eClaims frequently asked questions

eClaims is a web-based system where healthcare providers can submit claims online on behalf of their patients. The portal is accessible via the internet and offers eligible extended healthcare providers the convenience of capturing and submitting electronic claims to their patient’s insurance company at their point-of-sale.

You can register for eClaims at telushealth.co/eclaims. TELUS Health will then provide you with all of the login information needed to access the eClaims Provider Portal.

The service allows you to submit claims or estimates (predetermination of benefits) on behalf of your patients at the point of care. Depending on the insurer's offering, the submission could adjudicate automatically, with confirmation on coverage, types of expenses claimed and provider eligibility. In that case, you will immediately receive a notice of the result of the transaction to share with the patient.

TELUS Health is responsible for the registration of providers as well as offering the online portal allowing providers to submit claims to the participating insurance companies.

• Reduce your credit card fees by having patients pay only their deductible

• Inclusion on the eClaims provider search tool, available on many of our participating insurers’ plan member portals. It’s free marketing.

• Increase patient satisfaction and patient loyalty by offering your patients a value-add service that reduces their paperwork and their out-of-pocket fees.

• Registration and utilization are free and there are no fees for your patients

• A robust solution with easy access

• Faster claim submission with a lower margin for error

eClaims is free for healthcare providers and their patients.

• Canada Life

• Manulife Financial

• Sun Life Financial

• BPA

• Canadian Construction Workers Union (C.C.W.U.)

• Chambers of Commerce Group Insurance Plan

• CINUP

• ClaimSecure

• Cowan Insurance Group (managed by Express Scripts Canada)

• D.A. Townley

• Desjardins Insurance

• First Canadian

• GMS Carriers 49 and 50 (Express Scripts Canada)

• GroupHEALTH

• GroupSource

• Industrial Alliance

• Johnson Inc.

• Johnston Group

• LiUna Local 183

• LiUna Local 506

• Manion

• Maximum Benefit

• TELUS AdjudiCare

• Acupuncturists

• Chiropodists

• Chiropractors

• Dietitians

• Massage Therapists

• Naturopathic doctors (Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario, Saskatchewan)

• Physical Rehabilitation Therapist

• Physiotherapists

• Podiatrists

• Psychologists

• Speech language pathologists

• Vision care providers (Opticians and Optometrists)

Following registration, processing time may take between one and three weeks depending on the complexity of the validation and the information you have provided. Once your application has been processed, you will receive an email confirming your registration and a welcome package including your user login(s) for the Provider Portal.

If you are eligible for eClaims, you can register and terminate your utilization of the service at any time, without fee or penalty. You can also reactivate your registration after terminating it.

If you have received your eClaims Welcome Package and account login information, please login here: https://providereservices.telushealth.com

Check that you are accessing the portal via this link: https://providereservices.telushealth.com

Please call 1-866-240-7492, Monday to Friday from 8:00 a.m. to 8:00 p.m. ET. You can also send an email to provider.mgmt@telus.com.

Please call 1-866-240-7492, Monday to Friday, from 8:00 a.m. to 8:00 p.m. ET. You can also send an email to provider.mgmt@telus.com.

If you enter the incorrect password for your account 5 times in a row your account will be locked for 15 minutes. After 15 minutes, you can open a new browser session and re-enter your existing password. If you are still not able to access your account, please call us at 1-866-240-7492.

This can happen if you recently changed your password and previously used a password retention function on your web browser. The login screen is populating your old password even though you will only see ******. Try manually typing your new password and having your browser remember the new one. It is important to remember if you log in on different computers that the password will need to be re-entered and re-saved on all computers. It is recommended to always key-in the password.

Yes. Visit the resource center to view training videos and other support material.

You can share this page with them.

Once you log into the provider portal using your username and password, you will notice there is a section called My Profile. Click on Other Profile Updates. Go through the web form and fill out the specific change(s) you would like to update in your profile.

Once you log into the provider portal, there is a section called My Profile. Click on Email and Banking Information and follow instructions to update your banking details.

Once you log into the provider portal, there is a section called My Profile. Click on Other Profile Updates. Go through the web form and fill out the specific change(s) you would like to update in your profile.

Once you log into the provider portal, you will notice there is a section called My Profile. Click on Email and Banking Information and then follow instructions to update your email address.

To create a new user:

1. Click on "User Access & Permissions" link

2. Click "New user" button

3. Fill in the required fields with the appropriate information (especially the email address field)

4. In the role section, select the role that the user should have access to

5. Please note: if eClaims submission is selected, then a work location must also be selected to proceed

6. Click the "Create" button

7. Click the "Done" button

The system will generate 2 separate emails; One outlining the new user ID and the other for the temporary password.

The above steps will not add a licensed healthcare practitioner to your eClaims account.

Please refer to the User Access & Permissions User Guide for additional details.

1. Login to the eClaims Provider Portal

2. Click “Associate a Provider”

   • If your provider is already registered with TELUS Health, enter their first and last name, their TELUS Provider ID and the start date of the association.

   • If your provider is not yet registered with TELUS Health, click the “New provider” button, then enter the provider’s first and last name, start date, and license information.

Please refer to the Associate Provider User Guide for additional details.

To modify an existing user:

1. Log into the eClaims Provider Portal.

2. In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.

3. From the available results, click the username of the user that you want to modify.

4. Update the required field(s) and/or role access.

5. Click the “Submit” button.

6. Click the “Done” button.

The above steps will not add a licensed healthcare practitioner to your eClaims account.

Please refer to the User Access & Permissions Guide for additional details.

To deactivate a user:

1. Log into the eClaims Provider Portal.  

2. In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.

3. From the available results, click the username of the user that you would like to deactivate.

4. In the “Status” field, use the drop-down list to select “Inactive”.

5. Click the “Submit” button.

6. Click the “Done” button

The above steps will not add a licensed healthcare practitioner to your eClaims account.

Please refer to the User Access & Permissions Guide for additional details.

To delete a user permanently:

1. Log into the eClaims Provider Portal.

2. In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.

3. From the available results, locate the user to delete and click the  trash button.

4. Review the warning message.  Deletions are permanent.

5. Click the “Delete” button.

The above steps will not add a licensed healthcare practitioner to your eClaims account.

Please refer to the User Access & Permissions Guide for additional details.

To provide another user with "User Admin" access:

1. Log into the eClaims Provider Portal.

2. In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.

3. From the available results, click the username of the user to whom you want to provide user administrator access.

4. Select  the “User Administrator” check box.

5. Click the “Submit” button

6. Click the “Done” button

Please refer to the User Access & Permissions Guide for additional details.

Once you log into the eClaims portal, click on ‘Other Profile Updates’ in the ‘My Profile’ section of the homepage. You will then be able to go through the web form to add additional providers and make any other required changes to your profile.

Once you log into the provider portal using your username and password, you will notice there is a section called My Profile. Click the Other Profile Updates link to open the TELUS Health Provider Profile Change Management page. Go through the web form and fill out the specific change(s) you would like to update in your profile.
Organizations cannot have multiple work locations and must register each new location through the new registration page.

Providers cannot add service codes; these are agreed upon by the insurers and the TELUS Health product team. If you would like to request a service code be added to the list, please send an email to provider.mgmt@telus.com.

You will need to be converted to an Organization account to add additional servicing providers. Please:

1. Register for eClaims as an Organization here

2. A TELUS Health team member may reach out to you to confirm if you are converting to a clinic account

You will need to be converted to an Organization account for the location where you plan on adding additional association providers. Please:

1. Register for eClaims as an Organization here

2. A TELUS Health team member may reach out to you to confirm if you are converting to a clinic account

Please note that you will remain an independent biller at your other location(s).

Please advise the clinic to submit a change request to add you to their drop-down list of servicing providers. To do this, they will have to:

1. Log into the eClaims Portal.

2. Click “Other Profile Updates”.

3. Select “Manage providers and their roles for eClaims”.

Please note that you will remain an independent biller at Location A.

Yes, the security questions are required so that you can reset your password if needed in the future.

Click the “Forgot/reset my password” link in the Provider Portal login screen.  You will be prompted to answer your personal security questions to reset your password. If you want to change your security questions, you can do so from the Provider Portal, by clicking the “Update my security profile information” link.

You will be prompted to change your password every 6 months for security reasons.

You will see this message if another user at your clinic is using the same email address for their security profile. The security profile requires a unique email address to be entered. You can leave this field blank to bypass the message and it will not affect your direct deposit but you will not be able to use the Forgot Username function to retrieve your username if needed in the future. You can also use a personal email address if you prefer as long as it has not been used on another eClaims user profile.

Providers and users are not always the same.

Users are people who:

• Have access to use eClaims.

• Submit claims on providers’ behalf.

• Can be clinic owners, receptionists, or billing administrators.

Providers are healthcare practitioners who treat patients. They may also have user access to eClaims if they submit claims themselves.

