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Search these help files
| Live Search | ||||
|---|---|---|---|---|
|
Configure Private Health Claiming from the Configure > Claiming Parameters screen.
...
This user guide explains the steps and requirements in preparing you and your practice to configure and use the latest and newest version of HICAPS called HICAPS Connect via EXACT. HICAPS Connect is a new software version introduced by HICAPS in 2009 which incorporates the normal Health Fund processing.
A new interface program called HicapsConnect.exe operates as an intermediate program which reads and writes claim information from EXACT and transmits it to the terminal for processing.
...
Information transfer between EXACT and HICAPS Connect
Below is a representative diagram showing the transfer of information between EXACT and HICAPS Connect:
- A patient is billed in EXACT.
- The patient's Health Fund membership card is swiped through the HICAPS terminal.
- The patient's claim information is sent to the HICAPS Connect program which then transmits the claim information to HICAPS via the Terminal.
- HICAPS processes the claim and sends back the approved claim information to the HicapsConnect.exe program via the Terminal.
- If there is a difference between what was claimed and what was approved (the 'gap amount'), the patient pays the difference. If the 'EFTPOS' option of HICAPS Connect has been enabled, the patient then has the option of paying the gap amount via a debit or credit card.
- Depending on what settings have been enabled, a HICAPS transaction statement is printed on the HICAPS terminal, or on the terminal and the printer attached to EXACT.
Prerequisites
Before using HICAPS Connect in EXACT, the following prerequisites must be met:
- Practices are required to sign up with HICAPS to obtain the latest Terminal Software and Hardware.
This is usually supplied to you on a CD provided by Software of Excellence. - Ensure the latest Terminal Software Version is at least HICT42.H4A.
To update the software version, please contact Software of Excellence for assistance.
- The EXACT software must be at least Version 10.11. For correct operation, please contact Software of Excellence to ensure your installed version includes the latest updates for HICAPS.
A CD is available from SOE Support which contains everything required for ensuring your software is up to date and for installing HICAPS Connect.
...
Installation and Configuration of HICAPS Connect for EXACT:
Software of Excellence Australia
Main: 03 9873 1133
Fax: 03 9873 1033
Support: 1800 147 537
Email: support@soeidental.com
...
- Ensure a backup copy of your EXACT database has been made.
- Install or upgrade to EXACT Version 10.11 (or later).
- Install HICAPS Connect components.
- Configure HICAPS Connect in EXACT.
Important Notes
This HICAPS Connect program does not need to be installed onto all PCs - only onto the machines which are going to interface with the HICAPS Terminal. For example, if you do not process HICAPS Claims from your Server or Surgery machines, then you do not need to install HICAPS Connect on those machines.
...
To use HICAPS Connect, ensure that you have installed or have been upgraded to EXACT version 10.11 or later.
For more information on how to install or upgrade EXACT, please refer to Software of Excellence Support.
If you already have an EXACT Version 10.11 (or later) upgrade CD, but haven't yet run the update, do the following:
- Insert the CD supplied into the CD drive of your computer.
- Read all of 'Step 1 - Upgrade Instructions' on the menu displayed, and follow the instructions to backup EXACT, disable your antivirus software etc.
- Proceed to 'Step 2 - Install EXACT'.
- When EXACT has been installed/upgraded, proceed to 'Step 3 - Misc Items', and install HICAPS Connect (see the next Help topic for more details).
...
The process described below assumes you have already upgraded EXACT to the appropriate version, as described in the previous section. If this is not the case, please do so before continuing.
For your convenience, a CD is available from Software of Excellence Support which contains all the components required to upgrade EXACT, the .Net framework, and install HICAPS Connect.
...
NOTE: The introduction of SOE Pay in EXACT v12.15 has necessitated a re-alignment of HICAPS as an optional payment method under Claiming Parameters, which affects some historical screenshots.
...
- Select Configure > Claiming Parameters to display the HICAPS Parameters window:
Configure the fields and settings:
Process claims through HICAPS
This checkbox must be checked (ticked) in order for HICAPS to be used within EXACT.
Process EFTPOS Payments
If you wish to process EFTPOS payments on the HICAPS terminal, tick this checkbox.
Note that if this is unticked, you will need to change your existing EFTPOS Payment type to Debit Card – This can be done as follows:- Click Configure > Patient Payments,
- Highlight the 'EFTPOS' payment type,
- Click the
button, - Select the "Debit Card" option,
- Click
to save.
