Configuring Capable 21C to support Tyro Healthpoint functionality for Health Fund claims

Abstract

Capable 21C supports the Tyro system for Health Fund claims via Healthpoint. This article describes how to configure Capable 21C to correctly support that functionality.

Underlying challenge

A Tyro terminal is an external device that is connected to Australia's Medicare network. Using a Tyro terminal independently of Capable 21C is quite easy, and Tyro provide instruction on how to do that. Using a Tyro terminal with Capable 21C is also easy. A few setup steps need to be performed before that can happen.

Resolution

Before configuring these features, it is important to enable Tyro functionality

To configure Capable 21C to use Tyro for processing Health Fund claims, the following steps must be performed:

• Go to Setup|Setup Payment Methods.
• There must be a payment method specifically for Health Fund Payments. If one does not already exist, click the button to make a new one. If one does exist, double click on it to see its properties.
• Tick the box entitled 'Tyro Payment Method'.
• Make a note of the exact spelling of the name of the payment method. This will be used a little later.
• Click Close.
• Go to Setup|Settings.
• Go to the 'Other' tab.
• Click on the 'Tyro' System Component.
• Click on the 'Tyro Healthpoint Payment Method' System Setting.
• Change the setting to match the exact spelling of the payment method noted earlier.

In order for Capable 21C to be able to submit health fund claims, it must be able to calculate the item codes required by each health fund. Capable 21C has the ability to use a different item code for each insurer. Thankfully, in Australia, most insurers use the same codes. This means that an office has the option to either a) use one generic entry for all insurers; and/or b) have each individual insurer configured.

Capable Software recommends configuring one generic health fund for all claims that use the same item number (eg call it 'Health Fund'). Additional health funds can be added later if needed.

Follow these steps to setup the health funds that you wish to use:

• Go to Setup|Setup Insurers.
• The names of the insurers are not relevant to HealthPoint. They will only be used to determine the item numbers being used for health fund claims.
• If new insurers need to be added, click the 'Add Insurer' button and enter the details.
• Repeat these steps as many times as needed.

In order for Capable 21C to be able to submit health fund claims, it must have appropriate invoice line items configured. When an invoice is processed, each line item will be sent to the Health Fund. Payment will only be made if the configuration is correct. Follow these steps to setup the invoice line items:

• Go to Setup|Setup Appointment Types and Fees.
• Double click on the relevant type of appointment (on the left).
• Go to the Services tab.
• identify the invoice line item that will be used for Health Fund claims and double click on it.
• The name of the service is not relevant to the claim. The health fund only considers the Item Number for a claim.
• Check that the correct item number has been entered. For example, a Chiropractic Spinal Adjustment has item number 1001 with most Australian funds.
• On the General tab, the tickbox entitled 'Medicare claimable' should NOT be ticked.
• On the General tab, the tickbox entitled 'Include on Insurance claims/invoices' should be ticked.
• On the General tab, the tickbox entitled 'Include on Private invoices/receipts' should be ticked.
• If there is a Body Part required by the health fund, enter it as well. For example, most Chiropractic claims do NOT require a body part.
• Go to the Fees tab and ensure that the 'Insurance Fee' is set appropriately (see Detailed Information for a discussion of fees).
• Click Close.
• Repeat these steps if there are other invoice line items you wish to claim via Healthpoint. For example, Chiropractors will typically have five services as follows
  • Initial Consultation - 1001
  • Initial Consultation WITH treatment - 1002
  • Reexam Consultation - 1004
  • Standard consultation - 1005
  • Standard long consultation (over 15 minutes) - 1006

The last configuration step is to ensure that each practitioner is configured appropriately for Healthpoint claiming. Follow these steps:

• Go to Setup|Setup Doctor Details.
• Double click on the practitioner who will be providing the treatment.
• Healthpoint is not concerned with the name of the practitioner. It will approve claims based on the practitioner's provider number.
• Enter the practitioner's provider number (typically 7 digits and one letter).
• If multiple insurers have been configured, it is possible to record different provider numbers for each of them.
• Click Close.
• Repeat these steps if there are other practitioners who will provide treatment.

Detailed Information

Discussion of fees

Offices should consider carefully what fees to charge for Healthpoint claims. Each health fund provides compensation using their own particular formula.

Some health funds will pay a fixed amount per visit up to the patient's care limit (eg 12 visits per year). However, these funds will typically only pay up to the amount requested by the clinic. For this reason, it is generally considered to be better to charge a larger amount.

Some health funds will pay a percentage of the claim (up to a certain figure) for each visit. This also suggests that claiming the maximum amount is better.

Some health funds will audit practitioners to ensure that they are not submitting fraudulent claims. For this reason, it is important not to claim too much. A clinic should never claim more from a health fund than what they would normally charge a private patient.

Copyright 2006 Capable Software Pty Ltd

Training Sessions

Installing and getting started

Fundamentals Training 1

Fundamentals Training 2

Fundamentals Training 3

Fundamentals Training 4

Tyro User Guide

Setup and Configuration 1

Setup and Configuration 2

Other Resources

Intermediate Training

Return to Capable Software home

View knowledgebase articles

Contact Technical Support