The below instructions assume HICAPS is setup to claim via Dental4Windows/PSS, the correct patient is in view and items are already entered in Treatment tab, ready to process the claim. 

1. Go to Patient Records > Treatment tab
2. Itemised Invoices menu > New Invoice Only / Press F2 key / Click New Invoice icon
3. Click HICAPS
   
   
4. Check the details of the claim are correct. Its possible to deselect items to exclude from the claim or Cancel to start again.
5. Click OK to proceed with the claim
   
   
6. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   
   
7. When prompted, swipe the patients' insurance card
8. After the claim is processed, the gap will appear onscreen, click OK to proceed
   
   
9. Depending on settings, the claim will print to the terminal or printer
10. Within the Create Itemised Invoice window, select to
11. Discount: Enter an amount to discount from the gap amount
12. Receive Payment: Click to receive the gap payment
13. Preview: Click to view, e-mail and/or add a custom message to the invoice
14. Print: Click to print a copy and leave the gap outstanding
    
    

Uninvoiced Treatment refers to items not created into an invoice - showing as yellow in the Treatment tab. If items have already been created into an invoice, see Process Family Claim on Invoiced Treatment via HICAPS below.

Patients linked as a family, with the same health fund card and treated by the same provider can be claimed via HICAPS in the one transaction, saving time and reducing the amount of paper used per claim.

When a family claim is processed, all the patients involved in the claim will appear in one invoice.

1. HICAPS Terminal is Connected to Dental4Windows / PSS
2. Accounts are NOT automatically broken down into separate patients
3. Patients must be linked as a family in Dental4Windows / PSS
4. Family members must be on the same health fund card 
5. Treatment must be from the same Provider
6. Providers must have their Provider ID entered to process claims
   

1. Go to Patient Records > Treatment tab
2. Itemised Invoices menu > New Invoice Only / Press F2 key / Click New Invoice icon
1. Click HICAPS
   
   
2. Check the details of the claim are correct. Its possible to deselect items to exclude from the claim or Cancel to start again.
3. Click OK to proceed with the claim for first family member
   
   
4. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   
   
5. Click OK for next family member
   
   
6. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   
   
7. Repeat as necessary if any further family members
8. When prompted, swipe the patients' insurance card
9. After the claim is processed, the gap will appear onscreen, click OK to proceed
   
   
10. Depending on settings, the claim will print to the terminal or printer
11. Within the Create Itemised Invoice window, select to
1. Discount: Enter an amount to discount from the gap amount
2. Receive Payment: Click to receive the gap payment
3. Preview: Click to view, e-mail and/or add a custom message to the invoice
4. Print: Click to print a copy and leave the gap outstanding
   
   

Quote

Cancel

Discount Category

Adjusted GAP ADJ discount category is automatically used to reflect the adjusted fee amount for items in the invoice.

HICAPS: Process Claim on Invoiced Treatment

Invoiced Treatment refers to items already created into an invoice - showing as red in the Treatment tab. If treatment is un invoiced, see HICAPS: Process Family Claim section above.

Patients linked as a family, with the same health fund card and treated by the same provider can be claimed via HICAPS in the one transaction, saving time and reducing the amount of paper used per claim.

1. Go to Patient Records > Invoices tab 
2. Select the relevant Invoice 
3. Invoices menu > HICAPS Claim 
1. Click OK to proceed with the claim
   
   
2. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   
   
3. When prompted, swipe the patients' insurance card
4. After the claim is processed, the gap will appear onscreen, click OK to proceed
   
   
4. After the claim is processed, the following options are available
1. Against the relevant invoice, enter a Discount
2. Select the relevant invoice > Click Print icon to print the gap amount
3. Go to Receipts tab to process the Gap amount
   

HICAPS: Delete (reverse) a Claim

A claim can only be reversed once the associated receipt is removed. Reverse the receipt, then follow these steps. 

1. Go to Patient Records > Claims tab
2. Highlight the Claim to reverse
3. Click Reverse Claim icon 
4. If security is setup, enter Username, Password and Reason
1. Click Reverse 
2. Follow the prompts of the claiming system

To see reversed details from the patients file, place a tick in Show Reversed Records. 

HICAPS: Store and Forward / Invoice not Paid by Insurance

The Store and Forward (SAF) transactions are claims that are stored in the HICAPS host when the Health Fund host is unavailable due to various reasons. When the Health Fund host becomes available, the stored transaction will be sent to the Health Fund for processing.

When Dental4Windows / PSS receives a Transaction Return Code of 10 for Store and Forward claim from the HICAPS terminal, Dental4Windows / PSS will treat this as a successful claim, though the HICAPS receipt will differ slightly:

1. GAP column is removed from the claim form.
2. SAF Declaration should be printed on the Provider copy

Any Store and Forward claims transaction that need to be reversed have to be done from the Claims tab. The reason for this is because there is no benefit paid for this type of claim.

HICAPS - Worksafe (Vic only)

Dental4Windows users in Victoria have the opportunity to submit HICAPS Claims for the Worksafe Health Fund.

The Worksafe health fund differs from other HICAPS Health Funds.

Transactions are not assessed immediately and no benefit is returned at the time of processing the claim.
Claims are assessed as a batch at a later time, and payments are sent to the Provider accordingly.

Worksafe does not issue a card to its members. Each patient is issued with a Claim Number that is used in place of a card number when sending claims. The Claim number is 19 digits and is comprised of:

1. The Worksafe Card no. Prefix
   
2. An individual patient number

Create Insurance Fund and Plan

Add New Insurance Company for Worksafe with the following details:

1. Name: Victoria WorkSafe
2. Abbreviation: VWA
3. E-System: Select HICAPS 
4. Card No Prefix: 90360115
5. Limit of items per claim: 24
6. Tick Worksafe
   
   
7. Plan Code: VWA
8. Plan Name: VWA
9. E-System: Select HICAPS
   
   

Add WorkSafe to a Patient's Record

Before sending the Claim via HICAPS terminal, the relevant information needs to be entered into the Patient's record. 

1. Member ID: Enter Patient's Claim number 
2. Series: Enter Patient's series number
   
   

Send WorkSafe Claim via HICAPS terminal

All actions (Charting, Treatment Plan, Treatment) are the same as per the usual treatment procedures.

Visit https://www.worksafe.vic.gov.au for information on approved items/services.

1. Go to Patient Records > Treatment tab
2. Itemised Invoices menu > Select New Invoice Only (or press F2)
3. Click Hicaps
4. Click OK
5. The Claim will now be submitted via the HICAPS terminal

This claim has not been paid, it is submitted. The method of payment from WorkSafe Victoria to you will not change.

Receive Payment from WorkSafe

It is recommended to add a Payment method called WorkSafe Payments. 

1. Go to Patient Records > Receipts tab
2. Receipts menu > Select New Receipt
3. Enter Amount > Enter Payment Type
4. Click Ok
   

Reverse WorkSafe Claim

WorkSafe claims can only be reversed on the same day it was submitted.

1. Go to Patient Records > Claims tab
2. Select the Claim to be reversed
3. Claims menu > Select Reverse Claim

HICAPS: Process EFTPOS ePayment