Medibank Private Preferred Provider Error when Processing HICAPS claim through D4W


When processing a HICAPS claim for a Medibank Private Preferred Provider patient, the correct fee must be entered into Treatment Plan/Treatment prior to the claim being processed.

If the fee entered into Treatment Plan/Treatment is higher than the fee permitted by Medibank Private, an error will appear in Dental4Windows.

This error is caused due to item 012 being claimed for $100. This doesn't equal the returned fee of $50.

Sent: 010012001111010000
Received: 010012001111005000

This will result in the claim failing in D4W. After clicking OK, the user is returned to this screen.

The Hicaps terminal returns a receipt with the approved claim.

No invoice, claim or receipt are created within D4W.

The fee/s would need to be modified in the Treatment tab, then an Invoice and Receipt need to be created manually.

To resolve this issue, the following is required.

  1. A separate fee level is required for Medibank Private Preferred Providers.

    1. A new Fee Level for Medibank Private Preferred Providers would need to be created and the correct fees entered.

    2. If a feel level for Medibank Private Preferred Providers exists, the correct fees will need to be entered.

  2. The patient's Fee Level would need to be set as Medibank Private Preferred Providers

  3. If the fees in Treatment Plan/Treatment are incorrect, click Treatment > Recalculate select item fee based on current Fee Level for selected items or Recalculate ALL item fees based on current Fee Level for all items not invoiced.

We recommend linking the Insurance Plan with the Fee Level

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