Health 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 Modality).
Please note developing this feature is optional.
Claims Reconciliation Report
- Report HealthpointClaimsReconciliationReport(string date).
- IReport HealthpointClaimsReconciliationReport(string merchantID, string terminalID, string date).
| Parameter Name | Description | Valid Values |
|---|---|---|
| date | The date of the report. | Format: yyyyMMdd |
| 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. |
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 from 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: |
| 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. |
| 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:
Example claims reconciliation report response XML
<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-healthfund-total-benefit-amount>
<private-health-fund-response-code>00</private-health-fundresponse-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-healthfund-total-benefit-amount>
<private-health-fund-response-code>00</private-health-fundresponse-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>info
If the report is unavailable, a report unavailable response is returned.
Report Unavailable Response Body
<claims-reconciliation-response>
<claims-reconciliation>
<healthpoint-terminal-id>TYR11111</healthpoint-terminalid>
<claim-date>20120601</claim-date>
</claims-reconciliation>
<unavailable>
<text>Report unavailable.</text>
<text>Please try again later.</text>
</unavailable>
</claims-reconciliation-response>Payments Reconciliation Report
- IReport HealthpointPaymentsReconciliationReport(string date)
- IReport HealthpointPaymentsReconciliationReport(string merchantID, string terminalID, string date)
| Parameter Name | Description | Valid Values |
|---|---|---|
| date | The date of the report | Format: yyyyMMdd |
| 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. |
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 from 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-payments | 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
<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-healthfund-total-benefit-amount>
<private-health-fund-response-code>00</private-health-fundresponse-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-healthfund-total-benefit-amount>
<private-health-fund-response-code>00</private-health-fundresponse-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>If the report is unavailable, a report unavailable response is returned:
Report Unavailable Response Body
<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>