Process Medicare Easyclaim Claims
Select the Configure button to open the Medicare Easyclaim Setup:
...
Note this instruction on the screen:
The list below shows the information that will be sent with Medicare Easyclaim claims per service code range. You can add additional code ranges by selecting the +1 button below. EXACT will ensure the ticked items in the table below are sent with the claims appropriately.
Screen detail:
Prompt for Service Item information
Displays further information
Pass patient name to HICAPS terminal
If this is ticked, the patient's name will be sent to the terminal when a claim is being processed for them.
Print HICAPS statements using
There are two settings for this:
EXACT Only - If this is selected, HICAPS statements will be printed through EXACT, and the user will be presented with a Print Statement dialog.
HICAPS Terminal Only - With this option, the user will never be required to print the statements, and they will be printed instead by the terminal.
Terminal Details
This section is display only, and shows the IP address of the terminal and what COM port it is connected to, the merchant's HICAPS Merchant ID, and the terminal's ID.
Health Funds
This displays all the Health Funds currently available. These details are loaded automatically when the 'Health Fund Synch' process is initiated (see below).
The number in the right-hand column (9, 24, 16, etc.) is the limit to the number of entries that particular fund will allow in a claim, and is stored on the terminal, and loaded from there into EXACT. This number is then used by EXACT to break claims bundles up into smaller allowable numbers. In the case of a claim being broken up into (for example) two blocks, two statements will be printed when the claim is submitted. When subsequently viewing or printing the HICAPS statements, they will be displayed or printed together.
- Click the Configure Terminal button
to display the HICAPS Connect Setup:
This enables you to select the terminal you wish to use (if there is more than one available in the Terminals drop-down list), and test the terminal via the Terminal Test button. The test request signal is shown in the Request field, and the response is shown in the Response field, as shown in the example above. This includes a test of the communications, and shows the Merchant and Terminal IDs stored.
- Click the
button to synchronise the Health Funds list in EXACT with those stored on the HICAPS terminal as a CardList:
Once the list has been retrieved from the terminal, if there is no difference, the window closes with no message.
If there is a difference - any Health Funds that exist on the CardList on the terminal, which are not in EXACT - they will be added to the Health Funds list in EXACT.Note that the Health Fund Synch process does not indicate what changes have been made, nor does it transfer the figure for the maximum number of items in a claim for that fund. It is up to the user to read this from the HICAPS terminal, and manually edit by means of the Editbutton
(see Health Funds above). - Click the
button to compare the provider numbers stored on the terminal for the current Merchant ID with those stored in EXACT:
If a provider ID is found on the terminal but not in EXACT, and if the user is an EXACT user with Administrator security, then the Missing Providers window similar to the example below will display:
You will be able to click either the Add Provider button to add a new provider, or the Edit Provider button to open the Provider File and amend the details so they match those on the terminal.Users without Administrator rights will not see this window and are not able to make any changes to the EXACT database.
As part of HICAPS certification, the Health Fund Synch and Provider Synch are run automatically the first time a HICAPS claim is sent each day. The buttons described above allow you to perform the synchronisation manually whenever you wish to make sure your database is up to date. Note that if you wish to add a new provider number to the terminal, or change the details of one already stored, you must first notify HICAPS Australia in writing using a Change of Practice Details form. You will receive written notice once the new provider number has been registered.
...
NOTE: The introduction of SOE Pay in EXACT v12.15 has necessitated a re-alignment of HICAPS as an optional payment method under Claiming Parameters, which affects some historical screenshots.
...
- Select Configure > Claiming Parameters to display the HICAPS Parameters window:
Configure the fields and settings:
Process claims through HICAPS
This checkbox must be checked (ticked) in order for HICAPS to be used within EXACT.
Process EFTPOS Payments
If you wish to process EFTPOS payments on the HICAPS terminal, tick this checkbox.
Note that if this is unticked, you will need to change your existing EFTPOS Payment type to Debit Card – This can be done as follows:- Click Configure > Patient Payments,
- Highlight the 'EFTPOS' payment type,
- Click the button,
- Select the "Debit Card" option,
- Click to save.
