Integrated Private Health Fund claiming

Inside the PMS, allow the staff to select a provider and a patient and build up a list of services that have been provided to the patient. Once finalised, the PMS invokes iClient passing in the list of claim items (in JSON format) along with some other details. The iClient window appears, and the claim is passed through to the terminal for processing. The patient swipes their health fund card in the terminal when prompted, and the claim is sent off to the appropriate health fund for approval. Once approved, the terminal prints the claim receipt and shows the gap amount to the patient. On the PMS, iClient shows the gap amount and asks the operator to Accept or Reject the claim. Pressing the Accept button prompts the terminal to print the patient copy and finalise the claim. Pressing the Reject button prompts the terminal to void the claim and print receipts showing that the claim has been voided. In either case, the result of the original claim is returned to the PMS.

You are ready to start developing your integrated private health fund claiming feature now that you have successfully setup your POS to initiate and process requests through iClient in the test environment. Before you begin, please have a look at the certification criteria, which provide a checklist of the minimum requirements for the certification of integrated private health fund claiming with Tyro.

Certification Criteria for iClient Health

iClient API

Please refer to the Please refer to the iClient API for a sample HealthPoint claiming code. After downloading the zip folder, unzip it and click on the iclient-api folder, and then index. At the top left corner underneath the APIs, click on Classes, and then click on TYRO.IClientWithUI, scroll down until you see the index and method tabs, then click on index.

Claim Payloads

The API offered by iClient for PHF claims (described below) requires a number of parameters to be supplied including a JSON claim payload.

When cancelling claims, the payload must be the same as the one used for the original claim and can only be performed on the same day as the original claim.

HealthPoint Claiming Implementation

initiateHealthPointClaim(requestParams, transactionCallbacks) - Tell the terminal to start a HealthPoint claim.

Request Parameters

claimItems Table

transactionCallbacks

transactionCompleteCallback Function:

statusMessageCallback Function:

questionCallback Function:

Example

iclient.initiateHealthPointClaim({
    providerId: "1455813F", 
    serviceType: "P", 
    claimItemsCount: "2", 
    totalClaimAmount: "20100", 
    claimItems: [
        {
            "claimAmount": "10000",
            "serviceCode": "500",
            "description": "Assessment Consult",
            "serviceReference": "01",
            "patientId": "02",
            "serviceDate": "20240217"
        },
        {
            "claimAmount": "10100",
            "serviceCode": "505",
            "description": "Subsequent Consult",
            "serviceReference": "01",
            "patientId": "02",
            "serviceDate": "20240217"
        }
    ]}, {
    transactionCompleteCallback: yourPosCode.handleComplete,
    statusMessageCallback: yourPosCode.handleStatusMessage,
    questionCallback: yourPosCode.questionAsked
});

Item Numbers

The item numbers for claims should be known to and provided by the PMS. Attached is a pdf of item numbers for the various modalities. However, the item numbers change from time to time and vary between health funds, so it is incumbent on the PMS to provide an authoritative list to medical practice installations.

Modalities

Modalities are the various types of allied health services provided, e.g. dental, optical etc. Allied health providers will have been issued with a provider number for the modality that they specialise in. The modality needs to be passed through for each claim in the field serviceType. They are:

Settlement

A single settlement (aside from HCF who issues a separate settlement) is issued by HealthPoint the following business day as an approved claim. The settlement claims period is 00:00:00 to 23:59:59.

Health funds supported by Tyro Healthpoint

HealthPoint Health funds by modality

specific criteria

*health funds marked as non consolidated in the PDF will not affect the Tyro merchants on consolidated settlement

Current list of supported funds by provider modality

Reference the following excel doc for a list of item codes and responses for each supported fund and modality:

Excel doc

Current list of supported funds by provider modality

Health funds not supported by Tyro Healthpoint

• MDHA
• GU Health *under migration to nib
• CDH

Gap Payments

Once a claim has been approved, there is typically a gap between the benefit amount paid by the health fund and the amount charged by the practitioner. If the patient would like to use a card to pay for the gap amount, the standard purchase method can be used to process the payment. Please be sure to pass in the healthpointTransactionId which is the transactionId returned in the response to the original HealthPoint claim.

Testing Integrated Health Fund Claiming

Please use the following patient and provider details when testing your implementation::

Patient IDs on Card:

• 00 John Citizen
• 01 Judy Citizen
• 02 Jack Citizen

Provider details:

HealthPoint Claiming Demo

Demo - JS Fiddle