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User Guide and Documentation |
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| | | | | | Document last updated on: 26/11/2020 |
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Software as a Service Cloud Practice Management |
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Ancillary Private Health Fund Claiming with SaaS Web |
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1 - Tyro Health Fund Claiming integratation with SaaS Web |
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Tyro is integrated with SaaS Web. No cables or connections are required. The integration is web-based, and multiple workstations on the same LAN can connect to a single Tyro Terminal.
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2 - Private Health Funds and Supported Modalities |
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SAAS Medical Systems integration with Tyro Private Health Fund Claiming is suitable for the following types of Practitioner. |
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| - Dentists - (including General Dentists, Endodontists, Periodontists, Prosthodontists, Paediatric Dentists)
- Dental Prosthetists
- Dietitians
- Optometrists and Optical Dispensers
- Podiatrists
- Physiotherapists
- Exercise Physiologists
- Chiropractors
- Osteopaths
- Psychologists
- Occupational Therapists
- Speech Pathologists
- Remedial Massage Therapists
- Acupuncturists
- Naturopaths
- Myotherapists
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3 - Health Fund Claiming Operational Workflow Overview |
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| | | | Health Fund Claims are based on a Gap Payment Method.
The Fund member (the patient) is able to make a Claim at the point of service in real time - and their Health Fund will then direct the payment of any benefit to the health service provider.
The member then pays the health service provider the GAP, which is the difference between the service fee and Health Fund benefit.
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| | | | There are four (4) Health Fund transaction types Claim A transaction for a Health Fund member’s (patient) Claim for benefit from their Health Fund for health services provided (initiated at the point of service). Void (rejection, abort & system) A transaction to invalidate the last processed Claim transaction. This happens when either the Health Fund member rejects the Claim assessment (at the point of service), or an operator abort (at the point of service) or because of a communications error (initiated by the system). Cancellation A Claim transaction that was previously accepted by the Health Fund member is now cancelled within the same day (initiated at the point of service). Reports Reports are created directly from the PMS and from the System. |
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ClaimEach Claim is made up of one or more health service items (max 16 items per Claim). When the Claim is submitted, the Health Fund sends a response for each individual item (in addition to the response for the Claim as a whole). These responses are next to each item on the claim receipt and SaaS Web display. Unless otherwise indicated, all responses except “00 - APPROVED” mean the item has been rejected. The member also has the option to either ACCEPT or REJECT the Claim following the Health Fund’s APPROVED response. If ACCEPT the Claim is finalised and the member then pays the health service provider the GAP and the Heatlh Fund pays the health provider the benefit. If REJECT, a VOID transaction is sent to the Health Fund to invalidate the Claim transaction and the member is required to pay the health service provider the full service fee.
 The Health Fund membership card must be present and swiped for a Claim to be submitted. Manual entry or having stored in the Practice Management System is not permitted by the Funds and not supported by SaaS Web
Information required to submit a Claim for Health Fund assessment: - Health Fund membership number – swiped from patients Health Fund card
- Family member number – the no. on the front or rear of the membership card corresponding to this patient
- Provider number – unique Medicare or Health fund supplied no. associated with the Health provider at this point of service
- Date of service
- Service Item(s) number(s) and associated cost of service(s)
- Body part number or Tooth number associated with service item where applicable
For a Health Fund “Approved” Claim- Health service details are entered and reviewed in the SaaS Web HealthPoint Billing screen
- Patients Health Fund membership card is swiped
- Patients family member number on their card is entered if not already known by SaaS Web ( 0, 1, 2, 3 etc)
- Claim is processed and the response is sent by the Health Fund in real time
- A Claim assessment receipt is printed from terminal and displayed in SaaS Web which details the Health Fund response to each service item and to the Claim as Approved. This can be printed for the patiient if requested.
