Definitions

Inclusion Date: Deadline for data submissions to be included in the frozen views of data.

Publication Date: Guaranteed SUS+ publication date for all inclusion extracts run on the inclusion day, inclusion +1 day and inclusion +2 days, by 8am on the day.

Reconciliation and post-reconciliation (first-phase and second-phase)

SUS+ provides for a two phase reconciliation process to arrive at a final agreed position for each month's activity as defined in the NHS Standard Contract.

Reconciliation (first-phase)

In the first phase of reconciliation, providers submit initial calendar month activity data to SUS+.

At a nationally determined deadline (Inclusion date), a snapshot of this data is taken. The point at which this first snapshot is taken is referred to in SUS+ as the Reconciliation point. The NHS Standard Contract uses the term First Reconciliation Date for the point at which this first snapshot is available from SUS+.

Under the contract, providers will base the first reconciliation account they send to commissioners on the first-phase reconciliation data they submit to SUS+ by the Reconciliation Inclusion date above.

Post-reconciliation (second-phase)

In the second phase, providers and commissioners review and validate the data submitted in the first phase with the aim of agreeing the final level of payment to be made for the period. At a second nationally determined inclusion date a second snapshot of the data is taken. This second snapshot point is referred to in SUS+ as the Post-reconciliation point. The NHS Standard Contract uses the term Final Reconciliation Date for the point at which the data in this snapshot is processed and available.

Under the contract, providers base the final reconciliation account they send to commissioners on this second-phase reconciliation data which they submit to SUS+ by the Post-Reconciliation Inclusion date.

Once the provider has sent the final reconciliation account, the contract then allows the commissioner a brief period to validate the final data and contest any elements of the final reconciliation account which it believes are incorrect via the process set out in the contract.