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How to send a Health Fund claim - AU πŸ‡¦πŸ‡Ί
How to send a Health Fund claim - AU πŸ‡¦πŸ‡Ί

Sending an electronic Health Fund claim or manually saving a Health Fund claim for Australian practices πŸ‡¦πŸ‡Ί

Shelley Withington avatar
Written by Shelley Withington
Updated over a week ago

How to send an electronic Health Fund claim

To send a claim, you must first have created an invoice for the treatment by ticking and charging through the items from the patient's chart.

  • Navigate to the patient's 'Account' tab.

  • Select the 'New Claim' drop-down and choose 'Electronic'.

screenshot of selecting Electronic claims on the patients account screen.
  • When the claim dialogue box appears, tick the items you want to send as part of this claim.

πŸ“ Please note: Only one provider or payment plan can be sent on a single claim. Once you begin ticking procedure codes, any other codes with different providers/plans will be greyed out.

  • Then, check the Health Fund Patient ID is correct and click 'Send'.

  • You will then be prompted to swipe the patient's health fund card on the terminal.

  • This may take a moment to process but once the claim has been successful, the information will be returned straight to Dentally.

  • You will then be presented with the key information about the claim.

screenshot of the completion screen when sending an electronic health fund claim.
  • Simply click 'Finish' to complete the claim process.

A payment line will then appear on the patients 'Account' tab displaying the amount covered by the claim and this will automatically be deducted from the total balance. Leaving the remaining balance against the patients account ready to be paid via normal methods.


How to save a manual Health Fund claim

In a scenario where you need to manually record a health fund claim you should:

  • Manually enter and process the claim directly on the HICAPS terminal.

  • After completing the claim on the terminal navigate the patients 'Account' tab.

screenshot of selecting manual on the patients account scree under new claim.
  • Select the 'New Claim' drop-down and choose 'Manual'.

  • You can then select the items you wish to include on the claim using the checkbox.

πŸ“ Please note: Only one provider or payment plan can be sent on a single claim. Once you begin ticking procedure codes, any other codes with different providers/plans will be greyed out.

  • Enter in the rebate amounts that have been covered, based on the already completed claim from the terminal into the 'Rebate Amount' column.

  • Then click 'Save'.

screenshot of the manual claims screen with item ticked and rebate amount entered.

A payment line will then appear on the patients 'Account' tab displaying the amount covered by the claim and this will automatically be deducted from the total balance. Leaving the remaining balance against the patients account ready to be paid via normal methods.


How to view a Health Fund claim

  • Navigate to the patients 'Account' tab

  • Under Payments locate the claim in question.

  • Then click 'View' under the Method column

screenshot of the accounts screen with the view link highlighted.

  • Once opened, you will be able to view claim in full including:

    • The Provider associated with the claim

    • The Type of claim (Electronic or Manual)

    • The Health Fund the claim was completed with

    • The Date and all specific line items along with their associated rebate amount.

screenshot of the viewing a health fund claim screen.


Having trouble sending electronic claims

If you are having trouble using electronic claims we recommend ensuring you have set up the following first before contacting Ellie Bot and the support team for further investigation.

🚨 Have you established the integration? The integration must be established before you can send claims direct to the terminal from Dentally. This is something we can assist you with so please contact Ellie bot and the support team to assist with the setup.

🚨Have you set up the terminal provider? You must have your card terminal provider set for claims to successfully send to your terminal. Go to Settings > Sites > Payments, select your terminal provider, and remember to hit 'Save'!

🚨HICAPS disconneting! If you are having trouble with HICAPS disconnecting you can try the following:

  • Troubleshoot your own wifi in the practice.

  • Ensure you can reload the Dentally app on chrome. If not this could be an issue with us please check the status page here.

  • Contact HICAPS. If the above are all ok the issue likely lies with HICAPS themselves, when we notice an issue with HICAPS directly we will always try to let you know via our in-app messaging system once the issue is resolved so you can stay on top of sending claims as soon as the system is back up and running!


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