Integrated Health Fund Claiming

Tyro HealthPoint offers the ability to process integrated Private Health Fund claims through the Tyro Terminal Adapter. There are two claiming functions available:

Process claim
Cancel claim

Workflow

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 the TTA passing in the list of claim items (in valid XML format) along with some other details. The TTA windows 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, the TTA shows the gap amount and asks the operator to Accept or Reject the claim. Pressing the Accept button prompts the TTA to print the patient copy and finalise the transaction. Pressing the Reject button prompts the terminal to void the transaction and print receipts showing that the claim has been voided. In either case, the result of the original claim is returned to them PMS.

Claim Payloads

The API offered by the TTA for PHF claims (described below) requires a number of parameters to be supplied including a valid XML claim payload. The format of the XML paylo ad is a follows:

HealthPoint Claim Payload Request

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<?xml version='1.0' encoding='utf-8'?>
<healthpoint-claim-items>
 <claim-item>
 <claim-amount>[claim amount in cents - max 10 digits]</claimamount>
 <service-code>[item number service code - exactly 5 characters 
long]</service-code>
 <service-reference>[body part or tooth number suffix - max 3 
characters]</service-reference>
 <patient-id>[patient ID on card - exactly 2 digits]</patient-id>
 <service-date>[claim date in YYYYMMDD format]</service-date>
 <description>[description of item to appear on receipt - max 32 
characters]</description>
 </claim-item>
</healthpoint-claim-items>
<healthpoint-claim-items>
 <claim-item>
 <claim-amount>[claim amount in cents]</claim-amount>
 <rebate-amount>[rebate amount in cents]</rebate-amount>
 <service-code>[item number service code]</service-code>
 <description>[description of item that appears on receipt]<
/description>
 <service-reference>[body part or tooth number suffix]</servicereference>
 <patient-id>[patient ID on card]</patient-id>
 <service-date>[claim date in YYYYMMDD format]</service-date>
 <response-code>[4 digit response code]</response-code>
 </claim-item>
</healthpoint-claim-items

Note:

The maximum number of claim-items is 16.

Item Numbers

Items numbers for claims should be known to and provided by the PMS. Attached is a spreadsheet 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 the authoritative list to medical practice installations.

Methods

Please note that integrated receipts are not supported for Health Fund Claiming.

Tyro.Integ.Domain.ITransactionResult Claim(string providerID, string serviceType, int claimItemsCount, long totalClaimAmount, string payload)
Tyro.Integ.Domain.ITransactionResult ClaimMidTid(string merchantID, string terminalID, string providerID, string serviceType, int claimItemsCount, long totalClaimAmount, string payload)
Tyro.Integ.Domain.ITransactionResult CancelMidTid(string merchantID, string terminalID, string providerID, string serviceType, int claimItemsCount, long totalClaimAmount, string refTag, string payload)
Tyro.Integ.Domain.ITransactionResult Cancel(string providerID, string serviceType, int claimItemsCount, long totalClaimAmount, string refTag, string payload)

Parameter Name	Description	Valid Values
providerId	The provider's id attending the patient.	8 alphanumeric characters.
serviceType	Category of service (D for Dental, O for Optical, P for Physiotherapy)	1 alphabetic character.
claimItems Count	Total number of claim items.	Positive integer. Minimum value is 1 and Maximum is 16.
totalClaim Amount	The total amount of all claim items in cents.	Positive integer. Max length of 15.
payload	The list of claim items in XML (see format above). 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.	N/A
refTag	The reference tag returned in the original claim's final transaction status response.	A refTag as previously returned for a transaction, from the same day.

Response

The methods added to ITransaction (available from ITransactionResult.getTransaction()) are as follows:

Method	Description
string GetHealthpointClaimItems()	Returns the XML payload response as detailed above.
string GetHealthpointFreeText()	Some optional free text containing extra information on error codes or other information from the Private Health Fund. May be empty.
string GetHealthpointGapAmount()	The gap amount in cents. Will only be present on successful claims and voids.
string GetHealthpointMemberNumber()	Private health fund member number of cardholder.
string[] GetHealthpointMessages()	Options list of current system notifications. The TTA shows the messages to the operator; however, the PMS may like to store or distribute them to a different audience.
string GetHealthpointPhfResponseCode()	The overall response code for the claim from the Private Health Fund.
string GetHealthpointPhfResponseCodeDescription()	The description of the response code from the Private Health Fund.
string GetHealthpointHealthFundIdentifyingDigits()	The ID of the Private Health Fund.
string GetHealthpointHealthFundName()	The name of the Private Health Fund.
string GetHealthpointProviderID()	Provider ID matching the original request.
string GetHealthpointServiceType()	Service type matching the original request.
string GetHealthpointSettlementDateTime()	Settlement date time as decided by the CSS system / Health Fund.
string GetHealthpointTotalAmount()	Total benefit amount for all claim items in cents.
string GetHealthpointTransactionDateTime()	The transaction date time of the claim.
string GetHealthpointTransactionID()	The Transaction ID or refTag for the claim. Required for cancels.
string GetHealthpointVoidResponseCode()	The void response code if the claim was rejected/voided.
string GetHealthpointErrorCode()	Returns the Error code for Healthpoint claims. This only works with TTA version 1.2.34 or higher.
string GetHealthpointErrorDescription()	Returns the Error code description for Healthpoint claims. This only works with TTA version 1.2.34 or higher.

Gap Payments

If the patient wants to pay for the gap payment using a card, the PMS must use one of the following new methods for processing gap payments:

bool PurchaseAdditionalData(int amountInCents, int cashOutInCents, string additionalData)
bool PurchaseMidTidAdditionalData(string merchantID, string terminalID, int amountInCents, int cashOutInCents, string additionalData)

Parameter Name	Description	Valid Values
amountInCents	The gap amount to be paid in cents.	Positive integer. Max length of 7.
cashOutInCents	An optional cash out amount. Specify 0 if not required.	Positive integer. Max length of 7.
additionalData	A JSON block of additional data containing the Transaction ID (or refTag) from the claim response.	E.g. {"healthpointTransactionId": "3oijiofw8uf"}
merchantId	Allows the PMS to pass in the desired Merchant ID for the gap payment (part of multi-merchant support).	The Tyro Merchant ID.
terminalId	Allows the PMS to pass in the desired Terminal ID for the gap payment (part of multi-merchant support).	The Tyro Terminal ID.