HICAPS: how it works and where it can be used

Rather than wait to be reimbursed, HICAPS lets you claim benefits on the spot.

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Rather than submitting your extras claim online and waiting to get reimbursed, HICAPS lets you claim your benefits there and then at the healthcare provider. Lots of providers have a HICAPS machine these days and it can be used for several different services including dental, chiro and physio.

What is HICAPS?

HICAPS (Health Industry Claims and Payments Service) is an electronic health claims system that lets you claim Medicare, WorkSafe Victoria or private health Extras benefits when you pay for treatment, rather than wait to be reimbursed.

When a service provider gives you the bill for your treatment, you hand them your Medicare, WorkSafe Victoria or health-fund membership card and they swipe it through an electronic HICAPS machine. The machine then automatically processes your claim. If you're claiming from your health fund, its contribution will be processed on the spot and you pay the remaining gap if applicable.

How does HICAPS work?

There are three main ways you can make a claim with HICAPs:

Private contract

Private health insurance

If you visit a healthcare provider such as a dentist or optician that offers HICAPS and you have extras cover, you can give them your health insurance card and they'll swipe it through the HICAPS terminal. This automatically pays the amount your health fund covers. You don't need to send them receipts and wait to be reimbursed; you just need to pay the remaining fee, if it's not totally covered by your insurance.

Public system

Medicare

Medicare Easyclaim is the HICAPS system used by Australia's public healthcare system. This lets you lodge your claim and receive rebates through the HICAPS terminal. It's available with many bulk billing services and other patient services across Australia including Chronic Disease Management.

Victoria

WorkSafe Victoria

The WorkSafe Victoria scheme allows healthcare providers to lodge invoices for injured workers via a HICAPS terminal. To do this, you'll need to provide your Medicare provider number and HICAPS claim number. This service is for lodging invoices only, not payment, so you won't receive an on the spot payment.

Which funds use HICAPS?

HICAPS is a service provided by most Australian health funds. These include:

What services can be claimed on HICAPS?

The following list summarises the services that can be claimed through HICAPS by many of the leading health funds.

  • Acupuncture
  • Chiropractor
  • Clinical psychology
  • Dentistry
  • Dietitian
  • Exercise physiology
  • Myotherapy
  • Naturopathy
  • Occupational therapy
  • Optometry
  • Osteopathy
  • Physiotherapy
  • Podiatry
  • Psychology
  • Remedial massage therapy
  • Speech pathology

What is the HICAPS Go app?

HICAPS Go is designed to be a one-stop healthcare app that allows you to find health services, get quotes, pay for your consultation and claim your private health benefit from your smartphone or mobile device.

It lets you access allied health services such as physiotherapists, chiropractors and remedial massage therapists in the greater Melbourne area. With it, you can:

  • Find a preferred provider in your area using location services
  • Get a quote and see your benefit contribution and any out-of-pocket costs upfront
  • Make an appointment and manage your booking
  • After the consultation, instantly claim your benefit and pay only the gap portion

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