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 Connect

Overview

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.

Information transfer between EXACT and HICAPS Connect

Below is a representative diagram showing the transfer of information between EXACT and HICAPS Connect:

1. A patient is billed in EXACT.

2. The patient's Health Fund membership card is swiped through the HICAPS terminal.

3. The patient's claim information is sent to the HICAPS Connect program which then transmits the claim information to HICAPS via the Terminal.

4. HICAPS processes the claim and sends back the approved claim information to the HicapsConnect.exe program via the Terminal.

5. 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.

6. 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:

1. 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.

2. Ensure the latest Terminal Software Version is at least HICT42.H4A.

   To update the software version, please contact Software of Excellence for assistance.

3. 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.

 

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

 

 

Installing HICAPS Connect

Requirements

Before starting on the installation, ensure that the following items have been completed:

1. Approval obtained from HICAPS to be able to process HICAPS and/or Medicare Claims.

2. The necessary software and hardware from HICAPS has been obtained.

3. You have registered with Medicare to use EasyClaim (if you are using this facility).

 

Overview

Below is a list of steps to implement in order to ensure a successful installation. These steps should be performed in the following order:

1. Ensure a backup copy of your EXACT database has been made.

2. Install or upgrade to EXACT Version 10.11 (or later).

3. Install HICAPS Connect components.

4. 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.

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.

 

Installing / Upgrading EXACY to Version 10.11+

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:

1. Insert the CD supplied into the CD drive of your computer.

2. Read all of 'Step 1 - Upgrade Instructions' on the menu displayed, and follow the instructions to backup EXACT, disable your antivirus software etc.

3. Proceed to 'Step 2 - Install EXACT'.

4. When EXACT has been installed/upgraded, proceed to 'Step 3 - Misc Items', and install HICAPS Connect (see the next Help topic for more details).

 

Installing HICAPS Connect Components

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:

1. Identify the computers which are to run HICAPS Connect, the terminal numbers, and how the computers are to connect to the terminals.

2. Microsoft .Net 3.5 SP1 must be present on these computers. If it is not already present, the installer on the CD will notify you it is missing, and install it for you.
   Note that this requires internet access, in order to download .Net from the Microsoft website.

3. Install the HICAPS Connect Service Controller.

 

 

Identify HICAPS Connect Computers

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:

• HICAPS Connect installed onto a standalone computer,

• Multiple computers each connected to their own HICAPS terminal,

• Multiple computers connected to one HICAPS terminal,

• A terminal services environment (i.e., Remote Desktop),

• A combination of any of the above.

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.

Instal Microsoft .Net Framework 3.5 SP1

1. Prior to installing the HICAPS Connect Service Controller, if you wish you can check if a copy is installed on your computer. To do this, go to Control Panel, which is accessed from your PC's "Start" menu.
   Versions up to Windows XP:
   Select the 'Control Panel' menu item "Add/Remove Windows Components" or "Add/Remove Programs". Look for the entry shown below:

   
   
   
   Windows Vista:
   Click on "Programs" then the "Programs and Features" option. Scroll down to the Microsoft .NET Framework entry and the version number is listed there.
   No 'Control Panel' access, or can't find the .NET version?
   Using Windows Explorer, find the folder C:\Windows\Microsoft.NET\Framework; there should be a "v3.5" folder:
   

2. If the framework is not installed, or you are unable to determine which version is installed using the methods above, go to the menu of the installation CD supplied, and select "Step 3: Misc Items".
   From this menu, select 2. Install Microsoft .NET Framework 3.5 as shown below:

3. Once the installation process is completed, go back to Control Panel to see if the Framework has been installed with the version 3.5 SP1. If it does not exist there, then you may have to reinstall the Framework.

4. After the .NET framework has been successfully installed, go back to the installation CD menu, and select 3. Install Hicaps Connect.
   (Note that if an earlier version of HICAPS Connect has already been installed, this will be replaced).

5. The following dialog will be displayed; this is a binding legal agreement, so read it carefully before making sure the "I Accept" checkbox is ticked, then click the

   
   button:
   

6. The following window specifies where HICAPS Connect is installed:

   
   
   Although you can change the location, we recommend you accept the default location, and click the
   
   button.

