Reports and reconciliation

There are two types of integrated health fund report: a claims reconciliation report and a payments reconciliation report.

The claims reconciliation report lists all the claims processed for a given calendar day.
The payments reconciliation report lists the payments made for approved claims that HealthPoint settles. Funds that HealthPoint classes as non-consolidated (currently only HCF) don't appear in these reports. The HealthPoint health funds by modality (PDF) shows which funds are consolidated and which aren't.

Developing reporting features is optional, but recommended to make financial reconciliation easier for providers.

Request a report

Use healthpointReconciliationReport, setting reportType to claims or payments, and reconDate to the report date in yyyyMMdd format.

// Claims report for 21 September 2024
iclient.healthpointReconciliationReport(
    {
        reportType: "claims",
        reconDate: "20240921"
    },
    yourPosCode.reportCallback
);

// Payments report for 21 September 2024
iclient.healthpointReconciliationReport(
    {
        reportType: "payments",
        reconDate: "20240921"
    },
    yourPosCode.reportCallback
);

Demo

This JS Fiddle example shows how the JS library can access the canned reports: Demo - JS Fiddle.

Don't click Save if you make changes in the JS Fiddle sample app. Click Run instead. Clicking Save may break the fiddle's functionality.

Claims reconciliation report

The response body consists of these XML elements:

Response element	Description
`claims-reconciliation-response/claims-reconciliation`	Contains the report header elements.
`claims-reconciliation-response/claims-reconciliation/healthpoint-terminal-id`	The terminal ID in the HealthPoint system. This is different from the Tyro TID.
`claims-reconciliation-response/claims-reconciliation/claim-date`	The date, in `yyyyMMdd` format, of the claims in the report. Amended claims can appear on a different date from the one they were submitted, if the amendment took place on this date.
`claims-reconciliation-response/claim`	Contains the details of a claim.
`claims-reconciliation-response/claim/terminal-date-time`	The local terminal time, in `yyyyMMddHHmmss` format, when the claim was submitted.
`claims-reconciliation-response/claim/transaction-date-time`	The time, in `yyyyMMddHHmmss` format, HealthPoint received the claim.
`claims-reconciliation-response/claim/response-date-time`	The time, in `yyyyMMddHHmmss` format, HealthPoint received the claim response.
`claims-reconciliation-response/claim/settlement-date-time`	The time, in `yyyyMMddHHmmss` format, the payment instruction is expected to be sent for execution.
`claims-reconciliation-response/claim/provider-id`	The provider who made the claim.
`claims-reconciliation-response/claim/private-health-fund-id`	The fund that processed the claim.
`claims-reconciliation-response/claim/ref-tag`	The unique transaction reference generated by the terminal, included on receipts.
`claims-reconciliation-response/claim/status`	The status of the claim. See the status table below.
`claims-reconciliation-response/claim/total-claim-amount`	The total claim amount, in cents.
`claims-reconciliation-response/claim/private-health-fund-total-benefit-amount`	The benefit amount, in cents.
`claims-reconciliation-response/claim/private-health-fund-response-code`	The response code from the fund, or 32 for an adjustment, or 93 if the fund didn't respond.
`claims-reconciliation-response/claim/text`	Any text entered when the claim was amended.
`claims-reconciliation-response/check`	A summary of the reconciliation data. Use it to check that all expected claims were received and processed.
`claims-reconciliation-response/check/total-number-claims`	The total number of claim elements.
`claims-reconciliation-response/check/sum-benefit-amount`	The sum of all benefit amounts, in cents.
`claims-reconciliation-response/check/sum-claim-amount`	The sum of all claim amounts, in cents.

Status	Definition
`NEW`	The claim is approved but not yet settled.
`CAN`	The claim has been cancelled.
`VOID`	The claim was rejected by the user.
`AVOID`	The claim was auto voided (reversed) due to a system error.
`PAY`	Settled through HealthPoint consolidated settlement.
`PRC`	Required action processed (reversed).
`TPY`	Test paid. Settled by the fund directly.
`EST`	Rebate estimate. A gap amount was returned, but it isn't an approved claim. Applies to rebate estimates, which are JS library only.

