About HICAPS
HICAPS is a digital claim platform that allows you to easily claim from
Government Schemes and Private Health Insurers. With HICAPS and splose, you can process claims for NDIA-managed participants directly via the NDIS API.
This help will cover the following:
What happens with HICAPS + splose integration
Getting started with HICAPS
How to connect HICAPS with splose
How to submit a claim using HICAPS
What happens with the HICAPS + splose integration
splose integrates with the NDIS program and enables NDIS-registered providers to submit claims directly to the NDIA and receive real-time responses against NDIA-managed participants.
Getting started with HICAPS
Getting started on the NDIS APIs involves two steps.
Create an account with HICAPS
Connecting to the NDIS APIs
Create an Account with HICAPS
Head to the HICAPS NDIS Solution for Providers page and click Get Started. Select Create account. HICAPS will ask you a few short account questions (company name, email,
bank details etc.) to create your account.
Once created, you will receive two emails from HICAPS – one is to verify your email address, and the other is to validate your bank details. Make sure to follow the instructions in both emails so that your account is validated.
Connect to the NDIS APIs
Before you can start submitting claims directly from Splose to the NDIA you need to
authorise HICAPS to connect you to the NDIS APIs and transmit claims
digitally on your behalf.
This step involves completing this online web form which will open an onboarding case within HICAPS. You will be asked to complete a few registration steps as follows:
NDIA declaration to be signed and returned to HICAPS; and
PRODA device registration and activation
HICAPS will guide you through the above process and advise when the final set up is complete and you're ready to go live.
Where to get help?
For more information on Signing up for the NDIS APIs, Activating your PRODA Device and What are the costs to use HICAPS? Please visit their website or contact the HICAPS Customer Support Team.
For more information on Connecting with NDIA systems, please visit the NDIA website or contact the Digital Partnerships Office at DPO@ndis.gov.au.
If you need help with PRODA, please call 1800 700 199 and select option 1. Call costs from your landline from anywhere in Australia to a 1800 number are free. For more information about PRODA, please go to servicesaustralia.gov.au/proda.
Connect HICAPS with splose
Go to Settings, Integrations and under HICAPS, click Connect.
Start claiming with HICAPS
Sign in with HICAPS to authorise splose to access your HICAPS account.
Select a payment method for receiving payments from HICAPS. An invoice will be automatically updated in splose when payment is received.
Add NDIS details
Add an NDIS number to a client
Create a client and add an NDIS number and select NDIA-managed.
Add NDIS item codes
In Settings, Services, check that you have added the correct NDIS item code to the service. You can validate the item codes within HICAPS or using the NDIS Price Guide and Support Catalogue.
Create an invoice and make a claim
Create an invoice for an NDIS participant and view the invoice. On the invoice page's right hand side panel, click Claim.
A list of available service bookings will be fetched from the NDIS. Click the available NDIS service booking. This can take up to 10 seconds.
The claim will then be validated and the claim results will be displayed on the HICAPS card.
Note that there is no pre-adjudication for the NDIA APIs.
The claim statuses are as follows:
Submitted – This is really whatever state splose provide until they get a response from us
Pending – The claim has been dispatched to the NDIS and is awaiting their adjudication
Approved – The NDIS has approved the claim and will be paid in the next payment cycle
Claims can be cancelled via the API. Here you can find the article on this process
Open in HICAPS
You can use the click Open in HICAPS link to open the invoice directly in HICAPS and view the claim results.