- Patient reviews the Claim assessment with the rebate(s) and Gap and may choose to either ACCEPT or REJECT the Claim
Patient advises they Accept the Claim- Patient signs Claim assessment receipt and the practice initials this receipt
- Patient signed assessment receipt is filed by the practice and retained for 2 years
- Practice activates Accept in PMS
- 2nd Claim assessment receipt printed as the Patient copy
- Patient is then asked how they wish to pay the Gap – cash, credit, debit or invoice.
- Payment method is selected in PMS
- Gap payment is performed with corresponding receipts printed for patient and practice
Patient advises they Reject the Claim- Practice activates Reject in SaaS Web
- Health Fund responds with Void accepted message displayed in SaaS Web and on the terminal
- Void receipt is printed from terminal which also details the Health Fund’s Claim assessment
- Patient is then asked options for this Claim?
- Adjust – return to Claim screen. Option to change details for new Claim assessment.
- Discard – No further Claim submissions for assessment.
- Payment of full service fee.
- Print receipt.
- Patient to claim directly with their Fund
For a Health Fund “Rejected” Claim- Health service details are entered and reviewed in SaaS Web.
- Patients Health Fund membership card is swiped
- Patients family member number on their card is entered if not already known by SaaS Web ( 0, 1, 2, 3 etc)
- Claim is processed and the response is sent by the Health Fund in real time
- A Claim assessment receipt is printed from terminal and displayed in SaaS Web which details the Health Fund response to each service item and to the Claim as a whole.
- Health Fund Rejects Claim showing reason code(s) on assessment receipt
- Patient is then asked options for this Claim?
- Adjust – return to Claim screen. Option to change details for new Claim assessment.
- Discard – No further Claim submissions for assessment. Payment of full service fee. Print receipt.Patient to claim directly with their Fund
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| For patients wanting to understand their Health Fund’s assessment to a Claim prior to proceeding with Health services.The options can be either of: - Call the patient’s Health Fund on their member services phone number or
- Submit a Claim and then Reject (Void) this Claim
- Claim is processed and the response is sent by the Health Fund in real time
- Practice activates Reject in SaaS Web
- Health Fund responds with Void accepted message displayed in SaaS Web and on the terminal
- Void receipt is printed from terminal and displayed in SaaS Web which details the Health Fund ‘s Claim assessment.
- Patient is then asked options for this Claim?
- Adjust – return to Claim screen. Option to change details for new Claim assessment.
- Discard – No further Claim submissions for assessment.
VoidVoid (rejection)- Claim is processed and the response is sent by the Health Fund in real time
- A Claim assessment receipt is printed (also displayed in SaaS Web) which details the Health Fund response to each service item and to the Claim as a whole
- Either of 1. The Health Fund Rejects Claim showing reason code(s) or 2. Patient advises they Reject the Claim
- Patient is then asked options for this Claim?
- Adjust – return to Claim screen. Option to change details for new Claim assessment.
- Discard – No further Claim submissions for assessment. Payment of full service fee. Print receipt.Patient to claim directly with their Fund
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| 4 - Initial Setup and Configuration:- Practitioners
- Modalities
- Item Codes
- Operator Defaults
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| Practitioners
Practitioner details must be entered in the Doctor And Medical Staff Registration page. Refer to the Administrator Guide if more help is required.
A Provider Number is required for the Ancillary Modality (and location).
For recognition with Health Funds via HealthPoint, the practitioner must be registered with Medicare Australia. Enter the Location Provider Number as shown below.
The Tyro and Terminal ID and Merchant ID can be entered if required.
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Modalities Modalities are pre-configured in saas web according to the supported types of practitioners (as shown above).
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Item Codes Item Codes and default descriptions are pre-configured. The can be modified in the Maintenance Menu. Default Item Pricing is NOT pre-configured, but these can by entered "on the fly" as the are required and used (described in the Patient Billing section) |
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Operator Defaults For Allied Tyro HealthPoint processing - set the following Operator Defaults:- Billing Mode - Tyro HealthPoint Ancillary Modality - Select from list Also set the Default Doctor / Practitioner (use Find Doctor)
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Enter Charge Amount - Update Pricing Table |
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6 - Process HealthPoint Claims |
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| Formatted assessment report can be printed or emailed to the patient if requested. |
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| In this example, the health fund has covered the entire charge amount. The invoice has been Paid in Full and the only active option is Completed - which will return you to the HealthPoint Billing screen. |
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| | In this example, there is a claim assessed Gap of $33
If the patient wants to Accept the claim amount - click on Accept. |
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The Claim and Benefit amounts are shown.