Example response

<claims-reconciliation-response>
    <claims-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <claim-date>20240921</claim-date>
    </claims-reconciliation>
    <claim>
        <terminal-date-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000010</ref-tag>
        <status>e.g. NEW, PAY, TPY (see table above)</status>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <text>any text entered when claim was amended</text>
    </claim>
    <claim>
        <terminal-date-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000011</ref-tag>
        <status>e.g. NEW, PAY, TPY (see table above)</status>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <text>any text entered when claim was amended</text>
    </claim>
    <check>
        <total-number-claims>2</total-number-claims>
        <sum-benefit-amount>10000</sum-benefit-amount>
        <sum-claim-amount>20000</sum-claim-amount>
    </check>
</claims-reconciliation-response>

Report unavailable

If the report is unavailable, a report unavailable response is returned:

<claims-reconciliation-response>
    <claims-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <claim-date>20240921</claim-date>
    </claims-reconciliation>
    <unavailable>
        <text>Report unavailable.</text>
        <text>Please try again later.</text>
    </unavailable>
</claims-reconciliation-response>

Payments reconciliation report

The response body consists of these XML elements:

Response element	Description
`payments-reconciliation-response/payments-reconciliation`	Contains the report header elements.
`payments-reconciliation-response/payments-reconciliation/healthpoint-terminal-id`	The terminal ID in the HealthPoint system. This is different from the Tyro TID.
`payments-reconciliation-response/payments-reconciliation/payment-date`	The date, in `yyyyMMdd` format, the payment instructions were sent to the bank.
`payments-reconciliation-response/payment`	Contains the details of a settlement payment.
`payments-reconciliation-response/payment/terminal-date-time`	The local terminal time, in `yyyyMMddHHmmss` format, when the claim was submitted.
`payments-reconciliation-response/payment/transaction-date-time`	The time, in `yyyyMMddHHmmss` format, HealthPoint received the claim.
`payments-reconciliation-response/payment/response-date-time`	The time, in `yyyyMMddHHmmss` format, HealthPoint received the claim response.
`payments-reconciliation-response/payment/settlement-date-time`	The time, in `yyyyMMddHHmmss` format, the payment was submitted to the provider.
`payments-reconciliation-response/payment/provider-id`	The provider who made the claim.
`payments-reconciliation-response/payment/private-health-fund-id`	The fund that processed the claim.
`payments-reconciliation-response/payment/ref-tag`	The unique transaction reference generated by the terminal, included on receipts.
`payments-reconciliation-response/payment/total-claim-amount`	The total claim amount, in cents.
`payments-reconciliation-response/payment/private-health-fund-total-benefit-amount`	The benefit amount, in cents.
`payments-reconciliation-response/payment/private-health-fund-response-code`	The response code from the fund, or 32 for an adjustment.
`payments-reconciliation-response/payment/payment-amount`	The amount paid for the claim, in cents.
`payments-reconciliation-response/payment/text`	Any text entered when the claim was amended.
`payments-reconciliation-response/payment/bsb`	The BSB number for settlement.
`payments-reconciliation-response/payment/account-number`	The bank account number for settlement.
`payments-reconciliation-response/payment/payment-reference`	The bank lodgement reference shown on the bank account statement.
`payments-reconciliation-response/check`	A summary of the reconciliation data. Use it to check that all expected claims were received and processed.
`payments-reconciliation-response/check/total-number-payments`	The total number of payment elements.
`payments-reconciliation-response/check/sum-payment-amount`	The sum of all payment amounts, in cents.
`payments-reconciliation-response/check/sum-claim-amount`	The sum of all claim amounts, in cents.

Example response

<payments-reconciliation-response>
    <payments-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <payment-date>20240921</payment-date>
    </payments-reconciliation>
    <payment>
        <terminal-date-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000010</ref-tag>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <payment-amount>5000</payment-amount>
        <text>any text entered when claim was amended</text>
        <bsb>069690</bsb>
        <account-number>100001</account-number>
        <payment-reference>your payment ref</payment-reference>
    </payment>
    <payment>
        <terminal-date-time>20240921123455</terminal-date-time>
        <settlement-date-time>20240921040000</settlement-date-time>
        <response-date-time>20240921123455</response-date-time>
        <transaction-date-time>20240921123455</transaction-date-time>
        <provider-id>2147661H</provider-id>
        <private-health-fund-id>PHF00999</private-health-fund-id>
        <ref-tag>0000011</ref-tag>
        <total-claim-amount>10000</total-claim-amount>
        <private-health-fund-total-benefit-amount>5000</private-health-fund-total-benefit-amount>
        <private-health-fund-response-code>00</private-health-fund-response-code>
        <payment-amount>5000</payment-amount>
        <text>any text entered when claim was amended</text>
        <bsb>069690</bsb>
        <account-number>100001</account-number>
        <payment-reference>your payment ref</payment-reference>
    </payment>
    <check>
        <total-number-payments>2</total-number-payments>
        <sum-payment-amount>10000</sum-payment-amount>
        <sum-claim-amount>20000</sum-claim-amount>
    </check>
</payments-reconciliation-response>

Report unavailable

If the report is unavailable, a report unavailable response is returned:

<payments-reconciliation-response>
    <payments-reconciliation>
        <healthpoint-terminal-id>TYR11111</healthpoint-terminal-id>
        <payment-date>20240921</payment-date>
    </payments-reconciliation>
    <unavailable>
        <text>Report unavailable.</text>
        <text>Please try again later.</text>
    </unavailable>
</payments-reconciliation-response>