Healthcode Electronic Billing

Healthcode is the trusted provider of secure online systems for the private health market, clearing and validating medical bills electronically for all major PMI insurers in the UK. Healthcode enables you to automatically submit your invoices to the UK’s major insurance companies, saving both time and money.

PPS Pro version 4.0.6804 and onwards includes Healthcode Electronic Billing functionality. To update to the latest version of PPS Pro please follow our Updating PPS Guide - Please note that a Support Contract is required to update. If you currently do not have a Pro version of PPS or a Support Contract, you can purchase or renew using our Help Guide or by contacting our Sales Team, on 0845 0680 7777 and selecting option 1.

If you do not have a Healthcode ID you will need to contact Healthcode customer services on 01784 263150. You can also visit their website by clicking here.

Note: As Healthcode requires submitting of Diagnosis codes for a successful billing claim you will need a Professional version of PPS to use the Healthcode Electronic Billing functionality.

Accepted Insurance Companies

The following Insurance companies can currently accept the Healthcode electronic billing function that PPS provides. For PPS to correctly work with Healthcode your Third Party insurance companies should be named as they are displayed here:

AXA-PPP
BUPA
BUPA International
AVIVA
CIGNA
EXETER FAMILY FRIENDLY
HEALIX HEALTHCARE SERVICES
SIMPLYHEALTH
PRUHEALTH
STANDARD LIFE HEALTHCARE
WPA

If your insurance companies are named differently to the above then please see our Third Party Contact Details help screen to modify an existing company name. Insurance company names are not case sensitive.

Setting up

To enable the Healthcode Electronic Billing button on your 'Print Invoices' screen you will first need to input two settings in your System Options screen.

Healthcode ID

Currency

Both of these settings can be changed by going to Tools > Options > General System Options and then navigating to the 'Accounts' tab. You will see the Healthcode Electronic Billing section as displayed below.



Note: Although the Healthcode button will now be displayed on the Invoice Print screen (shown here), there are further steps to complete your setup.


Setting up the Look-up Tables

After setting up the Healthcode ID and Currency you will need to setup the Look-up Tables via Tools > Look-up Tables. Within Look-up Tables there are 3 areas that will need to be addressed.

· Standard Charges and Stock Items

· Insurance Provider Codes

· Diagnosis

Diagnosis Codes

The first part of the system to setup for Healthcode to work correctly is Diagnosis codes. These are numerical codes assigned to specific diagnoses by your insurance company. Usually these codes are the same for all Insurance companies, but please contact the necessary insurance provider for a valid list of Diagnosis codes.


"Standard Charges and Stock Items" Table

Each charge raised that is submitted for Healthcode Electronic Billing needs a procedure code assigning to it. These procedure codes are unique to the type of treatment you are claiming for. For a full list of procedure codes please contact the the necessary insurance provider.

"Insurance Provider Codes" Table

Each Practitioner that you are claiming bills for needs their own Insurance Provider Code. This may be the same for all Insurance Companies (tick "Apply to Any Insurance Company") or you may have different codes for different Insurance companies in which case you may have to enter a practitioner multiple times for each insurance company. Additionally your insurance provider may require different provider codes for different "Locations" - this can also be setup from this screen.

Using Healthcode Electronic Billing

Once all the initial setup is complete you should now be ready to begin sending your bills electronically. A number of fields are mandatory for a claim to be successful, these are:

· Surname (Client Details screen)

· First Name (Client Details screen)

· Date of Birth (Client Details screen)

· Address (Client Details screen)

· Postcode (Client Details screen)

· Policy Number (Client Details screen)


Additionally you will need to ensure the following details are also in place.

Provider Code (Look-up Tables – for each practitioner)

Procedure Code (Look-up Tables – within Standard Charges and Stock Items)

Diagnosis Code (Set in the treatment episodes screen (Clinical Details tab))

The charge/invoice being claimed for needs to be associated to a Treatment Episode; this can be done on the appointment booking screen by selecting the Treatment Episode or by completing the appointment through the Consultation screen and raising the charge from there.

Each invoice will also need a diagnosis code associated to it. This is done during the consultation by clicking “Consultation Complete” which brings up the “Update Treatment Episode Details” screen. Under the Clinical Details tab there is an entry for “Diagnosis / Code”. Assign this and then complete the appointment as normal.


Once you are happy that the client has all the correct details set in their Client Details screen (see above) you will need to raise the charge on the account.

You can do this by completing the appointment from the Appointment Diary screen by either double clicking on the appointment and selecting “Complete Appointment” or right-clicking on the Appointment and choosing “Completed”.

This will bring up the Appointment Completed screen, where you will need to assign a charge to complete the appointment (the charge will need to have an associated Procedure Code).

You can then either:

- “Create Charge, Invoice Later” (if you have other charges you want to add on to the invoice)

or

- “Invoice Now, Pay Later” (if no more charges are to be included on the invoice).

Note: For more information on raising charges please look at the Creating Charges guide.

Once your charges have been created and you have raised your invoice, you will need to submit all invoices raised to Healthcode.

Submitting your Invoices to Healthcode

Navigate to your PPS Accounts Menu and then click on Accounts. Click the radio button to “Third Party” if it has not been selected already and then click “Search for 3rd Party”. From this next screen you can search for the insurance company you wish to create a claim file for. Search and select the required insurance company.

All the accounts for the selected Insurance Company are now displayed. At the top of the Accounts screen there is a button to “Print” if you click this button and select “Print Invoices” you should see the normal Print/Email screen which now also displays the “Healthcode” button.

You can now select the required invoice(s) and click “Healthcode” to generate a claim file. This will prompt you to choose where these files should be saved (ie. on your desktop).

Note: Holding down the CTRL key and clicking on the invoices will let you select multiple invoices to include in one claim file

A successful claim file generation will display a message including the exact location and file name.


Note: By default the claim file is output to the Healthcode folder located within the PPS database. An alternate save location can be specified within the general system options menu.

 

These files can then be selected and uploaded to the Healthcode website using the standard process. Please contact Healthcode Customer Services if you are having problems uploading Claim Files.

If for any reason the file is not generated successfully, please see the error code list below.

Error Messages

Error: The Insurer selected for this claim (Company Name) is not part of the compatible list of insurers. Please check and try again.

Reason: The Insurance Company that you are trying to claim for is not in the accepted insurers list. Please ensure the invoice you are claiming for is being billed to a valid insurer and that the insurance company is spelled correctly in your 3rd party contact list.

Error: The Client <client name and number> does not have a postcode

Reason: The client on the selected invoice does not have a valid postcode set. Please go to the client details screen of the specified client and input a postcode.

Error: The Client <client name> does not have a valid Date of Birth.

Reason: The client on the selected invoice does not have a valid Date of Birth set. Please go to the client details screen of the specified client and input a Date of Birth.

Error: <System User> (associated with Charge ‘<charge name>’ does not have an associated Insurance Provider Code.

Reason: The practitioner the charge was associated with does not have an insurance provider code set. Please go to Insurance Provider Codes under look-up tables and associate a provider code with the specified practitioner.

Error: The Charge ‘<charge name>’ does not have a valid Procedure Code.

Reason: The charge raised does not have a Procedure code set. Go to Charges and Stock Items under the look-up tables and add a valid procedure code with the specified charge.

 

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