7. After a brief time, the files will have been installed, and you will be advised that a reboot of your PC is required:

   
   
   
   If it is not convenient to restart the computer now, you may click the 'No' button and restart it later.
   In this case, the HICAPSConnect wizard will be finished and you will have to remember to restart the PC to complete the process.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.

8. There will now be a new icon on the taskbar of Windows, like this

   
   or this
   
   
   This provides access to the HICAPS Connect Service Setup window (see next topic).

 

Configure HICAPS Connect Service Controller

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

1. Select Configure > Claiming Parameters to display the HICAPS Parameters window:

2. Configure the fields and settings:

3. 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.

4. 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 Edit button
   
   (see Health Funds above).

5. 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.

 

Configure Claiming Parameters

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

1. Select Configure > Claiming Parameters to display the HICAPS Parameters window:

2. Configure the fields and settings:

3. 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.

4. 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 Edit button
   
   (see Health Funds above).

5. 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:

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:

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.

 

HICAPS / Medicare Charting

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

1. Open the Patient File by selecting File > Patients or the Patients shortcut button

   
   on the Toolbar.

2. Select the required patient by typing the first few letters of their surname into the search box at the top left of the screen, then use the

   
   and/or
   
   buttons to refine your search.

3. When the patient's record is displayed, click the Chart tab to open the tooth chart.

4. In the Treatment Plan area, click the

   
   button to create a new treatment plan:
   
   
   The Create Treatment Plan window displays:
   
   
   Adjust the Number of Appointments and colour details as required, then click the
   
   button.

5. You will now have to choose the provider who is to carry out the treatment, and the fee schedule used:

   
   
   Click in the entry box for the field and use the
   
   and/or
   
   buttons to select from the options displayed. Click the
   
   button when you have finished.

6. From the Service List on the right-hand side of the window, select the service to chart, by clicking once on it. Click the tooth surface the service is to apply to; this will add the treatment to the new treatment plan. Repeat for any other services and/or teeth surfaces included in the treatment.

7. If you make any mistakes with adding treatment, either highlight the item and press the

   
   key, or drag the item to the 'trashcan' icon in the bottom left corner of the screen. Either of these actions will remove the treatment item from the treatment plan.

8. When you have completed the patient's treatment, click on the checkbox for each item to mark it as complete:

   

9. Click the

   
   button at the bottom of the screen. This will create invoice entries for the treatment items.

10. A Print Invoice screen displays:

    
    
    This allows you to print or email an invoice if the practice or the patient requires one. If you wish to print an Invoice, select the appropriate details and format, click the 'Preview' button to check it, then the 'Print' button (there is also a 'Print' button on the 'Preview' window). If you do not require a copy, click the 'Cancel' button.

11. Click the

    
    button; this will mark the treatment plan as completed, move the treatment items into 'History', and allow you to set recall details for the patient's next appointment(s):
    
    To view the invoice details, click the
    
    (transactions) button. This will display all outstanding transactions for the patient.

 

View HICAPS Providers List

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.

 

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.

Once you have charted treatment for a patient, you can make a HICAPS claim as follows:

1. Click the

   
   button in the 'Patient Details' window to display transactions (the statement) for the patient:

2. Click the

   
   button in the toolbar at the bottom of the window.

3. A window like the following example will be displayed:

4. 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.

5. If there is discount, this is usually automatically applied, but you can override this if required.

6. The 'Allocations' field lists all the invoiced items, with a tick to the left of any

7. 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.

8. 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

   
   .

9. 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.

10. 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.

11. 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.

12. 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.

13. 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:
    
    

14. 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:

• For all successful ('Approved', or 'Approved with Signature', or 'Approved with Key Exchange') HICAPS claims

• For all 'Request in Progress' transactions.

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.

 

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.

 

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).

1. 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:

   

2. The

   
   button will be defaulted, forcing you to deliberately choose manual processing by clicking the
   
   button.

3. 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.

4. 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.