Healthcode

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.

You will need to register with Healthcode before you can begin utilising the Healthcode functionality within PPS alongside it. Contact Healthcode via their website in order to register.

Please Note: As Healthcode requires submitting of Diagnosis codes for a successful billing claim you will need a Pro version of PPS on version 4.0.6804 or above to use the Healthcode Electronic Billing functionality. To check this navigate to Help > About PPS and ensure you have Treatment Episodes and Consultations marked as registered. Contact our sales team via sales@rushcliff.com if you're looking to upgrade to a Pro system.

Section One - Accepted Insurance Companies

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

You'll need to add the relevant third party to your system as they are named above if you'd like to bill them using PPS and Healthcode. See our guide on adding and modifying third parties if you need to add any of the above or if existing entries do not match the name above.

Section Two - Setting up PPS for Healthcode Billing

a. To enable the Healthcode Electronic Billing option when printing your invoices you will need to input your Healthcode ID and currency via Tools > Options > General System Options > Accounts.

b. The other option you have here is to set an Alternative Claim File location. This is the place that PPS will save your Healthcode claim files which you'll then need to upload to Healthcode. By default these files will be saved to the output folder of your PPS database but you can come here to choose another location on the machine you're using.

PPS Hosted Users- As you do not have direct access to your PPS database files you will need to determine an alternative claim file location that you can access from your machine and set that here. This setting will be applied across your entire system for all of your Hosted users so you'll need to choose a location that can be accessed by all users who will be generating claim files. If you set the claim file location as a local drive on one machine this may not then be accessible to another user on another machine and they will not be able to save claim files. Alternatively, users can modify this location before each run of generating claim files and set it to somewhere accessible to them.

PPS Local Users- If preferable you can leave the Alternative Claim File location field blank as all users should have access to the Database and the Output folder over your local network. If you do set an alternative location then ensure that it is somewhere that can be accessed by all users who will be generating claim files as this setting applies to all users of the system. Alternatively, users can modify this location before each run of generating claim files and set it to somewhere accessible to them.

Section Three - Setting up the Look Up Tables & Invoice Options

a. After setting up your Healthcode ID, currency, and claim file location navigate to Tools > Look-up Tables. Within here there are three areas that will need to be addressed in order to bill to Healthcode.

- Diagnosis Codes

Diagnosis Codes 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. These will be assigned at Treatment Episode level. Add or modify diagnosis codes via Tools > Look Up Tables > Diagnosis.

- Procedure Codes

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. Procedure codes can be added to your standard charges via Tools > Look Up Tables > Standard Charges and Stock Items.

- Insurance Provider Codes

Each Practitioner that you are claiming bills for through Healthcode needs their own Insurance Provider Code. This code may be the same for all Insurance Companies (tick "Apply to Any Insurance Company") or they may have different codes for different insurance companies in which case you will 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 set up from this screen.

b. In addition, you'll need to ensure that your Invoice Options are enabled to display all the relevant details for Healthcode. 

Navigate to Tools > Options > Invoice Options. Choose the "Insurance Companies" Invoicee Type and ensure it's not set to use the same settings as the Client. Also make sure "Authorisation Code" is ticked. Choose Apply to save these settings if changes have been made.

Section Four - Using Healthcode Electronic Billing

a. Once the initial setup is done you're ready to begin submitting bills from PPS to Healthcode. A number of fields are mandatory for a claim to be successful, these are:

b. The charge/invoice being claimed for needs to be associated to a Treatment Episode; this can be done when adding or modifying the appointment screen by selecting the Treatment Episode and then raising the charge through Complete this Appointment or by raising the charge from the Consultation Complete screen.

Each invoice will also need a diagnosis code associated to it which is added into the Treatment Episode itself. You can insert or modify this code in the Consultation Complete screen when in a consultation or by accessing the Treatment Episode via Client > Treatment Episode. Enter the Diagnosis Code in the Clinical Details tab.

Once you are happy that the client has all the correct details set in their Client Details screen 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).

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

Section Five - Submitting your Invoices to Healthcode

a. 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 for and select the required insurance company.

b. 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).

Tip: 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.

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.

Section Six - 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.