HICAPS terminal and error codes

Each time a transaction gets processed through the HICAPS terminal, it will return a two-digit response code. This code identifies the reason the payment was approved or declined. A full list of HICAPS and EFTPOS response codes are below.

 

Code Receipt Print Out Description Next step
00 Approved(8) Approved or completed succesfully No further action required
01

Prov Not Approv (15)

Provider not approved by fund

Practitioner to call help desk
02

Mship Under Invest (19)

Membership under investigation

Seek alternate method of payment – card holder to follow up with fund

03

Invalid Prov Nbr (16) Invalid provider number Practitioner to call help desk
04 Retain Card (11) Retain card. Seek alternate method of payment – card holder to follow up with fund
Seek alternate method of payment – card holder to follow up with fund
09 Submitted Transactiom submitted from processing Seek alternate method of payment – card holder to follow up with fund
10 Rebate to MBR Pendg Rebate to member pending Patient to follow up with fund
12 Declined (8) Declined Patient to follow up with fund

14

Invalid Card Nbr

Invalid card number (no such number)

Seek alternate method of payment – card holder to follow up with fund

19

No Items Entered

No items entered

Retry claim

21

Call Help Desk – note 1

No action taken


Practitioner to call help desk

40

Mship Not Covered

Membership doesn't cover service

Seek alternate method of payment – card holder to follow up with fund

42

Mship Ended at DOS

Membership ceased/suspended at date of service

Seek alternate method of payment – card holder to follow up with fund

54

Expired card

Expired card

Seek alternate method of payment – card holder to follow up with fund

56

Invalid Mship Nbf

Invalid membership numbers

Seek alternate method of payment – card holder to follow up with fund

58

Txn Not Permited

Transaction not permitted on terminal

Practitioner to call help desk

60

Provider Not Recogd

Provider not recognised with fund

Practitioner to call help desk

61

Benefit Limit Excee

Benefit limit exceeded

Seek alternate method of payment – card holder to follow up with fund

69

No benefit payable

No Benefit payable

Seek alternate method of payment – card holder to follow up with fund

76

Approved

Approved (terminal will request new key)

No further action required

80

Refer Employer

Payment should be made by Claimant’s Employer

Card holder to follow up directly with employer

81

Unmatched Cancel

Unable to match cancel to previous claim

Practitioner to call help desk

82

Unsupported Cancel

Claim being cancelled has already been settled

Follow up with fund next business day

83

Too Many patients

Too many patients for this transaction

Retry claim reducing the number of patients

91

System Inoperative

Health fund system currently unavailable

Retry claim, if still failing seek alternate method of payment

94

Duplicate Tax

Duplicate transmission

Practitioner to call help desk

96

System Malfunction

System malfunction

Practitioner to call help desk

97

Reconc Totals Reset

Reconciliation totals have been reset

No further action required

98

MAC ERROR

Mac error

Practitioner to call help desk

P0 – PZ

Refer Health Fund

note 2

Refer to health fund

Card holder to follow up directly with fund

H1

 

Time out waiting for ACK from terminal

Practitioner to call help desk

H2

 

Maximum number of ACK time outs reached

Practitioner to call help desk

H3

 

Timed Out waiting form response message from terminal.

Practitioner to call help desk

H4

 

LRC Error in response message

Practitioner to call help desk

H5

 

Unable to send, terminal not connected

Practitioner to call help desk

H6

 

Terminal busy

Retry claim, if still failing, call help desk

HX

 

ActiveX internal error

Practitioner to call help desk

BZ

 

Communication error

Check terminal connectivity and retry transaction, if still failing, call help desk

CE

 

Communication error

Check terminal connectivity and retry transaction, if still failing, call help desk

ED

 

Destination error

Practitioner to call help desk

EN

 

Network request error

Practitioner to call help desk

HM

 

Hardware error

Practitioner to call help desk

HW

 

Hardware error

Practitioner to call help desk

LC

 

Unexpected loss of carrier

Retry claim, if still failing, call help desk

NA

 

Transaction type not available

Retry claim, if still failing, call help desk

ND

 

Reversal time out

Retry claim, if still failing, call help desk

NM

 

No sync with modem network failure contact help desk

Practitioner to call help desk

NS

 

Declined – settlement required

Practitioner to call help desk

Pf

Power fail

Power lost before completion of transaction

Practitioner to call help desk

QL

Quote Limit Reached

Quote limit reached

Card holder to follow up directly with fund

QN

Quote Not Available

Quote not available

Practitioner to call help desk

TO

 

Time out error

Retry claim, if still failing, call help desk

TC

 

Cancelled by user or input time out

Retry claim, if still failing, call help desk

VN

 

Void not allowed

Practitioner to call help desk

LR

 

Terminal logon required

Signon to terminal (Func 5 enter, NAB, enter)

JF

 

Journal Full

Practitioner to call help desk

IM

 

Invalid MAC

Practitioner to call help desk

DI

 

Duplicate Invoice

Practitioner to call help desk

TA

 

