Reports and Reconciliation

There are two types of integrated health fund reports: a claims reconciliation report and a payments reconciliation report. The claims reconciliation report provides a list of all claims processed for a given calendar day. The payments reconciliation report provides a report of payments made by funds that are settled by DXC. Funds that are classified as non-consolidated by DXC will not appear in these reports. Please click the link to view consolidated and non-consolidated funds DXC HP Health Funds by Modalityt .

info

Please note that developing this feature is optional.

Demo

This example using jsFiddle shows how iClient can be used to access canned reports.

Demo - JS Fiddle

JS Fiddle

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HealthPoint Claims Reconciliation Example

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// Claims Report for 24th June, 2015
iclient.healthpointReconciliationReport(
    {
        reportType: "claims",
        reconDate: "20150624"
    },
    yourPosCode.reportCallback
);

The response body consists of the following XML elements (see table below for example):

Response element name	Description
claims-reconciliation-response/claims-reconciliation	Contains report header elements
claims-reconciliation-response/claims-reconciliation/healthpoint-terminal-id	Terminal id in the DXC system (This value is different to the Tyro TID)
claims-reconciliation-response/claims-reconciliation/claim-date	Date of the claims included in the report (Note that amended claims may be included from a different date if the amendment took place on this date). Value is in yyyyMMdd format.
claims-reconciliation-response/claim Contains details of a claim.
claims-reconciliation-response/claim/terminal-date-time	Local time on the terminal when the claim was submitted. Value is in yyyyMMddHHmmss format.
claims-reconciliation-response/claim/transaction-date-time	Time that the claim was received by the DXC Claim Server.
Value is in yyyyMMddHHmmss format.
claims-reconciliation-response/claim/response-date-time	Time that the claim response was received by the DXC Claim Server.
Value is in yyyyMMddHHmmss format.
claims-reconciliation-response/claim/settlement-date-time	Time that the payment instruction is expected to be sent to DXC's bank for execution. Value is in yyyyMMddHHmmss format.
claims-reconciliation-response/claim/provider-id	Provider who made the claim.
claims-reconciliation-response/claim/private-health-fund-id	Fund that processed the claim
claims-reconciliation-response/claim/ref-tag	The reference tag generated by the terminal that identifies a transaction per terminal
claims-reconciliation-response/claim/status	Status of the claim, as swhon in below table.

Status	Definition
NEW	Claim is approved but not yet settled.
CAN	Claim has been cancelled.
VOID	Claim rejected by user.
AVOID	Claim autovoided (reversed) due to system error.
PAY	Settled via DXC consolidated settlement.
PRC	Required action processed (reversed).
TPY	Test Paid. Settled by fund directly.
EST	Rebate Estimate. Gap amount returned but not an approved claim.

Response element name	Description
claims-reconciliation-response/claim/total-claim-amount	Total claim amount in cents.
claims-reconciliation-response/claim/private-health-fund-total-benefit-amount	Benefit amount in cents.
claims-reconciliation-response/claim/private-health-fund-response-code	Response code from the fund, or 32 for adjustment via CSS, or 93 if no response from fund.
claims-reconciliation-response/claim/text	Any text entered when the claim was amended.
claims-reconciliation-response/check	Contains a summary of the reconciliation data. Can be used to check that all expected claims have been received and processed.
claims-reconciliation-response/check/total-number-claims	Total number of claim elements.
claims-reconciliation-response/check/sum-benefit-amount	Sum of all benefit amounts, in cents.
claims-reconciliation-response/check/sum-claim-amount	Sum of all claim amounts, in cents.

Example claims reconciliation report response XML

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<claims-reconciliation-response>
    <claims-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <claim-date>20131106</claim-date>
    </claims-reconciliation>
    <claim>
        <terminal-date-time-time>20120401123455</terminal-date-time>
        <settlement-date-time>20120402040000</settlement-date-time>
        <response-date-time>20120401123455</response-date-time>
        <transaction-date-time>20120401123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000010</ref-tag>
        <status>e.g. NEW, PAY, TPY (see table above)</status>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <text>any text entered when claim was amended</text>
    </claim>
    <claim>
        <terminal-date-time>20120401123455</terminal-date-time>
        <settlement-date-time>20120402040000</settlement-date-time>
        <response-date-time>20120401123455</response-date-time>
        <transaction-date-time>20120401123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000011</ref-tag>
        <status>e.g. NEW, PAY, TPY (see table above)</status>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <text>any text entered when claim was amended</text>
    </claim>
    <check>
        <total-number-claims>2</total-number-claims>
        <sum-benefit-amount>10000</sum-benefit-amount>
        <sum-claim-amount>20000</sum-claim-amount>
    </check>
</claims-reconciliation-response>

