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Configure Private Health Claiming from the Configure > Claiming Parameters screen.
SOE Pay:
See Configuring SOE Pay patient payments
HICAPS:
See Configuring HICAPS patient payments
HICAPS is an electronic health claims and payments system, which offers members of participating health funds the convenience of automatic claims processing in the practice.
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.
NOTE: This user guide does not provide details of how to use your HICAPS terminal. Please refer to the 'Terminal Operations Guide' provided with the terminal or contact HICAPS for further information about your terminal's functions and operation.
Below is a representative diagram showing the transfer of information between EXACT and HICAPS Connect:
Before using HICAPS Connect in EXACT, the following prerequisites must be met:
To update the software version, please contact Software of Excellence for assistance.
A CD is available from SOE Support which contains everything required for ensuring your software is up to date and for installing HICAPS Connect.
To obtain Help with HICAPS
Help is available as follows:
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
Help with HICAPS:
Ground Floor
151 Rathdowne Street
Carlton, VIC 3053
HelpDesk: 1300 650 852
Before starting on the installation, ensure that the following items have been completed:
Below is a list of steps to implement in order to ensure a successful installation. These steps should be performed in the following order:
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.
Each HICAPS terminal can support up to 26 providers (the limit to the number of Provider IDs that can be stored per terminal).The HICAPS Connect program will allow you to interface with the HICAPS terminal from a machine which does not have a HICAPS terminal attached to it – the HICAPS terminal(s) will be shared across the network, for other machines to 'talk' to. A maximum of two computers per HICAPS terminal is able to be supported.
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:
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.
In order for HICAPS Connect to function properly, the following steps must be taken:
Prior to installing HICAPS Connect or the .Net Framework, first identify the computers on which you would like to install Hicaps Connect. Depending on your configuration needs, you may have:
Once you have identified the computers to install to, you may then start installing the necessary files. Note that the HICAPS Connect Program only needs to be installed onto the computers which are going to interface with the HICAPS Terminal, not all machines.
Once the PC has been restarted, you may be advised by Windows Security that it has blocked some features of the software.
If so, click the "Allow Access" or "Unblock" button as appropriate.
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.
To configure Claiming Parameters
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.
|
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. |
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.
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 Edit button (see Health Funds above).
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.
To configure Claiming Parameters
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.
|
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. |
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.
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 Edit button (see Health Funds above).
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.
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:
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). |
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.
If you resubmit treatment to the chart, single line chart items will remain single line items with multiple teeth assigned.
Services which cover multiple teeth and which do not require tooth numbers for HICAPS claims will not be changed.
To Chart Treatment using HICAPS
To view the invoice details, click the (transactions) button. This will display all outstanding transactions for the patient.
This list is accessible from the Provider No. field in any Provider's configuration screen.
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.
IMPORTANT: The displayed list is valid only from the last terminal synchronisation. You need to manually synchronise to view a current list.
To manually synchronise the terminal and update / refresh the View HICAPS Providers List
In the View HICAPS Providers window, click the Provider Synch button, as shown in the above image.
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.
Once you have charted treatment for a patient, you can make a HICAPS claim as follows:
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 .
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.
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:
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:
For 'Declined' transactions, the user is prompted as to whether they wish to print a statement or not.
Note that if quote or statement is printed for a second time (reprinted), it is always marked as 'REPRINT' and marked with the time and date.
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.
To manually claim via HICAPS Connect
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).
HICAPS can handle electronic cancellation of claims within 24hrs of the claim being made, but this manageable only if
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.
(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
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.
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).
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:
(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.
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." |
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.
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:
"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.
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:
"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.
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.
HICAPS payments (manual or electronically created) cannot be resent, altered, or deleted once a HICAPS or EFTPOS transaction has been processed successfully. If you wish to cancel or reverse a HICAPS Claim due to an error being made, you need to make an adjustment or use the "Cancel" button (see previous topic). Both these methods create appropriate transactions to fix a payment error, without deleting the original transaction(s).
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:
To Create a HICAPS Quote
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." |
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.
If you want to cancel a debit card or credit card payment (i.e., undo the transaction) you need to select the payment to be cancelled, swipe the member's card and select the Cancel Item button.
This button is enabled only for transactions that can be cancelled; if it is 'greyed out' it means cancellation is not possible.
Selecting the Cancel Item button will send the appropriate information to the HICAPS terminal so that this transaction can be cancelled electronically.
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:
"EXACT could not connect to the HICAPS terminal. Would you like to cancel the transaction manually? Please note that manual cancellations only adjust the transaction details in EXACT and you will still need to ensure that the patient's funds are reinstated." |
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.
Cancellations of these types of payments will be included in the Cashing Up Report.