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 for approved claims that are settled by HealthPoint. Funds that are classified as non-consolidated by HealthPoint (currently only HCF) will not appear in these reports.

Please note that developing reporting features is optional, but recommended to ease provider financial reconciliation.

Demo

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

Demo - JS Fiddle

Note on JS Fiddle Please don't click on the Save button if you make any changes in the JS Fiddle sample app. Instead, please press run if you have made any changes. If you click save, it may break sample functionality.

HealthPoint Claims Reconciliation Example

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// Claims Report for 21st September, 2024
iclient.healthpointReconciliationReport(
    {
        reportType: "claims",
        reconDate: "20240921"
    },
    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 HealthPoint system (This value is different to the Tyro TID)
claims-reconciliation-response/claims-reconciliation/claim-date	Date (in yyyyMMdd format) of claims included in the report. Note date can differ from submission due to amendments
claims-reconciliation-response/claim	Contains details of a claim.
claims-reconciliation-response/claim/terminal-date-time	Timestamp (in yyyyMMddHHmmss format) when terminal submitted a claim
claims-reconciliation-response/claim/transaction-date-time	Timestamp (in yyyyMMddHHmmss format) claim was received by HealthPoint
claims-reconciliation-response/claim/response-date-time	Timestamp (in yyyyMMddHHmmss format) claim response was received byHealthPoint
claims-reconciliation-response/claim/settlement-date-time	Timestamp (in yyyyMMddHHmmss format) when settlement issued
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	Unique transaction reference, included on receipts
claims-reconciliation-response/claim/status	Status of the claim, as shown below

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 HealthPoint 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, or 93 if no response from fund.
claims-reconciliation-response/claim/text	Any text entered when the claim was amended.
claims-reconciliation-response/check	Reconciliation data summary. 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>20240921</claim-date>
    </claims-reconciliation>
    <claim>
        <terminal-date-time-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</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>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</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>20240921</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 21st September, 2024
iclient.healthpointReconciliationReport(
    {
        reportType: "payments",
        reconDate: "20240921"
    },
    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 HealthPoint system (This value is different to the Tyro TID).
payments-reconciliation-response/payments-reconciliation/payment-date	Date that payment settlement instruction was sent
payments-reconciliation-response/payment	Contains details of a settlement payment
payments-reconciliation-response/payment/terminal-date-time	Timestamp (in yyyyMMddHHmmss format) when terminal submitted a claim
payments-reconciliation-response/payment/transaction-date-time	Timestamp (in yyyyMMddHHmmss format) claim was received by HealthPoint
payments-reconciliation-response/payment/response-date-time	Timestamp (in yyyyMMddHHmmss format) claim response was received by HealthPoint
payments-reconciliation-response/payment/settlement-date-time	Timestamp (in yyyyMMddHHmmss format) the payment submitted to a provider
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	Unique transaction reference, included on receipts
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 from HealthPoint
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 for settlement
payments-reconciliation-response/payment/account-number	Bank account number for settlement
payments-reconciliation-response/payment/payment-reference	Bank Lodgement Reference displayed on bank account statement
payments-reconciliation-response/check	Reconciliation summary 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>20240921</payment-date>
    </payments-reconciliation>
    <payment>
        <terminal-date-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</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>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</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>20240921</payment-date>
    </payments-reconciliation>
    <unavailable>
        <text>Report unavailable.</text>
        <text>Please try again later.</text>
    </unavailable>
</payments-reconciliation-response>