Quicker Health Insurance Claims with HICAPS

Published: February 21, 2020

If you've claimed health insurance Extras like optical, physiotherapy or dental, then you may have been asked if you want to use the HICAPS system.

HICAPS, the Health Industry Claims and Payment Service, is an electronic claims system used by a variety of healthcare providers to help you make on-the-spot claims for out of hospital treatments and services. HICAPS makes the claiming process faster and easier because you’ll generally receive your rebate in your bank account immediately.

Find out more about the benefits and risks associated with HICAPS Australia, which health funds and providers use this system and how you can benefit.

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What is HICAPS?

HICAPS stands for Health Industry Claims and Payments Service. This electronic health claims system helps health care providers’ like your GP and dentist more efficiently process your Medicare, or health insurance Extras claim when processing payments.

Generally, these claims are made on the Verifone HICAPS terminal, which is like a standard EFTPOS machine used to make payments on. However, instead of communicating with your bank, the terminal sends a message to Medicare or your insurer to process the claim.

Take note: If you are not entitled to the full benefit on a particular treatment, you might need to make an additional payment.

Pros and cons of HICAPS

Advantages Disadvantages
You can use location services like their ‘Find A Practitioner’ option to find providers near you that have access to HICAPS Australia. HICAPS are not available to all providers. Practitioners need a reliable phone line or mobile connection to process payments.
Your benefit contributions and out-of-pocket costs are presented upfront so that you can know your HICAPS refund and avoid any nasty surprises. It might take longer for certain health insurance providers like Bupa, to process your claim, as they do not accept claims made through 3G. So, your request will need to be made through an Ethernet or dial-up connection which takes longer.
You have the option to claim immediately after treatment.
Claims are processed on the spot, in a matter of seconds.
Multiple claims from the same provider are returned in a single payment.

How to claim with HICAPS

Generally, the HICAPS manual claim process follows the below steps:

  1. After your treatment, your health care provider swipes your card through the terminal.
  2. Use the arrow buttons on the touch screen to select your health insurance provider and press the ‘Select’ button.
  3. Enter your 2-digit Patient ID, which is printed on your card, and press ‘OK’.
  4. Use the keypad to enter the item number of the treatment you have received.
  5. Add the clinical code, body part or tooth number related to your treatment.
  6. Using the keypad, enter the date of your treatment in a DD/MM/YY format.
  7. Add the cost of your treatment before pressing ‘OK’.
  8. You’ll then be redirected to the claim summary page where you can check the details of your claim. If there are any issues, you can click on 'Modify' or 'Add' to include additional items to your request. You also have the option to remove items from this list.
  9. If you are satisfied with your claim, press the ‘send’ button on the touchscreen.
  10. An additional confirmation screen will pop up if everything is correct. Press 'Yes' to send the claim to your health insurance provider.

Generally, all claims are processed on the terminal, which has a magnetic strip reader. If you do not have a card or your card does not have a magnetic strip, it is best to contact HICAPS Australia directly. If you would like to make a HICAPS claim without your card, you’ll need to use the HICAPS Go app.

Who can use this on-the-spot claiming system?

Australians that have either a Medicare, Private Health Insurance or WorkSafe Victoria membership card can use HICAPS to claim for their general treatments. However, if you are visiting Australia from overseas, you’ll generally only be able to use this claiming system if you have Overseas Health Cover.

Find an insurer that provides HICAPS refunds

Which health funds use HICAPS for claiming?

As at February 2020, the following HICAPS health funds are available:

  • HBF
  • Medibank
  • Bupa
  • Australian Unity
  • HCF
  • CBHS Health Fund
  • NIB
  • Navy Health
  • StLukes Health
  • Defence Health
  • Health.com.au
  • GMHBA
  • Frank. Health Insurance
  • Teachers Health
  • HIF
  • AHM
  • GUHealth
  • Health Partners
  • Queensland Country Health Fund
  • Phoenix Health Fund
  • Transport Health
  • ACA Health
  • Apia Health Insurance
  • Cua Health Insurance
  • Union Health
  • Mildura Health Fund
  • Peoplecare
  • Healthcare Insurance
  • Onemedifund
  • Railway and Transport Health Fund Ltd
  • La Trobe Health services
  • Police Health
  • Doctors Health Fund
  • RBHS
  • Westfund Health Insurance
  • ADF Family Health
  • Budget Direct
  • Uni Health
  • CBHS
  • Apia
  • Frequent Flyer Qantas Insurance
  • Emergency Services Health
  • Nurses Midwives Health
  • myOwn Health Insurance
  • AAMI
  • Suncorp
  • Territory Health Fund
  • Hunter Health Insurance

What is HICAPS Go, and how does it work?

HICAPS Go is a smartphone app that allows medical practitioners, health insurance providers and patients to submit claims without a terminal. An SMS is then sent to your phone, providing you with the option to complete the process by following the prompts.

Generally, this is convenient for all parties. Providers don't need to keep equipment in their rooms, and you (the patient) won't need to carry a card with you. However, you do need to know your membership details to complete a claim. Although it’s not necessary to download an app to make use of this service, you can visit the App Store or the Google App Store to download the app.

Frequently asked questions and answers

Can overseas visitors with health insurance use HICAPS for claiming?

Generally, overseas visitors and foreign nationals working or studying in Australia can make use of this system if they have Overseas Health Cover. However, specific Overseas policies might not allow for HICAPS refunds, so it is best to send a query to their contact service for more information.

What's the difference HICAPS and EFTPOS?

Both EFTPOS and HICAPS terminals are a type of device that facilitate transactions between businesses and financial institutions. EFTPOS, which stands for Electronic Funds Transfer at Point of Sale, is a terminal that allows customers to make payments. This machine is not meant for health insurance claims exclusively and is used more often for general goods and services. It relays the message to the bank and transfers the necessary funds to the business.

With a HICAPS terminal, the message is sent to your health insurance provider who makes sure the funds are delivered to your health care provider. Generally, these terminals also act as an EFTPOS point.

How do you cancel a HICAPS claim?

Generally, you’ll need to follow the below steps if you want to cancel your HICAPS claim:

  1. Click on the ‘Trans’ button on the terminals touch screen.
  2. Highlight the ‘Refund/Cancel’ option before clicking on ‘Select’.
  3. A prompt will appear on the terminal screen, requesting a card, which should then be swiped through the magnetic strip reader.
  4. All your transactions processed on that terminal will display on the screen. Scroll through the options until you find the one that applies to you before you click on ‘Select’.
  5. You will be asked to confirm the cancellation by clicking ‘Yes’ or ‘No’.
  6. Two copies of the cancellation receipt are printed, sign one for the provider’s records, keep the second one for your own records.

What other alternatives are there to claiming Extras health insurance?

Medipass is another option to consider if you don’t want to sign up for HICAPS Australia. It acts similarly; however, all claims are made on your mobile phone instead of on a terminal.

Other claiming options include claiming online or downloading your health fund’s app and submitting your documents and receipts on your mobile device. Alternatively, you could claim manually, by filling in a health insurance claim, which can be downloaded from the insurer’s website, attaching your invoice and sending it to your insurer.

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