Here the Claim Amount is $85.00 Benefit amount is $52.00 GAP Amount is $33.00
To continue - click on Continue (Accept Health Fund Claim Benefit).
Note that you can cancel the claim at this point (Cancel Claim) - and Return to Billing if required to make other adjstments to the Invoice/Claim. |
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The Payments and Receipts screen is displayed.
The Pay Gap with Tyro EFTPOS button is active and highlighted.
Click here if the patient wants to pay the gap with EFTPOS. |
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| Follow the Tyro Terminal prompts. |
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When the transaction completes, the EFTPOS screen is displayed.
Close this screen to continue. |
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| The Invoice is now fully paid.
If configured, an Invoice/Receipt will automatically be printed Otherwise select the Print HealthPoint Billing screen. |
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Other Gap Payment methods |
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If paying the Gap by some method other than EFTPOS, change the Payment Type (Cash/Cheque etc) and enter the details.
Click on "Add this payment" |
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When you have finished entering payments - ckick on Continue to return to the Billing sceen |
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8 - Health Fund Claim Cancellation |
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To cancel a HealthPoint Claim, the Claim must have taken place on same day as the Cancellation - prior to Claim settlement (12AM Sydney time – adjusted for day light savings). To cancel a Claim after the same day, the patient must directly request a cancellation with their Health Fund. |
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| | Access the Same Day Cancellation screen from the HealthPoint TAB of the Tyro Menu.
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Procedures and Processes for Cancelling a HealthPoint Claim - A Claim has been Approved by the Health Fund and Accepted by the Patient
- Patient now wishes to cancel this Claim
- The Claim is selected in the Same Day Cancellation screen
- Patients Health Fund membership card is swiped
- The Cancellation for this Claim is sent to the Health Fund
- The Health Fund responds and a Cancellation receipt is printed which shows the Health Fund’s responses to the Cancellation of each item and to the Claim as a whole.
- Patient payment of the full service fee is now required. - payment of Health fund benefit.
Note on healthpoint claim refund...
A healthpoint claim cannot be refunded to a patients bank account/card. A healthpoint claim being refunded would mean the health fund is paying the doctor/provider and then the provider is refunding/giving money to the patient. Having this functionality available would give an opportunity for a fraudulent transaction to occur. Therefore the healthpoint claim should only be allowed to be cancelled, not to be refunded as well. |
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Only HealthPoint Claims made TODAY are shown. There is no way to access previous day's claims.
Ensure that the correct claim is selected - then click on [Cancel Claim] and Confirm
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| | The Tyro process will begin.
Follow the instruction (patient to swipe card etc.)
Wait until the process completes. |
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After the HealthPoint Claim has been cancelled - the Cancelled HealthPoint Payment screen will be automatically be displayed.
Verify that this is what is intended - then click the [Confirm] button. This will create a payment reversal - and adjust the Invoice balance and status.. |
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To REFUND a Tyro Payment - first select the Tyro Transaction TAB from the Tyro Admin Menu
Then select the option REFUND Tyro EFTPOS |
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Cancel Receipt or Payment / Refund Tyro EFTPOS
First use Find Patient to select the patient. If the patient has multiple invoices - the latest invoice is displayed first. |
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| | | | Enter refund password on Terminal |
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| | Swipe or insert Card to be refunded |
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| | Processing transaction - please wait |
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| If a signature is required - the Merchant Receipt will display in a pop-up window.
This should be printed, signed, and the signature verified.
You can now click on YES for Signature OK? |
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10 - Reporting - summary, detail, health fund payments with consolidated view option |
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