If you would like to make changes to your providers, please follow these steps:

1. Log into the eClaims portal.

2. Click "Other Profile Updates".

3. Click "Clinic", then click "Manage Providers and their roles for eClaims".

Claims should be submitted while the patient is in your office at the time the service is provided. The insurance company will return a response immediately for you to view and print. You must give a copy to your patient.

Depending on the insurer, an explanation of benefits could be returned. 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. You have up to 31 days from the date the services were rendered to submit the claim but the sooner the claim is submitted, the faster payment will be issued by the insurance company.

In general, claims are processed the day they are submitted; however, at certain times and depending on the insurer, claims cannot be adjudicated in real time. If this is the case, you will receive an acknowledgment advising you that the claim has been received and accepted for further processing. The eClaims portal will not show an updated status for the acknowledged/pended claims; please contact the insurer after 48 hours to confirm the status or paid amount. Note that some insurers will automatically change the payee from the provider to the insured member. To avoid this, you can void an acknowledged claim, collect the full amount from your client and resubmit with payment to the insured member.

Separate claims must be submitted for each patient. If you have multiple patients within the same family, for example, you can print and save the insurer’s response, and then create a separate claim for a different family member. In such cases, eClaims will prepopulate certain fields.

A predetermination request, which relates solely to services that have not yet been rendered, is a request to obtain the amount that the insurer would pay if these services were provided on that same day.

This can be done by selecting “Predetermination Request” rather than “Payment Request”. However, you should not submit a predetermination request if the service has already been provided. Note that the “Payable to” field is not available for predetermination requests.

Note: Online predetermination requests are not supported by all participating insurance companies. Refer to the Insurer Specific section for further details.

Certain provinces do not allow the patient to submit healthcare expenses covered by provincial plans to a private healthcare insurance company until provincial coverage has been fully exhausted. Check this box ONLY if:

• this directive applies in your province, and

• it applies to the services rendered, and

• provincial coverage has been fully exhausted.

Note: This field applies only to physiotherapists at this time.

Such claims cannot be submitted electronically at this time, as the adjudication of claims covering medical supplies requires additional information which the portal cannot currently capture.

To enable the Service Code search tool, you must enter a valid service date for payment requests, and then select the service code field to enable the magnifying glass icon.

Perhaps some of the service codes you previously used during the submission process no longer exist. The current service code list will help you pinpoint the codes that are still active and actionable.

It is not currently possible to select both left and right eyes on the same line of the claim. If the service code applies to both eyes, there are two possible options:

• Do not use the eye checkboxes, or

• Split the service into two different lines, one for each eye.

You can only use the “New claim – same family” option when the same provider performed the claimed services for various members of a single family. If a different provider performed these services for the patient, a new claim must be created and the correct provider must be indicated on the second claim.

A saved transaction can only be completed on the same day it was initially saved. These transactions may be found under “Today’s transactions”.

You may view previously submitted transactions for the current month as well as the previous month. Go to the “Past Transactions” section, where you can search among the available transactions. Click the PDF icon in the "PDF Response" column to access the explanation of benefits after the day the claim is submitted. Please print or download a PDF version of the explanation of benefits for your records as it will only be available while the transaction is displayed in the “Past Transactions” tab. To request a copy of the explanation of benefits after it is archived, please contact the insurer directly.

Call the insurer directly to report the problem. Insurer contact information can be found in the Insurer-specific section of this page.

The electronic claim for vision apparatus must be submitted preferably when the service has been fully provided and the patient has received the apparatus. However, it is also permitted for the claim to be sent when the patient leaves a deposit for the ordering of his apparatus as long as the claims is submitted only once for the same vision apparatus.

TELUS Health has changed the Provider Portal and the eClaims Mobile app as well as the claim messages to provide payers with the insights they need to understand how the service was rendered. The following question will be displayed to you at the service level: “Where was the service rendered?” You can select one of the following answers: In person, at the clinic; In person, at the patient’s location; Virtually. The question and answer will be included in the claim summary and PDF response.

Payment for virtual visits will be made in the same way as for regular visits. Payment will be issued to the provider/clinic based on the value selected in the ”Payable to” field in the request.

No. New service codes for virtual services will not be added. Select the service code that best describes the service rendered.

Providers should use their professional judgment with regards to the fees associated with the service and are expected to advise their patients (upfront) of all fees associated with services rendered virtually.

No. Providers should develop consent forms that meet the requirements from their regulating bodies.

This is a concern for providers who don’t have access to their records due to the lockdown. TELUS Health is working with insurers to extend the submission window. TELUS Health will communicate with providers if there is an update.

No. A doctor’s note will continue to be a requirement for some benefit plans.

Yes, providers can submit a virtual visit in eClaims through the TELUS Health Provider Portal and using third-party software certified on eClaims.

TELUS Health has introduced a new service code for PPE, 999001, which you can use to bill a primary coverage insurer. If this new code is not supported by the insurer, it is hidden from the service code search.

This error is displayed if your primary coverage insurer does not support this service code.

A claim should be voided if:

• You wish to change the payee; or

• You noted an error and wish to submit a corrected claim.

Voiding or cancelling a predetermination is unnecessary since the relevant services have not yet been rendered. As a result, the void option is not available for predeterminations.

Payment requests can only be voided or cancelled on the 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.

If the request was submitted that day, you can void or cancel it in the “Today’s transactions” section. Simply locate the original request and click on the Void button. You can void the claim before midnight Eastern Time on the same day of submission. For claims submitted to Manulife and Sun Life, you will have to contact the insurer directly after 48 hours to request that the claim is cancelled.

If you wish to void a request due to its response, and not as a result of an error on the original submission, choose “Altered decision” as the reason for voiding the request. For example, you would select “Altered decision” as the void reason when changing the “Payable to” value after receiving an Acknowledgement.

No. A claim should only be voided if the original submission included an error regarding the patient, the patient’s coverage, or the details of the claim.

In “Today’s transactions,” the status of the response to the request will change to “Voided.” If the claim cannot successfully be voided or cancelled, a “Void request declined” message will appear on the original request. If this situation occurs, a message outlining the problem and next steps will be provided in the “Insurer notes” section.

The void function is not available on Manulife claims.

Coordination of Benefits applies when a patient is covered under more than one plan, either with a single insurance company or with multiple insurers. Coordination rules determine which insurer or plan pays first and which one(s) pay(s) subsequently.

You can use coordination of benefits if both the Primary and Secondary coverage are under the same insurance company and through an insurer that supports coordination of benefits. When you submit the coordination request, only the primary is processed in real-time, the secondary claim is processed manually and sent to the recipient member. Refer to the Insurer-specific section to see which insurers support coordination of benefits.

If your patient has secondary coverage but this insurer is not listed in the Secondary Coverage section, you may select “Other Healthcare Insurance Company.”

You are not obliged to complete the secondary coverage section if the patient does not have additional coverage. However, if the patient does have secondary coverage, this information must be provided to the primary insurer for the purpose of claim adjudication.

The following guidelines will help you properly identify and differentiate between primary and secondary coverage:

• Patients submit their claims under their own plan (policy) and identify their spouse’s plan (policy) for secondary coverage purposes.

• If the patient is a child and is covered under both policies, the claim should be submitted under the policy of the parent whose birthday occurs earliest in the year. For example, if the father’s birthday is February 1 and the mother’s birthday is September 1, list the father’s policy as primary and the other’s policy as secondary.

An Explanation of Benefits (EOB) is a response generated by the insurer when it has fully adjudicated or processed the payment request. This statement provides the actual results of the adjudication, including the amount payable by the insurer, if applicable.

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.

Actual adjudication results will be provided at a later time by other means, depending on the insurer’s preferred method. These results are based on the individual designated to receive payment and may, in some cases, vary from the information listed on the request. In such situations, a comment often appears in the Insurer notes section.

The TELUS acknowledgement status will not change in eClaims once the insurer has processed that claim to reflect the paid amount. Please contact the insurer to confirm the status within 24 to 48 hours.

The language of the comments included in these responses is that of the member’s preferred language as it appears in the insurer’s files.

If the “Payable to” field of the Acknowledgement indicates that payment will be made to the “Recipient member,” you should request full payment from your patient as all insurer payments will be sent directly to the recipient 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 the outstanding balance from your patient or the insured member, as applicable, or

• Cancel (void) the Acknowledgement and resubmit the same claim with the payee listed as the “Insured member.” This option is especially useful in cases where you are unsure of your ability to collect unpaid balances from your patients after they have left your office. It enables you to 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. For future claims submitted by this patient, select the “Insured member” option in the “Payable to” field. Please refer to the Insurer-specific section for further details.
  

No. When an Acknowledgement is generated, you will not receive a notification through the portal. A response will be sent by other means, depending on the insurer’s preferred method, once the claim has been processed.

Yes. All submitted claims are automatically saved when a “Problem encountered” message appears, regardless of the success of the transmission. However, when an attempt to submit a claim results in an “Application error”, the claim may not necessarily be saved, depending on the cause of the error.

Should a connection error occur during the submission process, the claim in question may be resubmitted only the same day as the original submission attempt. A new request must be created if you attempt to submit the claim again on a subsequent date.

