{"product_id":"health-fund-hicaps-claiming-guide-2026","title":"Health Fund \u0026 HICAPS Claiming Guide 2026","description":"\u003cp\u003e\u003cmeta charset=\"utf-8\"\u003e\u003cspan\u003ehe Complete Staff Reference Guide for Processing Health Fund, Medicare, CDBS, and DVA Claims in Australian Dental Practices\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003eEvery FOC team member who works at a dental reception desk needs to understand how health fund claiming works — not just how to swipe the card, but what each funding stream covers, what to do when HICAPS is declined, how to check CDBS eligibility, and what DVA patients need. Most practices train their FOC verbally on this. This guide puts it all in writing.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003eThe \u003cstrong\u003eHealth Fund \u0026amp; HICAPS Claiming Guide 2026\u003c\/strong\u003e is the complete staff reference guide for processing health fund claims, Medicare, CDBS, and DVA payments in an Australian dental practice — covering the full Australian health funding landscape, step-by-step HICAPS claiming, ADA item number reference, CDBS eligibility checking and claiming, Medicare CDM plans, and DVA Gold and White Card claiming. Suitable for both new FOC team members and experienced staff needing a refresher.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\u003cstrong\u003eThe guide is structured across 5 parts:\u003c\/strong\u003e\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\n\u003cstrong\u003ePart 1 — The Australian Health Funding Landscape\u003c\/strong\u003e A clear, plain-language overview of every funding stream an FOC will encounter — private health insurance (HICAPS), Medicare CDBS, Medicare Chronic Disease Management plans, DVA Gold and White Card, self-funded patients, and payment plans (Afterpay, Zip, DentiCare). Presented as a reference table covering who each stream covers, how it works, and exactly what the FOC does.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\n\u003cstrong\u003ePart 2 — HICAPS: The Private Health Claiming System\u003c\/strong\u003e A complete 7-step HICAPS claiming procedure at checkout — including what to watch for at each step, how to handle HICAPS declines and rejections (the most common cause: annual limit exceeded), and how to run HICAPS estimates before the appointment so patients know their gap payment in advance. Includes the key patient communication script for declined claims and the non-negotiable rule: always process the gap payment after HICAPS, not before.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\n\u003cstrong\u003ePart 3 — ADA Item Numbers\u003c\/strong\u003e A practical FOC reference table covering 16 of the most commonly used ADA item numbers — examinations (011, 012, 013), radiographs (022, 037), hygiene (111, 114, 121, 131, 141), restorations (311, 322), crowns (521), and extractions (615, 631). Includes the non-negotiable compliance rule: never enter an item number for a service not actually provided — this is fraudulent claiming and a serious offence.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\n\u003cstrong\u003ePart 4 — Medicare and CDBS\u003c\/strong\u003e Step-by-step CDBS eligibility checking (via PMS, HPOS, or Medicare phone), processing a CDBS claim including assignment of benefit form requirements, and what to do when the child has no remaining CDBS balance. Covers Medicare Chronic Disease Management plans — referral requirements, registration, bulk-billing vs gap-billing, and MBS item numbers.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\n\u003cstrong\u003ePart 5 — DVA Claiming\u003c\/strong\u003e Gold Card vs White Card coverage explained, prior approval requirements for major prosthetic work, how to submit DVA claims, the DVA fee schedule rule (the practice cannot charge more than the DVA scheduled fee for DVA-covered treatment), and record retention requirements.\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e\u003cstrong\u003eWho this is for:\u003c\/strong\u003e\u003c\/div\u003e\n\u003c\/div\u003e\n\u003cul\u003e\n\u003cli class=\"u-break-words ps-[2px] hide-loading-dot\"\u003eNew FOC team members being trained on health fund claiming for the first time\u003c\/li\u003e\n\u003cli class=\"u-break-words ps-[2px] hide-loading-dot\"\u003eExperienced FOCs who want a written reference for less common claiming scenarios (DVA, CDM, CDBS)\u003c\/li\u003e\n\u003cli class=\"u-break-words ps-[2px] hide-loading-dot\"\u003ePractice Managers who want a written, consistent claiming reference that every FOC team member can access\u003c\/li\u003e\n\u003cli class=\"u-break-words ps-[2px] hide-loading-dot\"\u003eAny practice that currently trains health fund claiming verbally with no written guide in place\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cdiv class=\"my-[1px]\"\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e📄 \u003cstrong\u003eFormat:\u003c\/strong\u003e 7-page editable Microsoft Word document (.docx) — fully customisable with your practice name and team details; designed to be printed and kept at the reception desk as a daily reference\u003c\/div\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e⬇️ \u003cstrong\u003eInstant digital download\u003c\/strong\u003e — available immediately after purchase\u003c\/div\u003e\n\u003cdiv class=\"py-[3px] whitespace-pre-wrap u-break-words\"\u003e🦷 \u003cstrong\u003eBuilt for Australian dental practices\u003c\/strong\u003e — covers HICAPS, Medicare Online Claiming, CDBS, CDM, and DVA\u003c\/div\u003e\n\u003c\/div\u003e","brand":"Resolve Dental Consultancy","offers":[{"title":"Default Title","offer_id":53830433800556,"sku":null,"price":29.0,"currency_code":"AUD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0988\/9657\/6876\/files\/photo_staff_1on1_a19cee0a-fc67-48e3-afa4-13ec2277e50a.png?v=1780299446","url":"https:\/\/www.resolvedentalconsultancy.com.au\/products\/health-fund-hicaps-claiming-guide-2026","provider":"Resolve Dental Consultancy","version":"1.0","type":"link"}