Configure Claiming Parameters

NOTE: The introduction of SOE Pay in EXACT v12.15 has necessitated a re-alignment of HICAPS as an optional payment method under Claiming Parameters, which affects some historical screenshots.

To configure Claiming Parameters

1. Select Configure > Claiming Parameters to display the HICAPS Parameters window:

   

2. Configure the fields and settings:

   	Process claims through HICAPS This checkbox must be checked (ticked) in order for HICAPS to be used within EXACT.
   	Process EFTPOS Payments If you wish to process EFTPOS payments on the HICAPS terminal, tick this checkbox. Note that if this is unticked, you will need to change your existing EFTPOS Payment type to Debit Card – This can be done as follows: Click Configure > Patient Payments, Highlight the 'EFTPOS' payment type, Click the button, Select the "Debit Card" option, Click to save.
   	Process Medicare Easyclaim Claims Select the Configure button to open the Medicare Easyclaim Setup: ... Note this instruction on the screen: The list below shows the information that will be sent with Medicare Easyclaim claims per service code range. You can add additional code ranges by selecting the +1 button below. EXACT will ensure the ticked items in the table below are sent with the claims appropriately. Screen detail:
   	Prompt for Service Item information Displays further information
   	Pass patient name to HICAPS terminal If this is ticked, the patient's name will be sent to the terminal when a claim is being processed for them.
   	Print HICAPS statements using There are two settings for this: EXACT Only - If this is selected, HICAPS statements will be printed through EXACT, and the user will be presented with a Print Statement dialog. HICAPS Terminal Only - With this option, the user will never be required to print the statements, and they will be printed instead by the terminal.
   	Terminal Details This section is display only, and shows the IP address of the terminal and what COM port it is connected to, the merchant's HICAPS Merchant ID, and the terminal's ID.
   	Health Funds This displays all the Health Funds currently available. These details are loaded automatically when the 'Health Fund Synch' process is initiated (see below). The number in the right-hand column (9, 24, 16, etc.) is the limit to the number of entries that particular fund will allow in a claim, and is stored on the terminal, and loaded from there into EXACT. This number is then used by EXACT to break claims bundles up into smaller allowable numbers. In the case of a claim being broken up into (for example) two blocks, two statements will be printed when the claim is submitted. When subsequently viewing or printing the HICAPS statements, they will be displayed or printed together.

3. Click the Configure Terminal button to display the HICAPS Connect Setup:

   

   This enables you to select the terminal you wish to use (if there is more than one available in the Terminals drop-down list), and test the terminal via the Terminal Test button. The test request signal is shown in the Request field, and the response is shown in the Response field, as shown in the example above. This includes a test of the communications, and shows the Merchant and Terminal IDs stored.

4. Click the button to synchronise the Health Funds list in EXACT with those stored on the HICAPS terminal as a CardList:

   
   Once the list has been retrieved from the terminal, if there is no difference, the window closes with no message.
   If there is a difference - any Health Funds that exist on the CardList on the terminal, which are not in EXACT - they will be added to the Health Funds list in EXACT.

   Note that the Health Fund Synch process does not indicate what changes have been made, nor does it transfer the figure for the maximum number of items in a claim for that fund. It is up to the user to read this from the HICAPS terminal, and manually edit by means of the Edit button (see Health Funds above).

5. Click the button to compare the provider numbers stored on the terminal for the current Merchant ID with those stored in EXACT:

   

   If a provider ID is found on the terminal but not in EXACT, and if the user is an EXACT user with Administrator security, then the Missing Providers window similar to the example below will display:

   
   
   You will be able to click either the Add Provider button to add a new provider, or the Edit Provider button to open the Provider File and amend the details so they match those on the terminal.

   Users without Administrator rights will not see this window and are not able to make any changes to the EXACT database.

   As part of HICAPS certification, the Health Fund Synch and Provider Synch are run automatically the first time a HICAPS claim is sent each day. The buttons described above allow you to perform the synchronisation manually whenever you wish to make sure your database is up to date. Note that if you wish to add a new provider number to the terminal, or change the details of one already stored, you must first notify HICAPS Australia in writing using a Change of Practice Details form. You will receive written notice once the new provider number has been registered.