For Practitioners Useful Local Information

Under GOS regulations, children qualify for unlimited repair and replacements of glasses on a GOS 4.

Adults only qualify if a health condition has led to the loss or breakage of the glasses. Under current regulation, all adult claims must be approved by NHS England prior to the service being provided to the patient, but there is a significant amount of variation in the way this process is currently managed. In order to introduce a standardised and robust approach, NHS Business Services Authority (NHSBSA) has been asked by NHS England to run a national pilot for the pre-authorisation of adult GOS 4 vouchers.

From Monday 5 November (2020) all claims for adult GOS 4 vouchers will need to be preapproved by NHSBSA. The process for pre-authorising a GOS 4 is as follows:

1. 1. Patient aged over 16 goes to GOS contractor, asks for a repair or replacement and explains why it is required.
   2. GOS contractor rings NHSBSA on 0300 330 9403 between 08:00 and 16:30 Monday to Friday and explains the circumstances of the request. Please note all queries must be made by GOS contractors, if patients contact NHSBSA directly they will be directed back to the appropriate contractor.
   3. NHSBSA will then assess the claim against the list of pre-defined medical conditions. For a voucher to be authorised, the cause of the repair and replacement must be linked to an underlying medical condition.
      Medical conditions include:
      • Alcoholism/ Substance Abuse • Arthritis • Brain Injury • Dementia • Diabetes • Epilepsy • Heart Attack • Huntington’s disease • Learning Disability • Mental Health Condition • Motor Neurone Disease • Multiple Sclerosis • Muscular Dystrophy • Stroke • Vertigo • Visual Impairment
   4. Should the contractor encounter a medical condition which is not on this list, NHSBSA will escalate to a clinical adviser for further review. NHSBSA will endeavour to resolve any such cases as quickly as possible.
   5. If the request is not approved the NHSBSA will provide the contractor with a reason and log the details of the call.
   6. If the request is approved, NHSBSA will provide the contractor with the following:
      1. 10-digit authorisation code
      2. Approver Name
      3. Date of approval

The contractor must update part 3 of the GOS 4 voucher with each of these pieces of information. The contractor should then also tick the approved box in part 3

Failure to update the form with each of these pieces of information may result in payment being rejected. Please note the contractor must also complete the rest of the GOS 4 form in full, including specifying the reason for the GOS 4 in Part 1. The voucher form should then be submitted to Primary Care Support England for payment in the normal manner.