Claim information is information that a funding body (i.e. the body that pays or subsidises a service you provide) uses to be able to identify a patient and determine their eligibility for services by a particular practitioner, paid for by the funding body.
For example, a government healthcare system may identify eligible patients by a patient number, a claim number, the details of a particular event (such as the date of an accident for accident compensation schemes) or a combination of these.
The claim information required differs for each funding body, which Halaxy automatically manages for you based on the fee type you select for a particular appointment. A patient's claim in Halaxy contains their identification (such as membership number), the default payer and paying organisation, and other required claim details as determined by the funder type.
Once you have added a patient's claim information, you can also add referrals under that claim.
A patient's claim information can be found in the Funding page of their patient profile:
You can access this page by clicking the patient's name in the Patient List, then clicking the Funding tab.
To add a new claim:
Go to a patient's profile and click the Funding tab.
Click New Claim in the top-right of the page.
In the Funder field, type part of the funding body's name and select it from the drop-down menu.
Complete the claim information form (depending on the funder, you will be asked for different claiming information):
RESULT: The patient's claim information for the funder is now saved to their profile and will appear on their appointments and invoices linked to this funder. You can now also add referrals by clicking Add Referral under the claim in their Funding page:
To edit the claim details, click the Edit (pencil) icon under the claim.
If you are creating a claim for a third-party funder, you must also set some additional options, such as the default payer for this patient's invoices.
These options are as follows:
Patient: the patient pays for the invoice
Organisation (new invoice): each time you use a fee associated with this funder, a new invoice billed to the paying organisation will be created
Organisation (existing invoice, same patient): all fees for this patient associated with this funder will be sent as a single collated invoice to the paying organisation for the invoice schedule period
Organisation (existing invoice, any patient): all fees for all patients associated with this funder will be sent as a single collated invoice to the paying organisation for the invoice schedule period
Paying organisation: The default organisation that will be billed. If you do not want to set a default organisation, leave this field blank - this is useful if the paying organisation changes (for example, NDIS claims where different organisations may pay for the patient or if you provide the same service to different schools or employers)
Invoice Schedule: how often invoices are sent when the payer is set to "Organisation (existing invoice, same patient)" or "Organisation (Existing invoice, any patient)". For example, you could choose to send collated daily invoices, weekly invoices or monthly invoices.
(Optional) Tick the "Anonymise patient details on invoice" checkbox to anonymise the patient details. If ticked, the patient will appear as an anonymised ID such as "HK 123456".
Alternatively, if a patient has been booked for an appointment covered by a particular funding body, you can add or edit a patient's claim information in other ways:
From an appointment: after you have made an appointment, click the appointment on the calendar and click the Edit (pencil) icon next to the claim field.
On an invoice: go to the invoice and click the Edit (pencil) icon in the Claim and Referral section of the invoice.
The claim details are recorded on the patient's Funding page, on relevant invoices and on the appointment listing in your calendar.
Third parties that pay for a patient's treatment are also listed on the patient's Funding page.
Duplicate records of the same claiming information can occur when you accidentally add the information multiple times, when you merge patient profiles or when you have a particular funding body entered multiple times on your Funders List.
If a patient's claim information has been entered on their Funding page multiple times, you can merge the claiming information listings into the one listing. When this happens, a Merge icon (two arrows pointing to each other) appears next to the relevant listings.
Click this link for instructions on how to merge claims.
You can delete claims that have been added in error (e.g. for the wrong patient, or added as a duplicate) and archive claims that have been used but are not required anymore.
Deleting a claim removes its information entirely and cannot be reversed. You can only delete claims that have no appointments. referrals or invoices linked to the claim.
Archiving a claim will retain the associated information but will render it inactive so it cannot be used; this is appropriate if there are appointments and invoices linked to the claim.
To delete or archive a claim:
Click the Delete icon to the right of the claim information on the patient's Funding page.
Select whether you want to delete or archive the claim, then click Submit.
NOTE: When you archive a claim, a new active claim with the same details (but not linked to any existing appointments, invoices or referrals) is created. This allows you to use the new claim easily and automatically. You can edit the claim details by clicking the Edit (pencil) icon.