What Is HICAPS? How It Works And Where You Can Use It

what is HICAPS

HICAPS makes claiming health insurance and Medicare benefits easy. Rather than submitting an online claim, or lining up at a Medicare branch to lodge your claim in person, with HICAPS you can claim the benefits you’re entitled to on the spot at your healthcare provider when you make a payment¹.

Many of us will remember waiting for a cheque from Medicare in the mail – thankfully, with HICAPS those days are behind us!

What is HICAPS?

HICAPS is an acronym for the Health Industry Claims and Payments Service – an electronic health claims and payments system that allows Australians to claim Medicare, WorkSafe Victoria, and private health insurance benefits when they make a payment for a health service².

HICAPS allows registered healthcare providers to process these claims instantly, which means you receive the benefit you’re entitled to on the day of treatment, rather than being out of pocket until your claim is assessed and paid manually². Except for WorkSafe Victoria claims, which are lodged instantly to be assessed before payment is processed³.

How does HICAPS work?

Many healthcare providers offer HICAPS so that they can process private health insurance, Medicare, and WorkSafe Victoria claims for their patients on the spot⁴.

A HICAPS terminal works in a similar way to an EFTPOS machine, but communicates with the government or your private health insurance provider rather than your bank.

The process for claiming your benefits depends on whether you’re making a private health insurance, Medicare or WorkSafe Victoria claim – read on for more information.

How do I make an extras claim with my private health insurance provider using HICAPS?

Suppose you visit a dentist that offers HICAPS, and dental benefits are part of your private health insurance extras policy. When you’re paying for your service, the receptionist will ask if you have private health insurance – simply present your card and they’ll swipe it through the HICAPS terminal.

Details of your claim will be sent to your health fund and it will be processed instantly. If your extras policy covers the cost of your treatment, you won’t need to make any further payments⁴.

If only part of the cost of your treatment is covered, you’ll need to pay for the remainder of the service yourself by EFTPOS or credit card.

How do I make a Medicare claim using HICAPS?

If you’re visiting a healthcare provider and believe that treatment is likely to be covered by Medicare, you can use the Medicare Easyclaim system (fulfilled via a HICAPS terminal) to lodge your claim and receive your rebate.

Generally, you’ll be asked to pay your account in full using EFTPOS; your Medicare card will then be swiped through the HICAPS machine and your rebate paid directly into your bank account almost immediately⁵.

How do I make a WorkSafe Victoria claim using HICAPS?

Healthcare providers can lodge invoices for injured workers via a HICAPS terminal as part of the WorkSafe Victoria scheme. You’ll need to provide your claim number, which the receptionist will enter into the HICAPS terminal⁶.

Your claim will then be sent to WorkSafe Victoria for assessment. Please note, you won’t receive an on the spot payment for WorkSafe claims.

What’s the difference between HICAPS and Medicare Easyclaim?

HICAPS is the system that supports Medicare Easyclaim payments. Using a HICAPS terminal, patients can lodge claims and receive payments on the spot at their healthcare provider, if the account is fully paid⁵.

If your account is partially paid or unpaid and you’re entitled to Medicare benefits, a statement and/or cheque will be sent to you at the address Medicare holds on its system for you; you must then forward this cheque to your healthcare provider, along with any outstanding balance⁵.

Who can use HICAPS?

Anyone with a Medicare or private health insurance membership card with a magnetic strip can use HICAPS at participating healthcare providers. Simply present your card at the time of payment.

If your private health insurance membership card doesn’t have a magnetic strip, check with your health fund whether they’re a HICAPS partner⁴.

Where can I use HICAPS?

Many healthcare providers – from dentists to dieticians, optometrists and physiotherapists – allow you to lodge a benefits claim via HICAPS. You can claim instantly using HICAPS at registered:

Acupuncturists
Chiropractors
Clinical psychologists
Dentists
Dietitians
Exercise physiologists
Myotherapists
Naturopaths
Occupational therapists
Optical dispensers
Optometrists
Osteopaths
Physiotherapists
Podiatrists
Psychologists
Remedial massage therapists
Speech pathologists

Is HICAPS confidential?

Yes. Details of your treatment can only be viewed by your healthcare provider and your health fund. HICAPS uses secure encryption protocol to ensure your privacy is protected⁴.

Which health funds support HICAPS?

98% of health insurance providers are HICAPS partners⁷, which means it’s likely you’ll be able to make an extras claim on-the-spot following treatment at a healthcare provider with a HICAPS terminal.

To check whether your health insurance provider provides instant payment of claims via the HICAPS scheme, you’ll need to call them directly.

What is HICAPS Go?

HICAPS go is a smartphone app that allows you to make a booking with your healthcare provider, claim the cost of the treatment with your private health fund, and pay any out-of-pocket expenses using your mobile phone⁸.

Users can also check their out-of-pocket expenses before making a claim.

Need more information about claiming with HICAPS?

The HICAPS scheme can be a little confusing if you haven’t used it before – but the receptionist at your healthcare provider is likely to be experienced with using the system and able to answer any questions you might have.

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Sources:
1. https://www.hicaps.com.au/patients
2. https://www.hicaps.com.au/common/about
3. https://www.worksafe.vic.gov.au/instructions-invoicing-worksafe
4. https://www.hicaps.com.au/patients/faqs
5.https://www.hicaps.com.au/content/dam/hicapsrwd/Documents/Medicare_Easyclaim%20Reference%20Guide.pdf
6. https://www.hicaps.com.au/content/dam/hicapsrwd/Documents/Worksafe_stepbystep.pdf
7. https://www.hicaps.com.au/private_health_insurers
8. https://www.hicaps.com.au/products/hicaps-go-product