Patient File Setup for HICAPS / Medicare

In general, most of your patient records for HICAPS patients should be already configured for HICAPS, apart from new patients or patients who are switching to HICAPS as a payor. For these patients, you need to ensure the following is done:

To set up the Patient File for HICAPS, for new patients or for patients switching to HICAPS

1. Open the Patient Details window and select the appropriate patient.
2. On the right-hand side of the screen, locate the Payor,Payor# field:
   
   As HICAPS is treated as a private payor in EXACT, the Payor should be left blank.
   
3. If this patient is part of a family where one person is invoiced and pays the bills, select the paying patient from the drop-down menu. (You will also need to make sure the other family members are listed in the 'Family Members' field lower down on the screen.)
4. Choose the appropriate Health Fund for the patient from the 'Health Fund' drop-down list. This is accessed by clicking in the field and using the or buttons:

   

   Alternatively (and this is preferable, as it reduces data errors), you can click the Swipe button , and when prompted by the HICAPS terminal, swipe the patient's card through the HICAPS terminal. This will identify the Health Fund and store it in the 'Health Fund' field. (Note that before exiting you will still need to save the patient's record to file to store this).

5. The 2-digit HICAPS Patient ID for HICAPS cards is not automatically derived from swiping the card; you will need to get this from the patient and manually enter it. Several patients can be assigned to one HICAPS claim card and so the prefix identifies individual patients that have the same card number (that is, family members). Family members related to the current patient are listed in the 'Family Members' field immediately below the HICAPS field.
6. Click the button to save any changes you have made to the patient's record.

   NOTE: While it is preferable to set up a HICAPS patient's details before processing claims, in the event that you forget to do this, EXACT will allow you to enter fund details when you click the Send HICAPS Claim button for a patient who has not been configured as a HICAPS patient.