As of the next day, a summary view of the request and response is available in the “Past transactions” section in the portal. The pdf version of the full response message will be available for all past claims displayed (current month and previous month transactions), select the PDF icon to access it.

Key204 is related to any invalid certificates on invoice requests. For example, you may get a Key204 message in the case where the patient, certificate or policy was not found in the insurer’s database. If you still have the page open, we recommend using your web browser’s “print” or “save as” functionality to capture the information on the page and keep it for reference.

Refer to the “Insurer notes” section in the box where the error message is displayed – it should provide further details on the error. If the “Insurer notes” section says “provider not found” or “banking not found”, please email us at provider.mgmt@telus.com. For all issues related to the patient’s information, please double check the information submitted. Reach out to the insurer if you still cannot determine the nature of the error.

BPA: Please dial 1-800-867-5615.

Canada Life: For questions regarding a response to a claim submitted to Canada Life, please call 1-800-957-9777.

Canadian Construction Workers Union (C.C.W.U.): Please dial 1 416-240-0047.

Chambers of Commerce Group Insurance Plan: Should you have any questions about your claim, please call the Group Insurance Line at 1-800-665-3365 , or Fax 1-866-878-0951 , or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

CINUP (Johnston Group): Should you have any questions about your claim, please call the Group Insurance Line at 1-800-665-1234, or Fax 1-877-786-3889, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

ClaimSecure: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please dial 1-888-513-4464. The Customer Response Centre is open Monday to Friday, from 7:00 am to 11:00 pm EST. Confidential member/patient information, coverage details and member payments will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the number provided on the member benefit card.

Cowan Insurance Group (managed by Express Scripts Canada): For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada Provider Processing Centre at 1-800-563-3274. Please note that at this time online reversal of claims is not supported. Prior to resubmitting, call Express Scripts Canada’s Call Centre to have your claim reversed. Confidential member/patient information, coverage details and payments, will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the Cowan Call Centre at 1-888-509-7797.

D.A. Townley: Please dial 1-800-663-1356.

Desjardins Insurance: For questions regarding a response to a claim submitted to Desjardins Insurance, contact the Service Desk at 1-800-463-7843 .Please note that confidential member/patient information, as well as payment details, will not be disclosed to the healthcare provider.

First Canadian (Johnston Group): Should you have any questions about your claim, please call the Group Insurance Line at 1-866-212-5644 or 1-800-561-1342, or Fax 1-877-526-2515, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

GMS: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada (ESC) Provider Processing Centre at 1-800-563-3274. Confidential plan member/patient information, coverage details and plan member payments will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the GMS Call Centre at 1-800-667-3699.

GroupHEALTH: For questions about your claims, please call us at 1-833-344-6944 or write to us at 626 – 21 Four Seasons Place, Toronto, ON M9B 0A6. Our email address is askus@mygrouphealth.ca. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

GroupSource: For questions about your claims, please call us at 1-888-547-6947 or write to us at 200 – 5970 Centre Street SE, Calgary, AB T2H 0C1. Our email address is askus@mygroupsource.ca. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

Industrial Alliance Insurance and Financial Services Inc.: You can contact the Client Service Department by phone at 1-877-422-6487.

Johnson Inc.: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada Provider Processing Centre at 1-800-563-3274. Confidential member/patient information, coverage details and payments, will not be disclosed to you. For questions regarding coverage, your client must contact Johnson Inc. at 1-866-773-5467.

LiUNA Local 183: Please dial 1 416-240-2103

LiUNA Local 506: Please dial 1 416-506-8841

Manion: For questions about your claims, please call us at 1-866-532-8999 or write to us at 626 – 21 Four Seasons Place, Toronto, ON M9B 0A6. Our email address is askus@mymanion.com. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

Manulife Financial: Contact Manulife at 1-866-407-7878 , Monday to Friday, from 8am to 8pm EST for English and 8am to 5pm ET for French.

Maximum Benefit or Johnston Group: Should you have any questions about your claim, please call the Group Insurance Line at 1-800-893-7587 , or Fax 1-866-878-0951 , or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

Sun Life Financial: For questions regarding a response from Sun Life Financial where payment has been assigned to the provider/clinic, contact the Sun Life Financial Customer Care Provider Line at 1-855-301-4SUN (4786) . Please note that enquiries from providers are accepted only if payment was assigned to the provider, if Sun Life Financial has asked the provider for additional information, or if the member/patient is present in the provider’s office at the time of the call. You must also provide the patient’s policy number and member ID during the call.

TELUS AdjudiCare: TELUS AdjudiCare is aggregated used by many different small insurers. The contact phone number will connect you with the TELUS AdjudiCare customer support team. If they are unable to answer your question about that claim or member, they will connect you with the appropriate insurer based on the member you are inquiring about. TELUS AdjudiCare Customer Support: 1-877-944-7100

BPA: At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. Therefore, claim submission is only available with the option “payable to” the patient. Please ensure you collect the full treatment amount from your clients covered by this insurer.

Canada Life: Monday to Friday 6am to 12am ET; Saturdays and Sundays 6:30am to 10pm ET

Canadian Construction Workers Union (C.C.W.U.): Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Chambers of Commerce Group Insurance Plan: 24/7 with a short maintenance window at 11pm EST.

CINUP (Johnston Group): 24/7 with a short maintenance window at 11pm EST.

ClaimSecure: 24/7, excluding maintenance periods.

Cowan Insurance Group (managed by Express Scripts Canada): We process transactions 24 hours a day, 7 days a week, excluding maintenance periods.

D.A. Townley: 24/7, excluding occasional maintenance periods.

Desjardins Insurance: Acknowledgements are generated 24 hours a day, 7 days a week. Deferred submitted claim requests are processed by Desjardins Insurance within two business days following the request.

First Canadian (Johnston Group): 24/7 with a short maintenance window at 11pm EST.

GMS: 24/7, except Sunday between 12:00 and 7:00 am EST.

GroupHEALTH: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

GroupSource: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

Industrial Alliance Insurance and Financial Services Inc.: Monday to Friday from 06:00 to midnight ET. Saturday and Sunday from 06:00 to 22:00 ET

Johnson Inc.: 24 hours a day, 7 days a week, excluding maintenance periods.

LiUNA Local 183: Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

LiUNA Local 506: Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Manion: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

Manulife Financial: The hours of adjudication are as follows: Monday to Friday: 5:30am to 12:30am EST. Saturday: 5:30am to 8:00pm EST. Sunday: 8:00am to 10:00pm EST

Maximum Benefit or Johnston Group: 24/7 with a short maintenance window at 11pm EST.

Sun Life Financial: The Sun Life Financial system can respond with payment details from 6:01 a.m. to 12:00 a.m. EST 7 days a week. Outside this period, only an Acknowledgement will be generated.

TELUS AdjudiCare: 24/7

BPA: A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Canada Life: Up to 5 business days.

Canadian Construction Workers Union (C.C.W.U.): A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Chambers of Commerce Group Insurance Plan: Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

CINUP (Johnston Group): Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

ClaimSecure: ClaimSecure will respond to the provider within 2 to 4 business days.

Cowan Insurance Group (managed by Express Scripts Canada): Cowan will respond to the provider within 2 to 4 business days.

D.A. Townley: A response following a claim acknowledgement is usually processed within one week. Predeterminations and rejected claims are mailed to providers daily. Cheques, along with explanation of benefit statements for payable claims, are mailed on the 1st and 15th of each month.

Desjardins Insurance: Desjardins Insurance sends members a response, including a confirmation that their claim was processed and the adjudication results, within 2 business days.

First Canadian (Johnston Group): Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

GMS: Claims are processed within a business day.

GroupHEALTH: Acknowledgements will be processed, and members sent a response, within three to five business days.

GroupSource: Acknowledgements will be processed, and members sent a response, within three to five business days.

Industrial Alliance Insurance and Financial Services Inc.: In 50% of cases, a response is provided within 24 hours; in all other cases, a response is provided within 5 business days.

Johnson Inc.: Claims are processed within one business day.

LiUNA Local 183: A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

LiUNA Local 506: A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Manion: Acknowledgements will be processed, and members sent a response, within three to five business days.

Manulife Financial: Manulife treats the Acknowledgement in five to seven working days. Payment for Acknowledgements is made to the patient.

Maximum Benefit or Johnston Group: Acknowledgements are treated in our offices and returned to providers within two to four business days.

Sun Life Financial: Up to five business days.

TELUS AdjudiCare: TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, the response time varies by each insurer/payer under TELUS AdjudiCare. The processing time varies from one to two weeks, plus transit time to mail the statements.

BPA: At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Canada Life: Yes.

Canadian Construction Workers Union (C.C.W.U.): At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Chambers of Commerce Group Insurance Plan: Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

CINUP (Johnston Group): Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

ClaimSecure: Yes.

Cowan Insurance Group (managed by Express Scripts Canada): No.

D.A. Townley: Yes, predetermination requests are accepted.