Process Medicare Easyclaim Claims
Select the Configure button to open the Medicare Easyclaim Setup:
...Note this instruction on the screen:
The list below shows the information that will be sent with Medicare Easyclaim claims per service code range. You can add additional code ranges by selecting the +1 button below. EXACT will ensure the ticked items in the table below are sent with the claims appropriately.
Screen detail:
Prompt for Service Item information
Displays further information
Pass patient name to HICAPS terminal
If this is ticked, the patient's name will be sent to the terminal when a claim is being processed for them.
Print HICAPS statements using
There are two settings for this:
EXACT Only - If this is selected, HICAPS statements will be printed through EXACT, and the user will be presented with a Print Statement dialog.
HICAPS Terminal Only - With this option, the user will never be required to print the statements, and they will be printed instead by the terminal.
Terminal Details
This section is display only, and shows the IP address of the terminal and what COM port it is connected to, the merchant's HICAPS Merchant ID, and the terminal's ID.
Health Funds
This displays all the Health Funds currently available. These details are loaded automatically when the 'Health Fund Synch' process is initiated (see below).
The number in the right-hand column (9, 24, 16, etc.) is the limit to the number of entries that particular fund will allow in a claim, and is stored on the terminal, and loaded from there into EXACT. This number is then used by EXACT to break claims bundles up into smaller allowable numbers. In the case of a claim being broken up into (for example) two blocks, two statements will be printed when the claim is submitted. When subsequently viewing or printing the HICAPS statements, they will be displayed or printed together.
- Click the Configure Terminal button to display the HICAPS Connect Setup:
This enables you to select the terminal you wish to use (if there is more than one available in the Terminals drop-down list), and test the terminal via the Terminal Test button. The test request signal is shown in the Request field, and the response is shown in the Response field, as shown in the example above. This includes a test of the communications, and shows the Merchant and Terminal IDs stored.
- Click the button to synchronise the Health Funds list in EXACT with those stored on the HICAPS terminal as a CardList:
Once the list has been retrieved from the terminal, if there is no difference, the window closes with no message.
If there is a difference - any Health Funds that exist on the CardList on the terminal, which are not in EXACT - they will be added to the Health Funds list in EXACT.Note that the Health Fund Synch process does not indicate what changes have been made, nor does it transfer the figure for the maximum number of items in a claim for that fund. It is up to the user to read this from the HICAPS terminal, and manually edit by means of the Editbutton
(see Health Funds above). - Click the button to compare the provider numbers stored on the terminal for the current Merchant ID with those stored in EXACT:
If a provider ID is found on the terminal but not in EXACT, and if the user is an EXACT user with Administrator security, then the Missing Providers window similar to the example below will display:
You will be able to click either the Add Provider button to add a new provider, or the Edit Provider button to open the Provider File and amend the details so they match those on the terminal.Users without Administrator rights will not see this window and are not able to make any changes to the EXACT database.
As part of HICAPS certification, the Health Fund Synch and Provider Synch are run automatically the first time a HICAPS claim is sent each day. The buttons described above allow you to perform the synchronisation manually whenever you wish to make sure your database is up to date. Note that if you wish to add a new provider number to the terminal, or change the details of one already stored, you must first notify HICAPS Australia in writing using a Change of Practice Details form. You will receive written notice once the new provider number has been registered.
...
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:
- Open the Patient Details window and select the appropriate patient.
- 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. - 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.)
- 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). - 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.
- 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.
...
Some Health Funds have rules that require each item of service that has a tooth number to be charted as an individual item instead of EXACT's usual format.
However, you can just chart services as normal, because where necessary EXACT will convert charted services into a format acceptable to HICAPS.
For example, if three adjacent teeth are extracted and charted as one item, EXACT will create three individual line items for sending to HICAPS. The charted items will not be changed, but the individual items will be stored and displayed in the HICAPS format wherever they are used in HICAPS claim and quote documents or reports.
...
File > Providers > click the selector button alongside the Provider No. field:
NOTE: From EXACT v12.11 there are new columns in the View HICAPS Providers window: Terminal ID and Merchant ID.
...
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.
...
- Click the
button in the 'Patient Details' window to display transactions (the statement) for the patient:
- Click the
button in the toolbar at the bottom of the window. - A window like the following example will be displayed:
- 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. - If there is discount, this is usually automatically applied, but you can override this if required.
- The 'Allocations' field lists all the invoiced items, with a tick to the left of any
- 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.
