HICAPS Processing Claims

Process Single Patient Claim

1. Click the navigation menu > Patients > Treatment page
2. Itemised Invoices toolbar > New Invoice Only / F2 key / Click New Invoice icon
3. Create Itemised Invoice:
   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
      
   4. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   5. When prompted, swipe the patients' insurance card
4. Once the claim is processed, the gap will appear onscreen
   1. Click OK
      
      
5. Depending on settings, the claim will print to the terminal or printer
   
6. Within the Create Itemised Invoice window:
   1. Discount: Enter an amount to discount from the gap amount
   2. RECEIVE PAYMENT: Click to enter the gap payment
   3. EXIT: Click to exit
   4. SAVE: Click to save and close, select this option if receipts printed from terminal
   5. PRINT: Click to print a copy from D4Web
      

Process Family Claim

1. HICAPS Terminal is Connected to D4Web
   
2. Accounts are NOT automatically broken down into separate patients
   
3. Patients must be linked as a family in D4Web
   
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. Click the navigation menu > Patients > Treatment page
2. Itemised Invoices toolbar > New Invoice Only / Press F2 key / Click New Invoice icon
   1. Click HICAPS
      
   2. Check the details, Its possible to deselect items to exclude from the claim or Cancel to start again.
   3. Click OK
      
3. Click Yes when ready to process the claim, i.e. the patient card is in hand, ready to swipe on the terminal
   1. When prompted, swipe the patients' insurance card
4. After the claim is processed, the gap message will appear onscreen
   1. Click OK
      
5. Depending on settings, the claim will print to the terminal or printer
   
6. Within the Create Itemised Invoice window:
   1. Discount: Enter an amount to discount from the gap amount
   2. RECEIVE PAYMENT: Click to enter the gap payment
   3. EXIT: Click to exit
   4. SAVE: Click to save and close, select this option if receipts printed from terminal
   5. PRINT: Click to print a copy from D4Web
      

Process Claim on already Invoiced Treatment

1. Click the navigation menu > Patients > Invoices page
1. Highlight the relevant Invoice 
2. Invoices toolbar > HICAPS Claim 
1. Click OK
   
3. Click Yes when ready to process the claim
   
1. When prompted, swipe the patients' insurance card
   
4. After the claim is processed, the gap message will appear onscreen
1. Click OK
   
5. Once 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 page to process the gap amount 
   

Process EFTPOS electronic Payment

1. Click the navigation menu > Patients > Receipts page..
   
2. Add new receipt
   
1. Amount: Enter the amount
   
2. Payment Type: Select EFTPOS ePayment
   
3. EFTPOS Payment: Click HICAPS
   
3. Are you ready to use HICAPS?
   
4. Click YES when ready to process - have the card ready
   
1. Swipe / Insert / Tap the patients card
   
2. If the payment was successful, click OK
   
5. If the payment was unsuccessful, click OK and select another Payment Type
   
6. Click Create /  Print to finalise the payment

HICAPS has removed the ability to send user entered card details in an EFTPOS Sale transaction.

The 'Enter Card Details" option is no longer available within D4Web receipt Window.  

Manual Credit Card entries can be completed directly via the terminal. 

HICAPS Delete / Reverse Claims

Delete (reverse) a Claim

A claim can only be reversed once the associated receipt is removed/reversed.

1. Click the navigation menu > Patients > Claims page
2. Highlight the Claim to reverse
3. Claim toolbar > Reverse Claim
   
4. If security is setup, enter the 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

Reverse a claim done on ANOTHER day

1. Click the navigation menu > Receipts page > Find the patient 
2. Select the HICAPS e-payment that you want to reverse
3. Receipts toolbar > Reverse Receipt.
4. The record will appear on screen
   
1. Click REVERSE
   
5. The permission username/password may appear
   
1. Complete and click OK
   
6. Due to the transaction being done more than 1 day ago, the cancel timeout period message will appear
   
1. Click YES  to proceed anyway, the receipt of the E-PAYMENT will be reversed.
7. Click YES, the receipt of the E-PAYMENT will be reversed.
8. Now go into the Claims page and REVERSE the associated Claim. Use ' Delete (reverse) a Claim' instructions above
   

*IMPORTANT: Call HICAPS HELP on 1300 650 852 and be sure that that CLAIM / E-payment has truly already been reversed from their system. (you will need the RRN of that claim)

Store and Forward / Invoice not Paid by Insurance

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

HICAPS - Worksafe (Vic only)

D4Web 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:

• The Worksafe Card no. Prefix
• An individual patient number
  

Create an Insurance Fund/Plan

1. Create an Insurance Fund and Plan for Worksafe with the following details:
   
1. Name: Victoria WorkSafe
2. Abbreviation: VWA
3. E-System: Select HICAPS from drop list
4. Card No Prefix: 90360115
5. Limit of items per claim: 24
6. Place a tick in the Worksafe checkbox
   
2. Add a Plan to above:
   
1. Plan Code: VWA
2. Plan Name: VWA
3. E-System: Select HICAPS from drop list
   

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. Enter the Patient's Claim number in the Member ID field
2. Enter 01 in the Series field
   

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. Click the navigation menu > Patients > Treatment page
   
1. Itemised Invoices toolbar > New Invoice Only (or press F2)
   
2. Click Hicaps
   
3. Check items selected are correct and click OK
   
4. The Claim will now be submitted via the Hicaps terminal

NOTE: 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. Click the navigation menu > Patients > Receipts page
   
2. Receipts toolbar > New Receipt
   
1. Enter Amount and the usual Payment Type

Reverse WorkSafe Claim

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

1. Click the navigation menu > Patients > Claims page
   
2. Select the Claim to be reversed
   
3. Claims toolbar > Reverse Claim