icare claiming through Halaxy (WorkCover NSW - SIRA)

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Practitioners in New South Wales can use Halaxy's integration with Medipass to process icare workers insurance claims (formerly covered by WorkCover NSW). This saves you the paperwork of manual claiming, gives you automatic decisions on claims and allows for faster settlement of accounts. Claims are usually processed in 24 hours.

All your patients need is their claim number, so the process is quick and convenient.

Currently only workers insurance claims with a claim number greater than 2000000 (seven digits) are supported. Invoices for other schemes, such as Dust Disease, LifetimeCare, Insurance for NSW, Sporting Injuries, and HBCF are not yet supported. Older legacy icare claims (claim numbers below 2000000) are not supported.

What you need to successfully process an icare claim

To process an icare claim, ensure that you have signed up for Medipass and registered for icare claiming via Medipass. Then you must connect your Medipass and Halaxy accounts. Once connected, any Halaxy invoice with a fee under the funder "WorkCover NSW - SIRA" will have a new button labelled Process icare in the Payments section:

A fee under the funder "WorkCover NSW - SIRA" with a button to process icare claims

You also need to have the following set up in Halaxy:

icare_Fee.png

Image: Editing a fee specifically set up for icare claiming (expand image)

  1. A fee set up under the funder "WorkCover NSW - SIRA". For information on how to import the "WorkCover NSW - SIRA" funder from Halaxy's database, please see Funders in Halaxy. For information on how to create a new fee, see Adding Fees to Your Fees List.

  2. The fee's item number in Halaxy is set to its SIRA item number so icare can identify the service being claimed. Please see SIRA's list of publications for advice on the correct item number (look up the most recent "Fees and rates orders").

  3. The fee has a rebate amount greater than $0.00 and no higher than the maximum in SIRA's fee schedule (the rebate amount is the amount paid by the insurer). By default, fees you import from Halaxy's database will be set to the maximum allowable. If the rebate amount is higher than SIRA's maximum, the claim will be rejected. See SIRA's list of publications for advice on the scheduled fee amount (look up the most recent "Fees and rates orders").

  4. icare_InvoiceBreakdown.png

    You have entered your SIRA workers compensation approval number (either on the invoice or on your Identifications page) for the funder "WorkCover NSW - SIRA" and this number has been registered with Medipass.

  5. Your patient's claim is set up for "WorkCover NSW - SIRA" on their Funding page. Ensure you include the patient's claim number; the paying organisation is set to icare; and the payer is set to bill the organisation rather than the patient.

    icare_PatientClaimPayer.gif

    Image: A patient's "WorkCover NSW - SIRA" claim on their funding page.

  6. The patient has a valid date of birth and mobile phone number on their patient profile.

You do not need to know which insurer provides funding to your patient. This will be handled by Medipass when you submit the claim.

Once you have the following set up, you can process claims by clicking Process icare on any invoice using a fee under the "WorkCover NSW - SIRA" funder.

Processing an icare claim via Halaxy

Once you have set up an appropriate fee and entered your SIRA approval number for the "WorkCover NSW - SIRA" funder, processing a claim takes just a few clicks from the invoice. The process is very similar to processing a private health insurance claim with Medipass via Halaxy.

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Image: Processing a private health insurance claim with Medipass (expand image)

To process an icare claim for workers insurance:

  1. From the invoice billed to icare, click Process icare.

  2. A pop-up appears that shows your Halaxy credit balance and a summary of the rebates that can be claimed. Click Process. You must have entered your SIRA approval number for the "WorkCover NSW - SIRA" funder, and this number must have been registered with Medipass.

  3. You will be taken to a confirmation page from Medipass. Click Continue to Payment to continue.

RESULT: Once payment is approved, the invoice will be updated in Halaxy with the rebate amount marked as paid. From the invoice, you can view the claim history and a Medipass statement by clicking the status link on the invoice. After the funds are transferred, you can log in to your Medipass portal to access remittance advice and to refund the payment if required.

If there is a gap fee remaining (i.e. the fee you used has a fee total that is higher than the rebate amount paid by icare), Halaxy would have already created a linked invoice billing the patient for the gap. A link to the patient invoice will appear on your icare invoice. You can process the remaining amount via Halaxy or take payment through another method and mark the invoice as paid.

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Image: Viewing the Medipass claim history and statement (expand image)

Note

To process a Medipass claim, the patient must have a valid date of birth, mobile phone number and email address on their patient profile. You can quickly add these details from the invoice by clicking Edit in the top-right of the Patient Details section.

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