Claiming via HICAPS Connect

HICAPS $10K RESTRICTION:
Card processing must be for amounts less than $10,000 per Claim Item.
However, you can enter multiples of the same Claim Item to work around this restriction.

To claim via HICAPS Connect

Once you have charted treatment for a patient, you can make a HICAPS claim as follows:

1. Click the button in the 'Patient Details' window to display transactions (the statement) for the patient:

   

2. Click the button in the toolbar at the bottom of the window.
3. A window like the following example will be displayed:

   

4. If there are extra items of stock such as toothbrushes, mouthwash, dental floss, etc., purchased by the patient, highlight them and use the button to move them into the 'Stock Items' field.
5. If there is discount, this is usually automatically applied, but you can override this if required.
6. The 'Allocations' field lists all the invoiced items, with a tick to the left of any
7. In the 'Payment Amount' field, enter the amount being paid, and select the appropriate 'Payment Type' from the drop-down menu. If there are any comments pertinent to the patient's account that you wish to record, enter them in the 'Comment' field.
8. If you click the HICAPS button at the bottom of the 'Payment' window, EXACT displays in the Patient Invoice Data window the items that can be claimed:

   

   These items are ticked by default; if there are any you wish to exclude from the claim for whatever reason, you can click on the checkbox to the left to deselect them.

   Alternatively, if there are a lot of items and you wish to claim only a few, you can click the 'Un-Tick All' button, then just select the items you want to claim, before clicking the Send HICAPS Claim button .

9. If a Patient ID has not been entered in EXACT for the patient, a dialog like the following is displayed:
   
   This defaults to '01', which will be the ID for most single-user cards, but this can be overwritten if not correct.
10. If the patient does not have a Health Fund code, a message like the following example is displayed:

    

    Click the 'Yes' button and swipe the patient's card through the HICAPS terminal.
    Health funds currently have limits of the number of entries they allow in a claim. So this doesn't cause problems for the user, EXACT allows you to select as many items as you wish to claim and then will simply break these up into claims of appropriate size and send them to the health fund one after the other. For example, If health fund XYZ has a 24-item limit and you select 26 items to claim, EXACT will create one claim for the 24 items, send it and receive the response back from the health fund. It will then bundle the remaining 2 items and send another claim. Once the response is received for this claim, you will be presented with the normal print dialog where you will be able to view both of the HICAPS statements one after the other.

11. When you are returned to the 'Payment' window, any adjustments made to the outstanding amounts will include benefits from both claims.
    These claims will still be treated as individual HICAPS payments as far as recording them and displaying them in the patient transaction window. You will be able to select them individually and print individual statements from them if required.
12. If there are any items which are problematic (such as an invalid or missing ADA code), an error message will be displayed, like the following example:
    
    Note the error condition, then click the 'OK' button to return to the previous window.
    Correct the error(s), or untick any problematic item to remove it from the claim, then click the 'Send HICAPS Claim' button again.
13. If a claim is rejected for some reason, a second claim will not be sent. You will be given the opportunity to fix the problem before attempting to send both claims again. If the first claim passes and the second is rejected, EXACT will report this and leave the remaining items as unclaimed so that you have the opportunity to send these items again at a later time.

    Once the claim is successfully processed, the 'Print HICAPS Statement' dialog is displayed' allowing you to make any necessary option selections before printing the HICAPS statement:
    
    The example shown is set to print a copy of the statement for the patient and another for the provider. Both have the same content, but the latter has a declaration to be signed in the space provided.
    
    Note that the example above is a representation only, and not necessarily an accurate portrayal of an actual statement.
    
    The provider copy is identical, apart from being labelled as such, and having the following section:
    

14. Any 'gap amount' (difference between what was claimed and what has been approved for each item as a benefit) is shown on the statement, as is any HICAPS Loyalty bonus. The patient can then pay the total gap minus any loyalty bonus. This gap payment may be paid via the terminal as an EFTPOS payment (credit or debit card), or the patient can pay it by cash or cheque.