Cancelling HICAPS Claims

Electronic cancellation

HICAPS can handle electronic cancellation of claims within 24hrs of the claim being made, but this manageable only if

• The patient is still in the practice with the required HICAPS card
• The connection between the HICAPS terminal and the computer is functional.

Manual cancellation

If either of the above conditions is not met and electronic cancellation is not possible, you can manually cancel HICAPS claims by means of the Cancel Item button, which is enabled for any HICAPS-related payment.

Manual cancellation of today's transaction

(possible from EXACT v11.3 SP7 onwards)

If you select the Cancel Item button for today's electronically created claim, EXACT passes the data to the terminal and when the required data is received back from HICAPS, EXACT

• Reverses the HICAPS payment on the original claim, and
• Creates a cancelled claim statement.

Manual cancellation of a previous day's transaction

If you select the Cancel Item button for an electronically created claim that was not created today you will be prompted with the following dialog:

"This claim cannot be cancelled through the HICAPS terminal as it was not created today. Would you like to cancel this claim manually? Please note that manual cancellations only adjust the transaction details in EXACT and you will still need to additionally cancel the claim with HICAPS."

You have the option of selecting Yes or No (default). If you choose Yes, EXACT will simply reverse the HICAPS payment and prefix the transaction particulars with "Manual" text. A claim statement will not be created in this case.

Manual cancellation of an electronically created claim, claimed today and EXACT cannot connect to the terminal

If you select the Cancel Item button for an electronically created claim, claimed today and EXACT cannot connect to the terminal, you will see the following dialog:

"EXACT could not connect to the HICAPS terminal. Would you like to cancel the claim manually? Please note that manual cancellations only adjust the transaction details in EXACT and you will still need to additionally cancel the claim with HICAPS."

You have the option of selecting Yes or No (default). If you choose Yes, EXACT will cancel the claim manually by reversing the HICAPS payment, prefixing the transaction particulars with "Manual" text and creating a cancelled claim statement (existing functionality).

To cancel HICAPS Claims

Swipe the member's card and use the Cancel Item button on the Statement Account window, which is enabled for any HICAPS related payment.

You will see the HICAPS Cancel window:

The cancellation process now depends on various scenarios as outlined below:

Electronically cancelling the claim through the HICAPS terminal

(this is possible from EXACT v11.3 SP7 onwards)

Note that cancellation of claims via the HICAPS terminal is only permitted for approved transactions for the current date.

If you select the Electronic option and select OK, EXACT will pass the data to the terminal and when the required response is received back from HICAPS, EXACT will reverse the HICAPS payment on the original claim and create a cancelled claim statement.

The original item will be marked "HICAPS Cancelled" in the Particulars column, and a new debit item labelled "HICAPS Payment Adjustment" and marked with a icon.

Electronically cancelling the claim when the HICAPS terminal connection cannot be made

If you select the Electronic option and select OK for an electronically created claim, claimed today, and EXACT cannot connect to the terminal, you will be presented with the following dialog:

The defaulted response is , to force you to consider whether this is the appropriate action to take.

If you choose to click the button, EXACT will cancel the claim manually by reversing the HICAPS payment, prefixing the transaction particulars with "Manual" text and creating a cancelled claim statement.

Manually cancelling an electronically created claim that was not created today

If you select the Manual Cancellation option and click OK, for an electronically created claim that was not created today, then you will be prompted with the following dialog:

The defaulted response is , to force you to consider whether this is the appropriate action to take. If you choose to click the button to cancel the claim manually, EXACT will reverse the HICAPS payment and prefix the transaction particulars with "Manual" text. A claim statement will not be created in this case.

Manually cancelling a manually created claim

If you select the Manual Cancellation option and click OK for a claim that was created manually, regardless of whether it was created today or not, you will be presented with the following dialog:

The defaulted response is , to force you to consider whether this is the appropriate action to take. If you choose to click the button to cancel the claim manually, EXACT will simply reverse the HICAPS payment and prefix the transaction with "Manual" text. A claim statement will not be created in this case.

Cancelled claims will flag items as not being claimed so that you can claim these items again if necessary. For those which are cancelled manually as described above, you will need to contact HICAPS with the original claim details

If HICAPS claims have caused transfers of patient amounts due to the paying patient feature, cancelling HICAPS payments will reverse these transfers as well.