- 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
. - 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. - 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. - 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. - 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. - 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:
- 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.
Note that a receipt (HICAPS statement) is always printed, either on the HICAPS terminal or from EXACT, depending on how it is set up in HICAPS Parameters. A receipt/statement is printed:
...
Manually 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.
...
If ever the connection between the HICAPS terminal and the computer is not working, you can still enter data into EXACT (this may have been processed through the terminal without being connected to EXACT).
- If EXACT cannot communicate with the terminal to send a claim you will be given an appropriate response from the HICAPS terminal interface and then prompted with the following message:
- The
button will be defaulted, forcing you to deliberately choose manual processing by clicking the 
button. - If you choose to process the claim manually, EXACT will launch another dialog asking you to enter the full benefit amount for the ticked items. This dialog sits on top of the Patient Invoice Data window so that you can drag it on the screen to view what is currently ticked.
Enter a figure with 2-decimal places and this will be used as the benefit amount for the claimed items. You can also select a health fund for the patient if they do not have a default health fund assigned. - Once selected EXACT will then use this health fund's details to display against the payment particulars. If you enter a health fund and click the button on the dialog, you will be asked if you wish to assign this health fund as the patient's (or family) default. If you choose to do so the patient/s should be updated accordingly.
- Once you have completed this you will be returned to the Payments window where the outstanding amount owing is displayed, with EXACT having calculated the gap amount.
At this point EXACT will create a HICAPS payment for the patient and will prefix it with "Manual" text. A statement will not be created for this manual payment as EXACT will not have the line item figures and the user should already have this information printed from the terminal.
...
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.
...
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.
...
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:
...
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).
...
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.
...
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:
"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." |
...
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.
...
"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." |
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.
...
"This claim cannot be cancelled through the HICAPS terminal as it was created manually in EXACT. 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." |
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.
...
There is a new feature which has been added to EXACT which is the ability to produce a HICAPS Quote for treatment to be carried out on a patient. EXACT will pass the items you wish to quote for through to the HICAPS Terminal, and a HICAPS Quote will be received back from the terminal. The quote will be stored within EXACT.
To access this feature, which is user-specific, you will have to enable the tab on the Chart screen, which is achieved as follows:
- Choose a patient within EXACT and go to the Chart Tab.
- Click the
button underneath the Service List – The Service List Setup Wizard.
- Tick the fourth box down: Select which tabs you see in the activity areas:
- Click the
button. - In the"Available Tabs" list on the left-hand side, highlight 'HICAPS Quotes' and then click the double right arrow button to place HICAPS Quotes into either the Upper Tab, or the Lower Tab, depending on your preference:
- Click the
button; the 'HICAPS Quote' tab will appear on the upper or lower tab as specified. - To view the 'HICAPS Quote' tab, make sure the lower tab is visible: click the
button in the lower middle of the screen.
...
To use the EFTPOS functionality of the HICAPS terminal, this option will need to be configured by ticking the 
checkbox in the HICAPS Parameters screen. Data for payment types assigned to the payment categories "Debit Card" and "Credit Card" will be sent by EXACT to the HICAPS terminal electronically.
There is very little functional difference in processing payments through the terminal. EXACT will simply provide the terminal with the payment amount so that you don't have to enter this on the terminal and when the payment has been accepted EXACT will process it. If the payment is declined, EXACT will return you to the Payment window without having created the payment.
...
If for whatever reason the terminal cannot be accessed by EXACT you will be presented with the following message:
"EXACT could not connect to the HICAPS terminal. Would you like to process the payment manually? Please note that manual payments will only affect the transaction details in EXACT and you will still need to collect the funds from the patient." |
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The button is defaulted, as in most cases if there is no communication between EXACT and the HICAPS terminal there is little point in using the EFTPOS option. If you choose to process the payment manually and click EXACT will simply create the payment with a "manual prefix" and will not attempt to send the data to the terminal. The payment will then need to be made by entering the payment details into the 'Payment' dialog in EXACT and the patient will need to pay by other means such as cash or cheque.
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If the cancellation is approved, EXACT will reverse the payment and display the payment type followed by the text "Cancelled" in the particulars for the transaction.
If EXACT cannot connect to the terminal to complete a cancellation the user will be prompted with the following message:
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The button is defaulted, but if you choose to cancel the transaction and click EXACT will reverse the payment and mark it as a manual transaction.
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