We want to address the most frequently asked questions we receive about TELUS Health eclaims – so let’s dive right in!
Who are the TELUS Health eClaims participating Insurers?
|Canada Life||CINUP||First Canadian||Johnson Inc.|
|Manulife Financial||ClaimSecure||GroupHEALTH||Johnston Group|
|Sun Life Financial||Cowan Insurance Group||GroupSource||Manion|
|Chambers of Commerce Group Insurance Plan||Desjardins Insurance||Industrial Alliance||Maximum Benefit|
|LiUNA Local 506||LiUNA Local 183||Canadian Construction Workers Union||Union Benefits|
|TELUS AdjudiCare||GMS Carrier 49||GMS Carrier 50|
What type of service providers can submit claims through eClaims? (not necessarily available for all insurers)
|Chiropodists||Physical Rehabilitation Therapist|
What is coordination of benefits?
Coordination of benefits is when a patient is covered under more than one group benefits plan. If a patient has secondary coverage, this information must be provided to the primary insurer for the purpose of claim adjudication.
When a claim is submitted, it is submitted to the primary insurer and that is processed in real-time. The secondary claim is processed manually via paper claim.
To learn how to complete claim forms quickly and accurately, check out Create and Modify Extended Health Care Claim Forms.
How is primary and secondary coverage determined?
If a patient has their own policy, they must first submit their claims under their own plan, then identify their spouse’s plan as secondary coverage. Unpaid portions may be submitted to their secondary coverage, if applicable, manually via paper claims to their secondary coverage.
If the patient is a child and is covered under both parents’ policies, the claim should be submitted under the policy of the parent whose birthday occurs earliest in the year.
What’s the timeframe for submitting a claim in eClaims?
You have up to 31 days from the date the services were incurred to submit the claim, but the sooner the claim is submitted, the faster payment will be issued by the insurance company.
Claims should be submitted while the patient is in your office at the time the service is provided. You and your patient will know right away what the insurance company covers, and you can then request the balance, if any, from your patient before they leave the office.
Once a claim is submitted, an EOB is returned immediately and a copy must be provided to your patient. A copy can be given by either printing the EOB or emailing it to your patient by selecting the email button at the top of the EOB within the Universal Office eClaims module.
What is a predetermination request?
This requests from the insurer to advise how much they would pay for a service that were to be provided and not yet incurred on that same day. Predetermination requests should not be submitted if the service has already been provided.
Online predetermination requests are not supported by all participating insurance companies. The participating supporting insurers are: Chambers of Commerce Group Insurance, ClaimSecure, CINUP, First Canadian, Great-West Life Assurance Company, GroupHEALTH, GroupSource, Industrial Alliance Insurance, Manion and Maximum Benefit or Johnston Group.
Predetermination requests can be created and submitted in Universal Office by opening the eClaims module and selecting predetermination from the “create new” menu. To learn more, check out Guide to Universal eClaims.
What is an Explanation of Benefits (EOB)?
An Explanation of Benefits (EOB) is a response generated by the insurer when it has fully adjudicated or processed the request for payment request. This statement provides the actual results of the adjudication, including the amount payable by the insurer, if applicable.
What is a Claim Acknowledgement (ACK)?
A Claim Acknowledgement (ACK) is a response generated by the insurer when it has successfully received a payment request, but is unable to complete the adjudication process. This statement simply serves as a confirmation of receipt of the payment request.
The Acknowledgement status in the eClaims module will not change once the insurer has processed the claim to reflect the paid amount. Please contact the insurer to confirm the status within 24 to 48 hours.
If the “payable to” field of the Acknowledgement indicates that payment will be made to the insured member, you should request full payment from your patient, as all insurer payments will be sent directly to the insured member.
If the “payable to” field on the response is blank, you can either wait for the insurer’s final response before requesting payment of your patient or void the Acknowledgement and resubmit the same claim – but with the payee listed as the “insured member.” This option is very useful in situations where you are unsure that you’ll be able to collect unpaid balances from your patients after they have left your office. It also lets you request full payment on the spot from your patients without the need for them to submit a paper claim to be reimbursed by the insurer.
How long do I have to void a claim?
Payment requests can only be voided on the same day they were submitted. If a payment request must be voided at a later date, either you or your patient must contact the insurer directly.
Can Manulife claims be voided?
Manulife will only accept electronic void requests for claims that received a payment. If the claim received an Acknowledgement response, it cannot be voided electronically. The provider has to contact Manulife directly to void it.
Can medical supplies claims be submitted to eClaims?
No. These claims are not accepted electronically at this time. The adjudication of claims for medical supplies requires additional information that cannot currently be captured in the TELUS Health portal and similarly not in Universal Office eClaims.
To find out why submitting claims through Universal Office eClaims is a no-brainer, check out 8 Reasons to Use Universal Office for TELUS Health eClaims Submissions.
Let us know if you have any other questions about eClaims that you don’t see listed above in the comments below.