Report Unavailable Response Body

If the report is unavailable, a report unavailable response is returned:

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<claims-reconciliation-response>
    <claims-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <claim-date>20120601</claim-date>
    </claims-reconciliation>
    <unavailable>
        <text>Report unavailable.</text>
        <text>Please try again later.</text>
    </unavailable>
</claims-reconciliation-response>

Payment Reports

HealthPoint Payments Reconciliation Example

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// Payments Report for 24th June, 2015
iclient.healthpointReconciliationReport(
    {
        reportType: "payments",
        reconDate: "20150624"
    },
    yourPosCode.reportCallback
);

The response body consists of the following XML elements (see table below for example):

Response element name	Description
payments-reconciliation-response/payments-reconciliation	Contains report header elements.
payments-reconciliation-response/payments-reconciliation/healthpoint-terminal-id	Terminal id in the DXC system (This value is different to the Tyro TID).
payments-reconciliation-response/payments-reconciliation/payment-date	Date that the payment instructions were sent to the bank.
Value is in yyyyMMdd format.
payments-reconciliation-response/payment	Contains details of a claim.
payments-reconciliation-response/payment/terminal-date-time	Local time on the terminal when the claim was submitted.
Value is in yyyyMMddHHmmss format.
payments-reconciliation-response/payment/transaction-date-time	Time that the claim was received by the DXC Claim Server.
Value is in yyyyMMddHHmmss format.
payments-reconciliation-response/payment/response-date-time	Time that the claim response was received by the DXC Claim Server.
Value is in yyyyMMddHHmmss format.
payments-reconciliation-response/payment/settlement-date-time	Time that the payment instruction is expected to be sent to DXC’s bank for execution. Value is in yyyyMMddHHmmss format.
payments-reconciliation-response/payment/provider-id	Provider who made the claim
payments-reconciliation-response/payment/private-health-fund-id	Fund that processed the claim.
payments-reconciliation-response/payment/ref-tag	The reference tag generated by the terminal that identifies a transaction per terminal.
payments-reconciliation-response/payment/total-claim-amount	Total claim amount in cents.
payments-reconciliation-response/payment/private-health-fund-total-benefit-amount	Benefit amount in cents.
payments-reconciliation-response/payment/private-health-fund-response-code	Response code from the fund, or 32 for adjustment via CSS.
payments-reconciliation-response/payment/payment-amount	Amount paid for the claim, in cents.
payments-reconciliation-response/payment/text	Any text entered when the claim was amended.
payments-reconciliation-response/payment/bsb	BSB number.
payments-reconciliation-response/payment/account-number	Bank account number.
payments-reconciliation-response/payment/payment-reference	Reference displayed on bank account statement.
payments-reconciliation-response/check	Contains a summary of the reconciliation data. Can be used to check that all expected claims have been received and processed.
payments-reconciliation-response/check/total-number-paments	Total number of payment elements.
payments-reconciliation-response/check/sum-payment-amount	Sum of all payment amounts, in cents.
payments-reconciliation-response/check/sum-claim-amount	Sum of all claim amounts, in cents.

Example Payments Reconciliation Report

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<payments-reconciliation-response>
    <payments-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <payment-date>20131106</payment-date>
    </payments-reconciliation>
    <payment>
        <terminal-date-time>20120402123455</terminal-date-time>
        <settlement-date-time>20120403040000</settlement-date-time>
        <response-date-time>20120402123455</response-date-time>
        <transaction-date-time>20120402123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000010</ref-tag>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <payment-amount>5000</payment-amount>
        <text>any text entered when claim was amended</text>
        <bsb>069690</bsb>
        <account-number>100001</account-number>
        <payment-reference>your payment ref</payment-reference>
    </payment>
    <payment>
        <terminal-date-time>20120402123455</terminal-date-time>
        <settlement-date-time>20120403040000</settlement-date-time>
        <response-date-time>20120402123455</response-date-time>
        <transaction-date-time>20120402123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000011</ref-tag>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <payment-amount>5000</payment-amount>
        <text>any text entered when claim was amended</text>
        <bsb>069690</bsb>
        <account-number>100001</account-number>
        <payment-reference>your payment ref</payment-reference>
    </payment>
    <check>
        <total-number-payments>2</total-number-payments>
        <sum-payment-amount>10000</sum-payment-amount>
        <sum-claim-amount>20000</sum-claim-amount>
    </check>
</payments-reconciliation-response>

Payments Reconciliation Report Unavailable Response Body

If the report is unavailable, a report unavailable response is returned:

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<payments-reconciliation-response>
    <payments-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <payment-date>20120602</payment-date>
    </payments-reconciliation>
    <unavailable>
        <text>Report unavailable.</text>
        <text>Please try again later.</text>
    </unavailable>
</payments-reconciliation-response>