Desjardins Insurance: Desjardins Insurance does not accept predetermination requests, but does accept online claims for services already rendered.

First Canadian (Johnston Group): Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

GMS: No, electronic submissions of predetermination requests are not accepted by the insurance company.

GroupHEALTH: Yes, predetermination requests are accepted.

GroupSource: Yes, predetermination requests are accepted.

Industrial Alliance Insurance and Financial Services Inc.: Electronic submissions of predetermination requests are not currently accepted.

Johnson Inc.: No, electronic submissions of predetermination requests are not accepted.

LiUNA Local 183: At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

LiUNA Local 506: At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Manion: Yes, predetermination requests are accepted.

Manulife Financial: No.

Maximum Benefit or Johnston Group: Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

Sun Life Financial: No.

TELUS AdjudiCare: Yes. Please note: Since TELUS AdjudiCare is aggregated and used by many different small insurers; the response time for a predetermination varies by each insurer.

BPA: No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. Please ensure you collect the full treatment amount from your clients covered by this insurer.

Canada Life: Canada Life allows benefit assignment, unless prohibited by the insured member’s policy. In such cases, it will be noted in the electronic response.

Canadian Construction Workers Union (C.C.W.U.): No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

Chambers of Commerce Group Insurance Plan: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

CINUP (Johnston Group): Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

ClaimSecure: Yes, ClaimSecure will allow assignment of payment to the provider, providing that the group has elected this feature. In the event that a claim is submitted with assignment to the provider and the group has elected to pay only members, the claim will be processed and will return a message indicating that the payee has been changed to the member. Please remind the patient that there is no need to submit the claim manually if you have received a successful response.

Cowan Insurance Group (managed by Express Scripts Canada): Yes.

D.A. Townley: Yes.

Desjardins Insurance: Benefit assignment is not available. Benefit payment is always sent directly to the member.

First Canadian (Johnston Group): Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

GMS: Yes, assignment of payment to the provider is possible, providing the plan member’s policy enabled this feature.

GroupHEALTH: Yes.

GroupSource: Yes.

Industrial Alliance Insurance and Financial Services Inc.: Yes, provided the Assignment of Claim document has been signed by the plan member. The provider must keep the signed document in the patient’s file for reference and possible referral by Industrial Alliance.

Johnson Inc.: Yes it’s possible, but it depends on the policy the member is insured on.

LiUNA Local 183: No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

LiUNA Local 506: No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

Manion: Yes.

Manulife Financial: Yes.

Maximum Benefit or Johnston Group: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

Sun Life Financial: Sun Life Financial will only accept assignment to providers if the provider is registered for Electronic Fund Transfer (EFT) or direct deposit. To update your TELUS Health profile with your relevant banking details, you must complete and submit the Provider Profile Change Request Form found in the Tools section of the portal.

TELUS AdjudiCare: TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, this varies by each insurer/payer under TELUS AdjudiCare. As long as the payer and the benefit plan allow for payment to the provider then the claim will be accepted. If payment to the provider is not allowed, then the claim submission will be rejected and the explanation of benefits returned to you. eClaims will indicate this as the rejection reason.

Print the Payment User Guide to get a quick view of the payment process by insurer.

BPA: You must always obtain payment from your client for services rendered. This insurer always issues payment for insured expenses directly to its members, in accordance with the method of payment applicable to their plan.

Canada Life: Canada Life will issue scheduled bundled payments to service providers, by cheque twice monthly or weekly by direct deposit. If you choose to register for direct deposit, payments will be issued by direct deposit into a bank account you designate.

Canadian Construction Workers Union (C.C.W.U.): Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Chambers of Commerce Group Insurance Plan: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. All other provider payments will be made by printed cheque.
All payments are processed every working day for claims processed the day before. Claims held for review or audit are typically released for payment within two business days.

CINUP (Johnston Group): Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a printed notification will be mailed to you. All other provider payments will be made by printed cheque. All payments are processed every working day for claims processed the day before. Claims that held for review or audit are typically released for payment within two business days.

ClaimSecure: Payment is made by direct deposit or cheque (providers requiring cheques will incur a fee), depending on how the provider is registered with TELUS Health. Payment is every two weeks. Providers who have opted in to direct deposit with TELUS will automatically be signed up for direct deposit with ClaimSecure and will have an eProfile account created. Login and password details will be sent to the email provided when signing up with TELUS. Please ensure to activate your account.

Cowan Insurance Group (managed by Express Scripts Canada): Providers are paid by cheque or direct deposit based on the information provided by the provider (Direct Deposit or Cheque) when registering with TELUS Health.Frequency: Twice a month (the 5th and the 20th of each month).The providers will be charged a fee for cheque and/or paper statement. By default, the providers are setup with electronic statements. In order to request a paper statement, please contact the Express Scripts Canada Call Centre at 1-800-563-3274
For further questions, please see the question, “How do I contact the insurance company?”

D.A. Townley: Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Direct deposit is not supported.

Desjardins Insurance: The provider must always obtain payment from the patient for services rendered. Desjardins Insurance always issues payment for insured expenses directly to its members, in accordance with the method of payment applicable to their plan.

First Canadian (Johnston Group): Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a printed notification will be mailed to you. All other provider payments will be made by printed cheque. All payments are processed every working day for claims processed the day before. Claims that held for review or audit are typically released for payment within two business days.

GMS: Payment is made by direct deposit or cheque (providers requiring cheques will incur a fee), depending on how the provider is registered with TELUS Health. Payment frequency is twice a month (on the 5th and the 20th of each month). Providers are setup with electronic statement by default. To request a paper statement, please contact the Express Scripts Canada Call Centre at 1-800-563-3274.

GroupHEALTH: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

GroupSource: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

Industrial Alliance Insurance and Financial Services Inc.: Direct deposit for providers is currently not supported. The provider will receive 1 cheque per claim along with a paper statement. The cheques are mailed to the provider every 2 to 5 business days depending on the patient’s group parameters. If payment is payable to the patient, the patient will have selected, within their plan parameters, whether they wish to receive an electronic or paper statement.

Johnson Inc.: You will be paid by cheque or direct deposit based on the information you provided when registering with TELUS.
Frequency: Twice a month (the 5th and the 20th of each month)
By default, you are set up with electronic statements. You will be charged a fee for cheques and/or paper statements. In order to request a paper statement, please contact Express Scripts Canada at 1-800-563-3274.

LiUNA Local 183: Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

LiUNA Local 506: Providers are paid by cheque every 2 weeks and payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Manion: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

Manulife Financial: Payments to providers will be issued daily via direct deposit only. No cheques will be issued. Payments made via direct deposit are forwarded to your financial institution within one business day of your claim being paid (claim is paid on business day following day of submission). Your financial institution determines when the payment is deposited to your account. Real-time statements are issued at the time of claims submission. Please ensure you print or save transaction responses at time of submission to facilitate reconciliation when payment is deposited to your account. Manulife’s solution is completely electronic – no paper cheques or statements will be issued. If you want to receive payment from Manulife, you must sign up for direct deposit with TELUS Health so that payments can be deposited directly to your bank account. If you have yet to provide your banking information to TELUS Health, you will still be able to submit claims to Manulife. You will receive a message that payment will go directly to the plan member and you should collect the full amount from your patient.

Maximum Benefit or Johnston Group: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. All other provider payments will be made by printed cheque.All payments are processed every working day for claims processed the day before. Claims held for review or audit are typically released for payment within two business days.

Sun Life Financial: Multiple direct deposit payments for claims processed on a given day may be sent out. Sun Life Financial will only provide payment through Direct Deposit. Where applicable, payments are deposited into the payee’s account and may take up to 48 hours to appear after the claim has been processed. A Sun Life Financial Provider Statement will be issued by email per deposit made to your bank account to help reconcile the claims with each deposit. It is crucial that you inform TELUS Health should your contact or banking information change (e.g. bank account details, email address, name, address, etc.) This is particularly important in the case of banking information, which may lead to payment rejection, and email address, since an incorrect address may cause the provider statement to bounce back.

TELUS AdjudiCare: TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, this varies by each insurer/payer under TELUS AdjudiCare. Payment is sent within 3 and 10 business days, by either cheque or EFT (direct deposit). At this time, payment statements are sent by mail. In 2020, electronic payment statements will be available.

BPA: No

Canada Life: If your patient holds both primary and secondary coverage with Canada Life, the provider must complete both the primary and secondary coverage sections of the patient’s claim. Canada Life will respond electronically to the primary coverage only and will automatically coordinate and handle the secondary claim manually. Though the provider will not receive an electronic response to the secondary claim, there is no need for their patient to submit a paper claim to Canada Life for the secondary claim. For vision care claims, payment for the secondary coverage will be paid out to the plan member. For all other claim types, payment for the secondary coverage will be paid out to the same recipient as the primary coverage.

Canadian Construction Workers Union (C.C.W.U.): No.

Chambers of Commerce Group Insurance Plan: Coordination of Benefits with the same provider is not supported at this time.

CINUP (Johnston Group): Coordination of Benefits with the same provider is not supported at this time.

