In the next several months we will focus on improving the eClaims module by gathering your feedback and adding new features.
At this moment, the relationship to policyholder details and referral doctor must be filled in at the time you complete the claim. We want to pre-populate this information for you as the system does for the rest of the claim, but first we have to allow you to add the relationship to policyholder details as well as the referral doctor name to EHC details in patient file. Another option we plan to add is to allow you to email the EOB response received from the insurer to the patient.
We can’t wait to explore the scope and capabilities of this new electronic claims technology with you by gathering your feedback and sharing our experiences.
In this post, we’d like to share with you what we have gathered from TELUS Health eClaims vendor support and your peers thus far.
Claim Your Guide to Universal eClaims
Before we begin, we’d like to point out again that we have put together a Guide to Universal eClaims to get you started with the process of setting up and submitting your first claims; find the article on our knowledge base.
In order to set up your eClaims system, you will need the “Provider Spreadsheet for Software Vendor”. You can get this document by contacting TELUS Health eClaims Tier-2 Service Desk at 1-866-240-7492.
Once you get this file, you are ready to start setting up your Universal Office. You want to make sure you enter the information into your Universal eClaims Settings exactly as it appears in the provided spreadsheet. If you omit details, make an error or a typo, your claims will be rejected.
Consider the following points when submitting via eClaims:
- Provider address must be identical to the one used when registering for TELUS Health eClaims. It’s essential to enter the provider address when configuring your provider settings. It is equally as important to add provider address and license number, as well the rest of the information exactly as it appears in the “Provider Spreadsheet for Software Vendor”. If the provider address registered with TELUS Health eClaims is different from the facility address, we recommend that you add the provider address in the Staff Manager (in Universal Office) first.
- Different codes for different professions. When adding Billing Items in claim or predetermination requests, you will notice that only some service codes appear in the Codes drop-down list. One of the TELUS Health eClaims business rules mandates what service codes are applicable per provider type. Thus, you will see only those service code interventions in the Code drop-down list that can be performed by the selected therapist (e.g. physio, chiro, massage therapist). See the How to utilize procedure/service codes in TELUS Health eClaims article posted on our knowledge base.
- Claims can be submitted via eClaims exclusively to primary insurer. This means that if a patient has a primary insurer and a secondary insurer where both are eClaims participants, you can submit electronically via eClaims* only to the primary.
*However, there is one exception where both the primary and secondary insurers are Great West Life. In that case, and only (exclusively) in that case, TELUS Health eClaims will accept claims submitted to patient’s secondary insurer.
- You may not submit more than 31 items per claim. This means that if you have more than 31 charges to invoice, you will want to break them down into different claims.
- You may not submit claims older than 31 days via eClaims. If you find that a billing item is older than 31 days, you will want to submit it manually as you would normally do it – by creating an EHC invoice in patient file in Universal Office, printing it out and sending it by mail to the insurer.
- You may submit a predetermination request and void submitted claims, however, these options are not supported by all insurers. All features, functions and related benefits available in Universal Office are inherent to the TELUS Health eClaims platform, but may not be supported by all participating insurers.
- The claims submitted from Universal Office will not appear in your TELUS eClaims Portal and vice versa. The claims submitted on the eClaims Portal cannot be downloaded into Universal Office. These conditions are set by the TELUS Health eClaims and applies to all Practice Management System vendors.
- Claims can be Void via eClaims on the same day of submission. To void claims outside of this period (on the next day) must be done manually by contacting the insurer.
Please note that you cannot void a Manulife claim. In order to void a Manulife claim, you need to call the insurer directly at 1-866-407-7878 Monday to Friday 8am to 8pm.
Like you, we will learn as we go, and we will share more insightful information acquired through the learning process that will answer your questions and help you avoid making mistakes by staying informed on effective eClaims processes.
In the next little while, our goal is to help you in the adoption process of this new technology.
Therefore, we are working to develop a training package as well as a video to help you adopt this new technology. We plan to introduce the training package as early as next week and post the video by the end of January.
Stay tuned for update announcements on our blog!