The official release of our TELUS Health eClaims integration was over two months ago. Since then, we’ve observed the way our customers are using this module and have made a number of adjustments based on the requests from our most frequent users.
To further explore ways that can improve the claim submission experience for our customers – many of whom have used HCAI for years and are new to eClaims – we compared the two in order to help you recognize the particularities of each service.
Before we begin, we want to point out that the two systems are meant to serve a different purpose, and therefore, are different in nature. eClaims is meant to satisfy the claim process of the Extended Health insurers Canada-wide, while HCAI is intended to communicate claim forms with automobile insures’ adjusters in the province of Ontario.
We have identified the 10 biggest differences:
Number of Electronic Message Types
In addition to submitting invoices (OCF-21), the HCAI system also allows for the electronic submission of two types of treatment plans – OCF-18 and OCF-23 – as well as the Assessment of Attendant Care Needs (Form 1). eClaims, however, goes as far as predetermination requests and invoices.
Option to Void Invoices
Voiding claims is allowed by eClaims, as long as it’s done on the same day it was submitted (the void option becomes unavailable at midnight).
The option to void (previously known as “withdraw”) was removed from the HCAI system back in 2015, which we covered in our Depreciating Withdraw Function article in September that year.
Number of Invoice Items
While there is no official limit on items allowed per Auto Insurance Standard Invoice (OCF-21) submitted via HCAI, eClaims limits up to 31 items per invoice. This encourages healthcare providers to submit claims more frequently or upon completion of each patient visit.
Claim Submission Period
Another business rule with TELUS Health is that the services submitted via eClaims cannot be older than 31 days. This is another indication that claims are expected to be submitted in “real time,” or in other words, right after the patient visit.
We are not aware of any limitations on invoicing for “outdated” services via HCAI. In fact, SABS commends submitting invoices no more than once per calendar month.
We know that every automobile insurer licensed in the province of Ontario is registered to work with HCAI. However, only a portion of extended health insurers are registered to work with eClaims. These participating insurers are listed on the TELUS Health website.
Healthcare facilities with a valid FSCO license are paid directly for claims submitted via HCAI. In the event of a pended claim, the payments for claims submitted via eClaims may still end up in the hands of the policyholder.
Mandatory vs. Optional
Claim submission via HCAI is mandatory for facilities who wish to receive payment directly from automobile insurers. In contrast, submitting via eClaims remains optional. That is a significant difference, as it attracts more healthcare providers to register and work with HCAI in order to invoice for services provided to motor vehicle accident patients.
The HCAI system allows taxes to be identified separately on the OCF-21. eClaims, however, mandates the inclusion of tax in the price of each service. There is no space on the claim form to identify taxes separately.
To help Universal Office users identify tax on invoices submitted via eClaims, we have added the tax field. When submitted, the tax is included in the line item of an eClaim.
Providers Per Claim
There are no limits on the number of providers that can appear on a single OCF-21 invoice submitted via HCAI. The HCAI system, however, requires the identification of one performing or billing provider per line item.
eClaims allows only one provider to be identified as having performed the service(s) specified on an invoice. If a patient has received multiple services from multiple providers on a given visit to a clinic, the facility must produce two claims.
Practice Management System & Online Portal
The OCFs and Form 1 submitted via your practice management system and directly through your online portal can be viewed on your HCAI portal.
However, claims submitted via practice management systems won’t appear on your TELUS Provider web portal. Only claims that were submitted directly from the portal will appear on the TELUS Provider Portal.
Both HCAI and TELUS Health eClaims speed up the process of submitting claims, receiving payment and reducing paperwork – but they differ in purpose. One bills Extended Health insurers, and the other bills Automobile Insurers. The bottom line is the more processes that can be automated, the more productive your office can become.