ClaimSecure: If your patient holds both primary and secondary coverage with ClaimSecure, ClaimSecure will respond electronically to the primary coverage only and will automatically coordinate and handle the secondary claim. Though the provider will not receive an electronic response to the secondary claim, there is no need for the patient to submit a paper claim for the secondary claim. Payment for the secondary coverage will be paid out to the member.

Cowan Insurance Group (managed by Express Scripts Canada): No.

D.A. Townley: No, coordination of benefits is not supported.

Desjardins Insurance: Desjardins Insurance will coordinate benefits for services submitted on a patient’s behalf when preference for such coordination is noted in the patient’s file. All provider-generated requests for coordination of benefits will be ignored. The member is responsible for updating all information in her/his file. Desjardins Insurance will issue electronic responses only for primary coverage issues. Coordination and processing of secondary coverage claims will be performed manually. Although you will not receive an electronic response for a secondary coverage claim, your patient is not required to submit a paper claim to Desjardins Insurance for this secondary claim.

First Canadian (Johnston Group): Coordination of Benefits with the same provider is not supported at this time.

GMS: No, coordination of benefits is not supported.

GroupHEALTH: No, this option is not currently available.

GroupSource: No, this option is not currently available.

Industrial Alliance Insurance and Financial Services Inc.: This option is not currently available.

Johnson Inc.: Not at this time, as currently not supported

LiUNA Local 183: No.

LiUNA Local 506: No.

Manion: No, this option is not currently available.

Manulife Financial: No.

Maximum Benefit or Johnston Group: Coordination of Benefits with the same provider is not supported at this time.

Sun Life Financial: If your patient has both primary and secondary coverage with Sun Life Financial, you must complete both the primary and secondary coverage sections of your patient’s claim. Sun Life Financial will issue an electronic response to the primary coverage request only. Your patient is required to submit a manual claim to Sun Life Financial for the secondary coverage claim.

TELUS AdjudiCare: No

BPA: Only one treatment per day for the same procedure code is eligible.

Canada Life: Claims must be submitted manually to Canada Life.

Canadian Construction Workers Union (C.C.W.U.): Only one treatment per day for the same procedure code is eligible.

Chambers of Commerce Group Insurance Plan: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

CINUP (Johnston Group): Yes, you can submit for the same service twice in one day but the second claim will be held for review.

ClaimSecure: Only one treatment per day from the same practitioner is eligible.

Cowan Insurance Group (managed by Express Scripts Canada): Yes, you can submit for the same service twice in one day but the second claim will be held for review.

D.A. Townley: Only one treatment per day for the same procedure code is eligible.

Desjardins Insurance: Members must sign and submit their claims under their Desjardins Insurance plan. Otherwise, claims will automatically be rejected.

First Canadian (Johnston Group): Yes, you can submit for the same service twice in one day but the second claim will be held for review.

GMS: Yes, it is possible, if the procedure code is allowed. If not, only the first claim will be paid.

GroupHEALTH: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan.

GroupSource: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan.

Industrial Alliance Insurance and Financial Services Inc.: Only one treatment per day from the same practitioner is eligible.

Johnson Inc.: Yes, you can submit more than one claim but only the first will be paid, the second claim will be sent to an examiner for review.

LiUNA Local 183: Only one treatment per day for the same procedure code is eligible.

LiUNA Local 506: Only one treatment per day for the same procedure code is eligible.

Manion: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan.

Manulife Financial: No. The member should submit both claims manually to avoid any delays in processing.

Maximum Benefit or Johnston Group: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

Sun Life Financial
Members must sign and manually submit their claim forms to Sun Life Financial.

TELUS AdjudiCare: Only one treatment per day for the same procedure code is eligible.

BPA:

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Canada Life: All eClaims-eligible healthcare provider disciplines are supported except for massage therapy in Quebec.

Canadian Construction Workers Union (C.C.W.U.):

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Chambers of Commerce Group Insurance Plan: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

CINUP (Johnston Group): Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

ClaimSecure: At this time we would like to allow the full list of provider roles to submit claims electronically.

• Vision Care Provider

• Speech language pathologist

• Physiotherapist

• Dietitian

• Chiropractor

• Acupuncturist – Regulated provinces. For un-regulated provinces, if provider is a member of one of the following associations they could be eligible for eClaims, as TELUS has an agreement in place with the association): Acupuncture and Traditional Chinese Medicine Association of Nova Scotia (ATCMANS), Nova Scotia Association of Acupuncturists (NSAA), Chinese Medicine and Acupuncture Association of Canada (2 agreements, one with national & one with Nova Scotia Chapter), Maritime Association of Registered Acupuncturists (MARA)

• Massage Therapist – Regulated provinces. For un-regulated provinces, if provider is a member of one of the following associations they could be eligible for eClaims, as TELUS has an agreement in place with the association: Massage Therapy Association of Alberta (MTAA), Remedial Massage Therapists Association (RMTA), Massage Therapy Association of Saskatchewan (MTAS), Massage Therapy Association of Manitoba (MTAM), New Brunswick Massotherapy Association (NBMA), Association of New Brunswick Massage Therapists (ANBMT), Massage Therapists’ and Wholistic Practitioners’ Association of the Maritimes (MTWPAM), Massage Therapists Association of Nova Scotia (MTANS), Natural Health Practitioners of Canada (NHPC), Prince Edward Island Massage Therapy Association (PEIMTA), Remedial Massage Therapists Society of Manitoba Inc. (RMTS-MB), Certified Registered Massage Therapist Association (CRMTA)

• Naturopathic Doctor: Not rolled out in Quebec at this time. Regulated provinces (BC, AB, SK, MB, ON, NS). For un-regulated provinces, if provider is a member of New Brunswick Association of Naturopathic Doctors (NBAND) they could be eligible for eClaims, as TELUS has an agreement in place with this association. Further provincial provinces in which ND’s are not regulated are being explored

• Podiatrist (currently launched in Quebec only)

Cowan Insurance Group (managed by Express Scripts Canada): At this time, only the following healthcare providers can submit expenses electronically:

• Acupuncturist (Alberta, British Columbia, Ontario, Québec, Newfoundland and Labrador)

• Chiropractor

• Massage therapist (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Saskatchewan)

• Naturopathic doctor (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Saskatchewan)

• Physiotherapist

• Podiatrist (Québec only)

• Psychologist (Québec only)

• Vision care provider (Optician and Optometrist)

The patient must manually submit all other extended healthcare claims.

D.A. Townley: Expenses for the following specialized healthcare providers are supported:

• Acupuncturists

• Chiropodists

• Chiropractors

• Dietitians

• Massage therapists

• Naturopathic doctors

• Opticians

• Optometrists

• Physical Rehabilitation Therapists

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists
  

Desjardins Insurance: All healthcare provider disciplines are accepted.

First Canadian (Johnston Group): Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

GMS: Expenses can be electronically submitted for all healthcare roles that TELUS Health currently supports.

GroupHEALTH: All eClaims-eligible healthcare provider disciplines are supported, except for dietitians and speech language pathologists.

GroupSource: All eClaims-eligible healthcare provider disciplines are supported, except for dietitians and speech language pathologists.

Industrial Alliance Insurance and Financial Services Inc.: The following healthcare providers can submit expenses electronically:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

• Vision care provider (Optician and Optometrist)

Fees are accepted provided the practitioner is licensed by the appropriate provincial or federal organization to practise his/her profession in accordance with the rules of his/her profession.

If the practitioner’s services are covered by a provincial health plan, no coverage will be provided under this benefit for the paramedical care given until the maximum under the provincial plan has been reached.

Johnson Inc.: At this time, only healthcare providers registered with TELUS Health can submit expense forms electronically:

• Acupuncturist

• Chiropractor

• Massage therapist

• Naturopathic doctor

• Physiotherapist

• Vision care provider (Optician and Optometrist)

LiUNA Local 183:

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

LiUNA Local 506:

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Manion: All eClaims-eligible healthcare provider disciplines are supported, except for dietitians and speech language pathologists.

Manulife Financial: Expenses can be submitted electronically for all health care provider roles that TELUS Health currently supports, except Physical Rehabilitation Therapists, Podiatrists, Psychologists, and Chiropodists.

Maximum Benefit or Johnston Group: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

Sun Life Financial: At this time, only the following healthcare providers can submit expense forms electronically:

• Acupuncturiss (Alberta, British Columbia, Ontario, Quebec, Newfoundland and Labrador)

• Chiropractor

• Massage Therapist (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Quebec, Saskatchewan)

• Naturopathic doctor (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Saskatchewan)

• Physiotherapist

• Vision care provider (Optician and Optometrist)

Patients must manually submit all other extended healthcare claims.

TELUS AdjudiCare: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Chiropodist

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Dietitian

• Speech Therapist

How do I contact the insurance company? Please dial 1-800-867-5615.

What are the hours of adjudication? At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. Therefore, claim submission is only available with the option “payable to” the patient. Please ensure you collect the full treatment amount from your clients covered by this insurer.