Transaction Not Allowed

Practitioner to call help desk

NP

 

Provider number not found

Practitioner to call help desk

LP

 

Locked provider

Practitioner to call help desk

IL

 

Number of items exceeded limit

Retry claim reducing the number of items

TP

 

The transaction password is protected

Practitioner to call help desk

II

 

Invalid max item setup

Practitioner to call help desk

FL

 

An (empty) claim initiated from Practice Management System.(i.e. only provider in the EA field)

Retry claim ensuring all required fields are entered

FC

 

Field content error – (a) check non-numeric fields such as patient ID, body part number, service date and amount for non-numeric data. e.g. anything other than accept ‘0’ to ‘9’

(b) alpha numeric field such as item number contains symbols. e.g. anything other than  ‘A’ to ‘Z’, ‘a’ to ‘z’, ‘0’ to ‘9’ and spaces)

Practitioner to call help desk

Note 1: Response code for the unmatched reversal, voice, cancellation transactions

Note 2: Response code in the range P0 – P9 and PA – PZ indicate that a transaction has been declined by the Health Fund for a specific reason. These transactions must be followed up directly with the fund.

 

Code Receipt Print Out Description Next Step
00 Approved (8) Approved or completed successfully Patient to follow up with fund
01

Prov Not Approv (15)

Provider not approved by fund

Patient to follow up with fund
02

Mship Under Invest (19)

Membership under investigation

Patient to follow up with fund

03

Invalid Prov Nbr (16) Invalid provider number Patient to follow up with fund

04

Previously paid

Nil benefit – benefit previously paid

Patient to follow up with fund

05

Limit reached

Nil benefit – limit reached

Patient to follow up with fund

06

Limit reached

Reduced benefit – limit reached

Patient to follow up with fund

07

Waiting Period

Nil benefit - qualifying period applies

Patient to follow up with fund

08

PreReq Ser Reqd

Nil benefit – pre-requisite service required

Provider to follow up with fund

09

Pre Existing

Nil benefit – pre-existing ailment

Patient to follow up with fund

10

Item Nbr Invalid

Item number invalid

You haven't entered a correct number. Please check the HICAPS item guide

11

Item Nbr Ceased

Item number ceased

Provider to check item guide

12

Item Not Valid

Item not valid for provider

Provider to check item guide

13

Item Not Apprvd

Item not approved – not payable by HICAPS

Patient to follow up with fund

14

Max Nbr Ser Exc

Service exceeds number of times permitted

Patient to follow up with fund

15

Cost Missing

Cost must be entered

Value needs to be entered in 0.05c increments

16

DOS Not Valid

Date of service must be before today

Provider to follow up with Help Desk

17

DOS too Old

Date of service too old

Patient to claim directly with fund

18

Clincl Code Rqd

Clinical code required

Provider to check item guide

19

Pat Not Covered

Patient not covered for this type of service

Patient to follow up with fund

20

Depd Status End

Dependent status ceased

Patient to follow up with fund

21

Invalid PAT Code

Invalid patient code

Provider to check patient details on card

22

Mship Not Covere

The member is not covered for the service

Patient to follow up with fund

23

Mship Ended DOS

Membership has ceased or is suspended at the date of service

Patient to follow up with fund

24

Mship Unfin DOS

Membership not current at date of service

Patient to follow up with fund

25

No Ancill Cover

The patient has no ancillary cover

Patient to follow up with fund

26

Item Not Coverd

The patient is not covered for this service

Patient to follow up with fund

27

Duplicate Serv

Duplicate service already processed

Patient to follow up with fund

28

Excess on Serv

Nil benefit – excess on service applied

Patient to follow up with fund

29

Excess on Serv

Reduced benefit – excess on service applied

Patient to follow up with fund

30

Quote Required

Nil benefit – excess on service applied

Patient to follow up with fund

31

Quote Required

Reduced benefit – quote required prior to service

Patient to follow up with fund

32

Exceeds Quote

Nil benefit – claim exceeds quote

Patient to follow up with fund

33

Exceeds Quote

Reduced benefit – claim exceeds quote

Patient to follow up with fund

34

Age Restriction

Nil benefit – age restriction applies

Patient to follow up with fund

35

Age Restriction

Reduced benefit – age restriction applies

Patient to follow up with fund

36

Gender Restrict

Nil benefit – gender restriction applies

Patient to follow up with fund

37

Gender Restrict

Reduced benefit – gender restriction applies

Patient to follow up with fund

38

Invalid Charge

Nil benefit – amount charged is invalid

Provider to follow up with fund

39

Notional Charge

Notional charge

 

40

Converted Item

Converted item

 

41

Refer to Health Fund

Refer to fund

Patient to follow up with fund

42

System Problem

System problem

Provider to follow up with Help Desk

43

Tran Declined

Transaction declined – refer tran to resp code

Refer to transaction response code

50

Prov Not Appro

Provider not approved by fund (at date of service)

Provider to follow up with Help Desk

51

Prov Not Appro

Provider not approved by fund for this service at DOS

Provider to follow up with Help Desk

52

Tooth id Reqd

Tooth ID number required

Provider to check item guide

53

DOS before Injury

Service date before injury date

Patient to follow up with fund

54

Submitted

Transaction submitted for processing

No Further action required

Po-PZ

Refer to Fund

Refer health fund – Not 1

Patient to follow up with fund

Note: Item codes in the range P0 – P9 and PA – PZ indicate that an item has been declined by the Health Fund for a specific reason. These items must be followed up directly with the Fund.

