September 13, 2023

Everybody happy about health payments digitisation

This article first appeared in the Australian Financial Review.

Everyone wins thanks to the innovations Health Industry Claims and Payments Service is bringing to healthcare, says the health claims solution’s chief executive Simon Terry.

The vision is to make it as easy as possible for everyone involved to operate within the healthcare system.

“It all starts with changing customer and health care provider needs,” says Simon Terry.

HICAPS stands for Health Industry Claims and Payments Service. It is an electronic payment and claiming system widely used by healthcare providers such as doctors, dentists and allied health professionals.

It efficiently and conveniently processes health insurance claims and payments at the point of service, he says.

It’s linked to many health insurers and funds in Australia, enabling real-time processing of claims for services covered by the patient’s health insurance policy. The patient typically pays the remaining out-of-pocket expenses.

More than 97,000 healthcare providers are part of the NAB-owned HICAPS network, which supports growing consumer expectations the services they use should be supported by digital tools

“We want everything to be online because many of us think carrying physical cards is old fashioned. We want people to go to their dentist or physio or other healthcare provider and have their health insurance claim settled on the spot,” says Terry.

“In the past patients accepted private health insurance and Medicare operated through different systems, but that’s no longer the case. Consumers want those experiences to be seamless, across all channels.”

To meet this need, recently HICAPS introduced functionality so people can put their health fund membership card in an Apple or Android Wallet and patients can use the card to make a claim. It’s just one example of the way HICAPS is facilitating the digitisation of health.

The proliferation of digital technologies across the healthcare sector delivers benefits to a broad spectrum of the community.

“Being able to immediately claim the cost of a treatment against your health cover through HICAPS and be reimbursed on the spot, or immediately put through a Medicare claim, makes a huge difference to so many people,” says Terry.

“A good example is overseas students who may need to see a local GP, but who are unfamiliar with the way the medical system works in this country.

“We streamline what can be a very uncertain process for people who are new to Australia and give them instant confirmation they’ll be paid overnight.”

It’s the same process for workers compensation and transport accident claims, he says.

“So if you’re injured at work and you need to go see your GP, you can submit the claim through HICAPS and get paid faster.

“With government claims, it can mean the difference between being paid in six weeks or being paid overnight.

“Simplifying a confusing process also has positive implications for people like NDIS participants, given the complexity of this scheme. Our solutions accelerate the healthcare admin process and provide transparency.”

The system offers quoting capability as well. “So before the service happens, you can find out whether you’re eligible for a refund.”

At the same time as consumer expectations about health are shifting, healthcare providers are also adapting to a changing market in services.

There’s more focus on co-ordinated care and care in different contexts such as home care over telehealth or through ecommerce channels.

“So, we’re adapting our solutions to address each of those consumer trends,” says Terry.

HICAPS is always introducing new features. For instance, new HICAPS terminals have optical character recognition (OCR) functionality, which allows them to convert a text image, of an invoice or receipt for example, into a machine-readable format.

“We’re looking at how we can make sure the claiming experience is identical across different channels, so everything works the same way. For instance, the OCR capability will work across our terminal, ecommerce solutions and other channels,” he says.

“We bring together moments that deliver a better experience for consumers and tools that enable providers to run their business easily and efficiently so they can focus on the services they offer.”

Because practitioners can have confidence a patient is eligible to make a claim, they don’t have to spend time on the phone verifying the patient’s identity and eligibility, which only takes time away from providing care.

”We do all that electronically,” says Terry.

Regulatory updates are also built into the system so practices don’t have to worry about complying with new rules.

More broadly, healthcare is transitioning to cloud technology, with core systems moving to this environment. This delivers huge efficiency gains to healthcare practices.

“There is a growing number of cloud practice management systems. We partner with these systems and we have delivered a new integration hub capability that makes it easier for partners to access the breadth of everything HICAPS offers,” says Terry.

“Whether it’s payments, claims or any of our features, it’s all available in one simple API. We have all that capability bundled together.”

Special Report: Health Sector