Once an Acknowledgement is generated, what is the time frame for receiving a response? A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Does the insurer accept predetermination requests that are submitted electronically? At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is payment to provider (benefit assignment) possible? No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. Please ensure you collect the full treatment amount from your clients covered by this insurer.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments? You must always obtain payment from your client for services rendered. This insurer always issues payment for insured expenses directly to its members, in accordance with the method of payment applicable to their plan.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer? No.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)? Only one treatment per day for the same procedure code is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

How do I contact the insurance company?: For questions regarding a response to a claim submitted to Canada Life, please call 1-800-957-9777.

What are the hours of adjudication?: Monday to Friday 6am to 12am ET; Saturdays and Sundays 6:30am to 10pm ET

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Up to 5 business days.

Does the insurer accept a predetermination request submitted electronically?: Yes.

Is payment to provider (benefit assignment) possible?: Canada Life allows benefit assignment, unless prohibited by the insured member’s policy. In such cases, it will be noted in the electronic response.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Canada Life will issue scheduled bundled payments to service providers, by cheque twice monthly or weekly by direct deposit. If you choose to register for direct deposit, payments will be issued by direct deposit into a bank account you designate.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: If your patient holds both primary and secondary coverage with Canada Life, the provider must complete both the primary and secondary coverage sections of the patient’s claim. Canada Life will respond electronically to the primary coverage only and will automatically coordinate and handle the secondary claim manually. Though the provider will not receive an electronic response to the secondary claim, there is no need for their patient to submit a paper claim to Canada Life for the secondary claim. For vision care claims, payment for the secondary coverage will be paid out to the plan member. For all other claim types, payment for the secondary coverage will be paid out to the same recipient as the primary coverage.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Claims must be submitted manually to Canada Life.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: All eClaims-eligible healthcare provider disciplines are supported except for massage therapy in Quebec.

How do I contact the insurance company? Please dial 1 416-240-0047.

What are the hours of adjudication? Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Once an Acknowledgement is generated, what is the time frame for receiving a response? A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Does the insurer accept a predetermination request submitted electronically? At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is payment to provider (benefit assignment) possible? No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments? Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer? No

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)? Only one treatment per day for the same procedure code is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Does Canadian Construction Workers Union (C.C.W.U.) provide real-time adjudication? At this time, C.C.W.U. is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response.
We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient.
C.C.W.U. expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

How do I contact the insurance company?: Should you have any questions about your claim, please call the Group Insurance Line at 1-800-665-3365, or Fax 1-866-878-0951, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

What are the hours of adjudication?: 24/7 with a short maintenance window at 11pm EST.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

Does the insurer accept a predetermination request submitted electronically?: Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

Is payment to provider (benefit assignment) possible?: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. All other provider payments will be made by printed cheque.
All payments are processed every working day for claims processed the day before. Claims held for review or audit are typically released for payment within two business days.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Coordination of Benefits with the same provider is not supported at this time.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

How do I contact the insurance company?: Should you have any questions about your claim, please call the Group Insurance Line at 1-800-665-1234, or Fax 1-877-786-3889, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

What are the hours of adjudication?: 24/7 with a short maintenance window at 11pm EST.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

Does the insurer accept a predetermination request submitted electronically?: Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

Is payment to provider (benefit assignment) possible?: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. All other provider payments will be made by printed cheque.
All payments are processed every working day for claims processed the day before. Claims held for review or audit are typically released for payment within two business days.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Coordination of Benefits with the same provider is not supported at this time.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

Why are my claim requests to ClaimSecure getting rejected?: Not all ClaimSecure clients have been enabled on eClaims yet. This depends on their plan sponsor’s decision. If you receive a rejected response, we recommend you collect the full treatment amount from your client and ask them to submit the claim themselves.

How do I contact the insurance company?: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please dial 1-888-513-4464. The Customer Response Centre is open Monday to Friday, from 7:00 am to 11:00 pm EST. Confidential member/patient information, coverage details and member payments will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the number provided on the member benefit card.

What are the hours of adjudication?: 24/7, excluding maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: ClaimSecure will respond to the provider within 2 to 4 business days.

Does the insurer accept a predetermination request submitted electronically?: Yes.

Is payment to provider (benefit assignment) possible?: Yes, ClaimSecure will allow assignment of payment to the provider, providing that the group has elected this feature. In the event that a claim is submitted with assignment to the provider and the group has elected to pay only members, the claim will be processed and will return a message indicating that the payee has been changed to the member. Please remind the patient that there is no need to submit the claim manually if you have received a successful response.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Payment is made by direct deposit or cheque (providers requiring cheques will incur a fee), depending on how the provider is registered with TELUS Health. Payment is every two weeks. Providers who have opted in to direct deposit with TELUS will automatically be signed up for direct deposit with ClaimSecure and will have an eProfile account created. Login and password details will be sent to the email provided when signing up with TELUS. Please ensure to activate your account.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: If your patient holds both primary and secondary coverage with ClaimSecure, ClaimSecure will respond electronically to the primary coverage only and will automatically coordinate and handle the secondary claim. Though the provider will not receive an electronic response to the secondary claim, there is no need for the patient to submit a paper claim for the secondary claim. Payment for the secondary coverage will be paid out to the member.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Only one treatment per day from the same practitioner is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: At this time we would like to allow the full list of provider roles to submit claims electronically.

• Vision Care Providers

• Physiotherapists

• Chiropractors

• Acupuncturists – Regulated provinces. For un-regulated provinces, if provider is a member of one of the following associations they could be eligible for eClaims, as TELUS has an agreement in place with the association): Acupuncture and Traditional Chinese Medicine Association of Nova Scotia (ATCMANS), Nova Scotia Association of Acupuncturists (NSAA)
  Chinese Medicine and Acupuncture Association of Canada (2 agreements, one with national & one with Nova Scotia Chapter), Maritime Association of Registered Acupuncturists (MARA)

• Massage Therapists – Regulated provinces. For un-regulated provinces, if provider is a member of one of the following associations they could be eligible for eClaims, as TELUS has an agreement in place with the association: Massage Therapy Association of Alberta (MTAA), Remedial Massage Therapists Association (RMTA), Massage Therapy Association of Saskatchewan (MTAS), Massage Therapy Association of Manitoba (MTAM), New Brunswick Massotherapy Association (NBMA), Association of New Brunswick Massage Therapists (ANBMT), Massage Therapists’ and Wholistic Practitioners’ Association of the Maritimes (MTWPAM), Massage Therapists Association of Nova Scotia (MTANS), Natural Health Practitioners of Canada (NHPC), Prince Edward Island Massage Therapy Association (PEIMTA), Remedial Massage Therapists Society of Manitoba Inc. (RMTS-MB), Certified Registered Massage Therapist Association (CRMTA)

• Naturopathic Doctors: Not rolled out in Quebec at this time. Regulated provinces (BC, AB, SK, MB, ON, NS). For un-regulated provinces, if provider is a member of New Brunswick Association of Naturopathic Doctors (NBAND) they could be eligible for eClaims, as TELUS has an agreement in place with this association. Further provincial provinces in which ND’s are not regulated are being explored

• Podiatrists (currently launched in Quebec only)

How do I contact the insurance company?: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada Provider Processing Centre at 1-800-563-3274. Please note that at this time online reversal of claims is not supported. Prior to resubmitting, call Express Scripts Canada’s Call Centre to have your claim reversed.Confidential member/patient information, coverage details and payments, will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the Cowan Call Centre at 1-888-509-7797

What are the hours of adjudication?: We process transactions 24 hours a day, 7 days a week, excluding maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Cowan will respond to the provider within 2 to 4 business days.

Does the insurer accept a predetermination request submitted electronically?: No.

Is payment to provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Providers are paid by cheque or direct deposit based on the information provided by the provider (Direct Deposit or Cheque) when registering with TELUS Health.Frequency: Twice a month (the 5th and the 20th of each month).The providers will be charged a fee for cheque and/or paper statement. By default, the providers are setup with electronic statements. In order to request a paper statement, please contact the Express Scripts Canada Call Centre at 1-800-563-3274.
For further questions, please see the question, “How do I contact the insurance
company?”

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: At this time, only the following healthcare providers can submit expenses electronically:

• Acupuncturist (Alberta, British Columbia, Ontario, Québec, Newfoundland and Labrador)

• Chiropractor

• Massage therapist (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Saskatchewan)

• Naturopathic doctor (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Saskatchewan)

• Physiotherapist

• Podiatrist (Québec only)

• Psychologist (Québec only)

• Vision care providers (Optician and Optometrist)

The patient must manually submit all other extended healthcare claims.

How do I contact the insurance company?: Please dial 1-800-663-1356.

What are the hours of adjudication?: 24/7, excluding occasional maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: A response following a claim acknowledgement is usually processed within one week. Predeterminations and rejected claims are mailed to providers daily. Cheques, along with explanation of benefit statements for payable claims, are mailed on the 1st and 15th of each month.