 

Code Receipt Print Out Description Next Step
00 Approved (8) Approved or completed successfully Patient to follow up with fund
01

Prov Not Approv (15)

Provider not approved by fund

Patient to follow up with fund
02

Mship Under Invest (19)

Membership under investigation

Patient to follow up with fund

03

Invalid Prov Nbr (16) Invalid provider number Patient to follow up with fund

04

Previously paid

Nil benefit – benefit previously paid

Patient to follow up with fund

05

Limit reached

Nil benefit – limit reached

Patient to follow up with fund

06

Limit reached

Reduced benefit – limit reached

Patient to follow up with fund

07

Waiting Period

Nil benefit - qualifying period applies

Patient to follow up with fund

08

PreReq Ser Reqd

Nil benefit – pre-requisite service required

Provider to follow up with fund

09

Pre Existing

Nil benefit – pre-existing ailment

Patient to follow up with fund

10

Item Nbr Invalid

Item number invalid

You haven't entered a correct number. Please check the HICAPS item guide

11

Item Nbr Ceased

Item number ceased

Provider to check item guide

12

Item Not Valid

Item not valid for provider

Provider to check item guide

13

Item Not Apprvd

Item not approved – not payable by HICAPS

Patient to follow up with fund

14

Max Nbr Ser Exc

Service exceeds number of times permitted

Patient to follow up with fund

15

Cost Missing

Cost must be entered

Value needs to be entered in 0.05c increments

16

DOS Not Valid

Date of service must be before today

Provider to follow up with Help Desk

17

DOS too Old

Date of service too old

Patient to claim directly with fund

18

Clincl Code Rqd

Clinical code required

Provider to check item guide

19

Pat Not Covered

Patient not covered for this type of service

Patient to follow up with fund

20

Depd Status End

Dependent status ceased

Patient to follow up with fund

21

Invalid PAT Code

Invalid patient code

Provider to check patient details on card

22

Mship Not Covere

The member is not covered for the service

Patient to follow up with fund

23

Mship Ended DOS

Membership has ceased or is suspended at the date of service

Patient to follow up with fund

24

Mship Unfin DOS

Membership not current at date of service

Patient to follow up with fund

25

No Ancill Cover

The patient has no ancillary cover

Patient to follow up with fund

26

Item Not Coverd

The patient is not covered for this service

Patient to follow up with fund

27

Duplicate Serv

Duplicate service already processed

Patient to follow up with fund

28

Excess on Serv

Nil benefit – excess on service applied

Patient to follow up with fund

29

Excess on Serv

Reduced benefit – excess on service applied

Patient to follow up with fund

30

Quote Required

Nil benefit – excess on service applied

Patient to follow up with fund

31

Quote Required

Reduced benefit – quote required prior to service

Patient to follow up with fund

32

Exceeds Quote

Nil benefit – claim exceeds quote

Patient to follow up with fund

33

Exceeds Quote

Reduced benefit – claim exceeds quote

Patient to follow up with fund

34

Age Restriction

Nil benefit – age restriction applies

Patient to follow up with fund

35

Age Restriction

Reduced benefit – age restriction applies

Patient to follow up with fund

36

Gender Restrict

Nil benefit – gender restriction applies

Patient to follow up with fund

37

Gender Restrict

Reduced benefit – gender restriction applies

Patient to follow up with fund

38

Invalid Charge

Nil benefit – amount charged is invalid

Provider to follow up with fund

39

Notional Charge

Notional charge

 

40

Converted Item

Converted item

 

41

Refer to Health Fund

Refer to fund

Patient to follow up with fund

42

System Problem

System problem

Provider to follow up with Help Desk

43

Tran Declined

Transaction declined – refer tran to resp code

Refer to transaction response code

50

Prov Not Appro

Provider not approved by fund (at date of service)

Provider to follow up with Help Desk

51

Prov Not Appro

Provider not approved by fund for this service at DOS

Provider to follow up with Help Desk

52

Tooth id Reqd

Tooth ID number required

Provider to check item guide

53

DOS before Injury

Service date before injury date

Patient to follow up with fund

54

Submitted

Transaction submitted for processing

No Further action required

Po-PZ

Refer to Fund

Refer health fund – Not 1

Patient to follow up with fund

Note: Item codes in the range P0 – P9 and PA – PZ indicate that an item has been declined by the Health Fund for a specific reason. These items must be followed up directly with the Fund.