Before you start...
Setting up the HICAPS Digital Claims integration is essential prior to processing any payments or claims for NDIS via HICAPS Digital Claims.
The HICAPS NDIS Plan Managed integration allows you to submit claims directly to NDIS Integrated Plan Managers. For successful claims, paid amounts are added to the invoice automatically, saving double handling. In addition to this, using this integration will save, on average, 5-7 days of processing time compared to using the Global Plan Managers functionality.
Adding Claimable Services and Classes
Once HICAPS Digital Claims is linked to Nookal, Services, Classes, Inventory and Passes will need to be set as Claimable.
1. Go to Setup > Items > Services.
2. Click on the Service to open the details page.
3. Tick Enable Integrations if not already ticked.
4. Tick Enabled next to NDIS.
Important!
Enable Integrations needs to be ticked for the item to be able to claim it with HICAPS Digital Claims.
5. Click Save Changes.
6. Repeat for all claimable Services, Classes, Inventory and Passes.
7. Once the items are set as claimable, go back to Setup > Connections > Integrations > HICAPS Digital Claims > Configure.
8. Click on the relevant NDIS tab and add the specific NDIS Codes for each item claimable with NDIS.
9. Once all the codes are added, click Save Custom Codes.
Submitting NDIS Integrated Plan Managed Claims
Before you start...
Within the Case, make sure the Integrated Plan Manager (eg, Leap in!) is set up as the Third Party Payer to automatically populate this information when claiming.
Find out more about Setting Up Third Party Payers.
1. In the Diary, open the booking and click Generate Invoice.
2. Edit or add items if required and click the Pay Via button and select HICAPS from the bottom of the invoice.
3. Select NDIS Plan Managed.
4. Click Setup to expand the section in which some required NDIS claiming details will be pre-filled from information in Nookal.
5. Enter or edit any missing or inaccurate information.
The Client's Patient Membership No. will automatically populate if this has been added into the NDIS Field in the Clients > Health section.
6. The Integrated Plan Manager will be automatically selected if it has been set up within the Case as the Third Party Payer.
7. Double check the correct items for claiming have been selected, and click Pay with HICAPS.
8. The invoice will be submitted to the NDIS Integrated Plan Manager, and its status will be set as Pending. Any action related to the claim can be seen in the History tab on the invoice and in the HICAPS Report.
If the claim is successful, the paid amount will be added to the invoice automatically.
Same Day Claim Cancellation
Same day cancellations of claims is possible up until 4pm AEST. To cancel a claim:
1. Open the invoice and click on Pay Via and then HICAPS.
2. Open the History tab, and click Cancel.
3. Enter a Reason for cancellation and click Cancel.
NDIS Integrated Plan Managed Claim Statuses
The below table outlines the different statuses of NDIS Integrated Plan Managed Claims and their definitions. These statuses can be found in the History section of the invoice, as well as in the HICAPS report throughout the claiming journey.
| Status | Definition |
| Awaiting Response | The claim has been submitted and is awaiting an adjudication response from the Integrated Plan Manager. |
| Pending | The Integrated Plan Manager has received the claim and is responding with pending to indicate they need more time to adjudicate. |
| Provisionally Approved | The Integrated Plan Manager has approved the claim and sent it to the NDIA for approval. |
| Rejected | The claim has been rejected by NDIS. |
|
Provisionally Approved - Part Funded |
The claim is approved and will be paid to the value of the specified benefit, which might be a full or partial funding amount. |
| Approved | Payment for the claim is successful. |
| Cancel Pending | The Integrated Plan Manager has processed the cancellation request and cancelled the claim in their system. |
| Cancelled | The claim is cancelled. |
Further to this, invoice statuses may be updated with various messages as the claim is being processed to provide more information. These can be found in the History section of the invoice, as well as in the HICAPS report throughout the claiming journey.
| Status | Definition |
| Awaiting Response | Awaiting response. |
| Member Review | The claim needs to be reviewed by the member. |
| NDIS Review | The claim is ready to be reviewed by the NDIS. |
| Operator Review | The claim needs to be manually reviewed by an Integrated Plan Manager Operator. |
| NDIS Rejected | The claim was rejected by the NDIS. |
| Member Rejected | The claim was rejected by the Member. |
| Not Claimable | The claim is deemed as not claimable after validation by the Integrated Plan Manager. |
| NDIS Approved | The claim is approved by the NDIS. |
| Cancelled | The claim is cancelled and/or the cancellation was rejected. Please contact the Integrated Plan Manager to cancel this claim. |
| Part Funded | One or more claim item/s have been rejected/approved by the NDIS. |
| Paid | Payment for the claim was successful. |
| Pending Refund | The claim is queued for a refund by the Integrated Plan Manager. |
| Refunded | The refund for the claim is successful. |
Discover more...
View a list of submitted claims and their statuses using the HICAPS Report via Reports > Financials > HICAPS.
Click here for more information on how to use the HICAPS Report.
Coming soon...
Watch this space! More Integrated Plan Managers will be available soon.