Does the insurer accept a predetermination request submitted electronically?: Yes, predetermination requests are accepted.

Is payment to provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Direct deposit is not supported.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No, coordination of benefits is not supported.

What do I enter in the Policy and Member ID fields? Where do I find the Policy and Member ID for my patient?: Please see the sample card shown below.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Only one treatment per day for the same procedure code is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses for the following specialized healthcare providers are supported:

• Acupuncturists

• Chiropodists

• Chiropractors

• Dietitians

• Massage therapists

• Naturopathic doctors

• Opticians

• Optometrists

• Physical Rehabilitation Therapists

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

How do I contact the insurance company?: For questions regarding a response to a claim submitted to Desjardins Insurance, contact the Service Desk at 1-800-463-7843. Please note that confidential member/patient information, as well as payment details, will not be disclosed to the healthcare provider.

What are the hours of adjudication?: Acknowledgements are generated 24 hours a day, 7 days a week. Deferred submitted claim requests are processed by Desjardins Insurance within two business days following the request.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Desjardins Insurance sends members a response, including a confirmation that their claim was processed and the adjudication results, within 2 business days.

Does the insurer accept a predetermination request submitted electronically?: Desjardins Insurance does not accept predetermination requests, but does accept online claims for services already rendered.

Is payment to provider (benefit assignment) possible?: Benefit assignment is not available. Benefit payment is always sent directly to the member.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: The provider must always obtain payment from the patient for services rendered. Desjardins Insurance always issues payment for insured expenses directly to its members, in accordance with the method of payment applicable to their plan.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Desjardins Insurance will coordinate benefits for services submitted on a patient’s behalf when preference for such coordination is noted in the patient’s file. All provider-generated requests for coordination of benefits will be ignored. The member is responsible for updating all information in her/his file. Desjardins Insurance will issue electronic responses only for primary coverage issues. Coordination and processing of secondary coverage claims will be performed manually. Although you will not receive an electronic response for a secondary coverage claim, your patient is not required to submit a paper claim to Desjardins Insurance for this secondary claim.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Members must sign and submit their claims under their Desjardins Insurance plan. Otherwise, claims will automatically be rejected.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: All healthcare provider disciplines are accepted.

How do I contact the insurance company?: Should you have any questions about your claim, please call the Group Insurance Line at 1-866-212-5644, or Fax 1-877-526-2515, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

What are the hours of adjudication?: 24/7 with a short maintenance window at 11pm EST.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed in our office and returned to the provider in hard copy form within 2 to 4 business days.

Does the insurer accept a predetermination request submitted electronically?: Electronic submissions of Predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

Is payment to provider (benefit assignment) possible?: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a printed notification will be mailed to you. All other provider payments will be made by printed cheque. All payments are processed every working day for claims processed the day before. Claims that held for review or audit are typically released for payment within two business days.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Coordination of Benefits with the same provider is not supported at this time.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

How do I contact the insurance company? For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada (ESC) Provider Processing Centre at 1-800-563-3274. Confidential plan member/patient information, coverage details and plan member payments will not be disclosed to the healthcare provider. For questions regarding coverage, the member must contact the GMS Call Centre at 1-800-667-3699.

What are the hours of adjudication? 24/7, except Sunday between 12:00 and 7:00 am EST.

Once an Acknowledgement is generated, what is the time frame for receiving a response? Claims are processed within a business day.

Does the insurer accept a predetermination request submitted electronically? No, electronic submissions of predetermination requests are not accepted by the insurance company.

Is payment to provider (benefit assignment) possible? Yes, assignment of payment to the provider is possible, providing the plan member’s policy enabled this feature.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments? Payment is made by direct deposit or cheque (providers requiring cheques will incur a fee), depending on how the provider is registered with TELUS Health. Payment frequency is twice a month (on the 5th and the 20th of each month). Providers are setup with electronic statement by default. To request a paper statement, please contact the Express Scripts Canada Call Centre at 1-800-563-3274.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer? No, coordination of benefits is not supported.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)? Yes, it is possible, if the procedure code is allowed. If not, only the first claim will be paid.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support? Expenses can be electronically submitted for all healthcare roles that TELUS Health currently supports.

I am unable to identify the carrier ID and group number on a client’s pay direct card because the pay direct card is missing this information. Which carrier ID and group number should I indicate? Some individual plan members do not have the carrier number and group number printed on their pay-direct card. The appropriate carrier ID and group number is determined by the member’s province of residence. For residents of Saskatchewan, indicate carrier ID 49 and group number 310138. For residents outside of Saskatchewan, indicate carrier ID 50 and group number 320221.

How do I contact the insurance company, GroupHEALTH Benefit Solutions?: For questions about your claims, please call us at 1-833-344-6944 or write to us at 626 – 21 Four Seasons Place, Toronto, ON M9B 0A6. Our email address is askus@mygrouphealth.ca. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

What are the hours of adjudication?: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed, and members sent a response, within three to five business days.
Will the insurer accept a predetermination requires that is submitted electronically?
Yes, predetermination requests are accepted.

Is payment to the provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No, this option is not currently available.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: All eClaims-eligible healthcare provider disciplines are supported, except dietitians and speech language pathologists.

How do I contact the insurance company, GroupSource?: For questions about your claims, please call us at 1-888-547-6947 or write to us at 200 – 5970 Centre Street SE, Calgary, AB T2H 0C1. Our email address is askus@mygroupsource.ca. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

What are the hours of adjudication?: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed, and members sent a response, within three to five business days.

Does the insurer accept a predetermination request submitted electronically?: Yes, predetermination requests are accepted.

Is payment to the provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No, this option is not currently available.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: All eClaims-eligible healthcare provider disciplines are supported, except dietitians and speech language pathologists.

How do I contact the insurance company?: You can contact the Client Service Department by phone at 1-877-422-6487.

What are the hours of adjudication?: Monday to Friday from 06:00 to midnight ET. Saturday and Sunday from 06:00 to 22:00 ET

Once an Acknowledgement is generated, what is the time frame for receiving a response?: In 50% of cases, a response is provided within 24 hours; in all other cases, a response is provided within 5 business days.

Does the insurer accept a predetermination request submitted electronically?: Electronic submissions of predetermination requests are not currently accepted.

Is payment to the provider (benefit assignment) possible?: Yes, provided the Assignment of Claim document has been signed by the plan member. The provider must keep the signed document in the patient’s file for reference and possible referral by Industrial Alliance.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Direct deposit for providers is currently not supported. The provider will receive 1 cheque per claim along with a paper statement. The cheques are mailed to the provider every 2 to 5 business days depending on the patient’s group parameters. If payment is payable to the patient, the patient will have selected, within their plan parameters, whether they wish to receive an electronic or paper statement.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: This option is not currently available.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Only one treatment per day from the same practitioner is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: The following healthcare providers can submit expenses electronically:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

• Vision care providers (Optician and Optometrist)

Fees are accepted provided the practitioner is licensed by the appropriate provincial or federal organization to practise his/her profession in accordance with the rules of his/her profession.

If the practitioner’s services are covered by a provincial health plan, no coverage will be provided under this benefit for the paramedical care given until the maximum under the provincial plan has been reached.

How do I contact the insurance company?: For questions regarding a claim response, whereby payment has been assigned to the provider/clinic, please contact the Express Scripts Canada Provider Processing Centre at 1-800-563-3274. Confidential member/patient information, coverage details and payments, will not be disclosed to you. For questions regarding coverage, your client must contact Johnson Inc. at 1-866-773-5467.

What are the hours of adjudication?: 24 hours a day, 7 days a week, excluding maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Claims are processed within one business day.

Does the insurer accept a predetermination request submitted electronically?: No, electronic submissions of predetermination requests are not accepted.

Is payment to the provider (benefit assignment) possible?: Yes, it’s possible, but it depends on the member’s insurance policy.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: You will be paid by cheque or direct deposit based on the information you provided when registering with TELUS.

Frequency: Twice a month (the 5th and the 20th of each month)

By default, you are set up with electronic statements. You will be charged a fee for cheques and/or paper statements. In order to request a paper statement, please contact Express Scripts Canada at 1-800-563-3274.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Not at this time, as currently not supported.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit more than one claim but only the first will be paid, the second claim will be sent to an examiner for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: At this time, only healthcare providers registered with TELUS Health can submit expense forms electronically:

• Acupuncturist

• Chiropractor

• Massage therapist

• Naturopathic doctor

• Physiotherapist

• Vision care providers (Optician and Optometrist)

How do I contact the insurance company? Please dial 1 416-240-2103

What are the hours of adjudication? Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Once an Acknowledgement is generated, what is the time frame for receiving a response? A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Does the insurer accept a predetermination request submitted electronically? At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is payment to provider (benefit assignment) possible? No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments? Providers are paid by cheque every 2 weeks. Payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer? No.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)? Only one treatment per day for the same procedure code is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Does LiUNA Local 183 provide real-time adjudication? At this time, LiUNA Local 183 is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. LiUNA Local 183 expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

How do I contact the insurance company? Please dial 1 416-506-8841

What are the hours of adjudication? Claims can be submitted 24/7. At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Once an Acknowledgement is generated, what is the time frame for receiving a response? A response following a claim acknowledgement is usually processed within a week. Pre-determinations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.

Does the insurer accept a predetermination request submitted electronically? At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is payment to provider (benefit assignment) possible? No. At this time, this payer is not providing payment to providers (benefit assignment) or real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication and payments to providers available in 2020. We will communicate this change when it occurs.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments? Providers are paid by cheque every 2 weeks and payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer? No.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)? Only one treatment per day for the same procedure code is eligible.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?

• Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)

• Chiropodists

• Chiropractors

• Massage Therapists

• Naturopathic Doctors

• Physiotherapists

• Podiatrists

• Psychologists

• Speech Therapists

Does LiUNA Local 506 provide real-time adjudication? At this time, LiUNA Local 506 is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient. LiUNA Local 506 expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.

How do I contact the insurance company?: For questions about your claims, please call us at 1-866-532-8999 or write to us at 626 – 21 Four Seasons Place, Toronto, ON M9B 0A6. Our email address is askus@mymanion.com. Please note that confidential member and patient information as well as payment details will not be disclosed to the healthcare provider.

What are the hours of adjudication?: We process claims 24 hours a day, 7 days a week, excluding occasional maintenance periods.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements will be processed, and members sent a response, within three to five business days.

Does the insurer accept a predetermination request submitted electronically?: Yes, predetermination requests are accepted.

Is payment to provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Payments can be made by direct deposit or cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. Direct deposit and cheque payments are made every business day.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No, this option is not currently available.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: In this case, the second of these claims will be considered a duplicate and will be declined. Your patient should submit it manually through their Health plan.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: All eClaims-eligible healthcare provider disciplines are supported, except dietitians and speech language pathologists.

How do I contact the insurance company?: Contact Manulife at 1-866-407-7878, Monday to Friday, from 8am to 8pm EST for English and 8am to 5pm ET for French.

What are the hours of adjudication?: The hours of adjudication are as follows: Monday to Friday: 5:30am to 12:30am EST. Saturday: 5:30am to 8:00pm EST. Sunday: 8:00am to 10:00pm EST

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Manulife treats the Acknowledgement in five to seven working days. Payment for Acknowledgements is made to the patient.

Does the insurer accept a predetermination request submitted electronically?: No.

Is payment to provider (benefit assignment) possible?: Yes.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Payments to providers will be issued daily via direct deposit only. No cheques will be issued. Payments made via direct deposit are forwarded to your financial institution within one business day of your claim being paid (claim is paid on business day following day of submission). Your financial institution determines when the payment is deposited to your account. Real-time statements are issued at the time of claims submission. Please ensure you print or save transaction responses at time of submission to facilitate reconciliation when payment is deposited to your account.

Manulife’s solution is completely electronic – no paper cheques or statements will be issued. If you want to receive payment from Manulife, you must sign up for direct deposit with TELUS Health so that payments can be deposited directly to your bank account. If you have yet to provide your banking information to TELUS Health, you will still be able to submit claims to Manulife. You will receive a message that payment will go directly to the plan member and you should collect the full amount from your patient.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: No.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: No. The member should submit both claims manually to avoid any delays in processing.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses can be submitted electronically for all health care provider roles that TELUS Health currently supports, except Physical Rehabilitation Therapists, Podiatrists, Psychologists, Dietitians, Speech Language Pathologists and Chiropodists.

How do I contact the insurance company?: Should you have any questions about your claim, please call the Group Insurance Line at 1-800-893-7587, or Fax 1-866-878-0951, or write to us at 1051 King Edward Street, Winnipeg, MB, R3H 0R4.

What are the hours of adjudication?: 24/7 with a short maintenance window at 11pm EST.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Acknowledgements are treated in our offices and returned to providers within two to four business days.

Does the insurer accept a predetermination request submitted electronically?: Electronic submissions of predetermination requests are accepted. In most cases, the predetermination will result in an immediate response of eligible amounts. In rare cases, the predetermination will be held for review. In those cases, the completed predetermination will be returned to the provider in hard copy form within 2 to 4 business days.

Is payment to provider (benefit assignment) possible?: Payments to the provider are supported. The insured will be notified of any claims processed using their identification numbers.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Provider payments can be made by direct deposit or by printed cheque. If you have signed up for direct deposit through TELUS Health, you will be paid by direct deposit and a notification will be emailed to you. All other provider payments will be made by printed cheque.All payments are processed every working day for claims processed the day before. Claims held for review or audit are typically released for payment within two business days.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: Coordination of Benefits with the same provider is not supported at this time.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Yes, you can submit for the same service twice in one day but the second claim will be held for review.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Speech language pathologist

How do I contact the insurance company?: For questions regarding a response from Sun Life Financial where payment has been assigned to the provider/clinic, contact the Sun Life Financial Customer Care Provider Line at 1-855-301-4SUN (4786). Please note that enquiries from providers are accepted only if payment was assigned to the provider, if Sun Life Financial has asked the provider for additional information, or if the member/patient is present in the provider’s office at the time of the call. You must also provide the patient’s policy number and member ID during the call.

What are the hours of adjudication?: The Sun Life Financial system can respond with payment details from 6:01 a.m. to 12:00 a.m. EST 7 days a week. Outside this period, only an Acknowledgement will be generated.

Once an Acknowledgement is generated, what is the time frame for receiving a response?: Up to five business days.

Does the insurer accept a predetermination request submitted electronically?: No.

Is payment to provider (benefit assignment) possible?: Sun Life Financial will only accept assignment to providers if the provider is registered for Electronic Fund Transfer (EFT) or direct deposit. To update your TELUS Health profile with your relevant banking details, you must complete and submit the Provider Profile Change Request Form found in the Tools section of the portal.

Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?: Multiple direct deposit payments for claims processed on a given day may be sent out. Sun Life Financial will only provide payment through Direct Deposit. Where applicable, payments are deposited into the payee’s account and may take up to 48 hours to appear after the claim has been processed. A Sun Life Financial Provider Statement will be issued by email per deposit made to your bank account to help reconcile the claims with each deposit. It is crucial that you inform TELUS Health should your contact or banking information change (e.g. bank account details, email address, name, address, etc.) This is particularly important in the case of banking information, which may lead to payment rejection, and email address, since an incorrect address may cause the provider statement to bounce back.

Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?: If your patient has both primary and secondary coverage with Sun Life Financial, you must complete both the primary and secondary coverage sections of your patient’s claim. Sun Life Financial will issue an electronic response to the primary coverage request only. Your patient is required to submit a manual claim to Sun Life Financial for the secondary coverage claim.

Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?: Members must sign and manually submit their claim forms to Sun Life Financial.

What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?: At this time, only the following healthcare providers can submit expense forms electronically:

• Acupuncturists (Alberta, British Columbia, Ontario, Quebec, Newfoundland and Labrador)

• Chiropractor

• Massage Therapists (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Quebec, Saskatchewan)

• Naturopathic doctors (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Saskatchewan)

• Physiotherapist

• Vision care providers (Optician and Optometrist)

Patients must manually submit all other extended healthcare claims.

What is TELUS AdjudiCare? On eClaims, TELUS AdjudiCare is an aggregated submission option that is used by many different small insurers and third party payers (TPPs) who cover small groups of plan members. They use a solution called AdjudiCare to process drug, dental and extended healthcare claims. They are now connected to eClaims as one aggregated submission option to help ease your experience when selecting an insurer in the claim submission process. Since TELUS AdjudiCare is aggregated and each payer under this name has its own processes, your experience when direct billing to this group will vary, depending on the payer receiving the claim/predetermination request.

How do I contact the insurance company? TELUS AdjudiCare is aggregated used by many different small insurers. The contact phone number will connect you with the TELUS AdjudiCare customer support team. If they are unable to answer your question about that claim or member, they will connect you with the appropriate insurer based on the member you are inquiring about. TELUS AdjudiCare Customer Support: 1-877-944-7100

What are the hours of adjudication? 24/7

How long does it take to receive a response when an Acknowledgement is generated? TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, the response time varies by each insurer/payer under TELUS AdjudiCare. The processing time varies from one to two weeks, plus transit time to mail the statements.

Are electronic submissions of Predetermination requests accepted by the insurance company? Yes. Please note: Since TELUS AdjudiCare is aggregated and used by many different small insurers; the response time for a predetermination varies by each insurer.

Is payment to provider (benefit assignment) possible? TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, this varies by each insurer/payer under TELUS AdjudiCare. As long as the payer and the benefit plan allow for payment to the provider then the claim will be accepted. If payment to the provider is not allowed, then the claim submission will be rejected and the explanation of benefits returned to you. eClaims will indicate this as the rejection reason.

How are we paid for claims, i.e. cheque or direct deposit? TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, this varies by each insurer/payer under TELUS AdjudiCare.

What is the frequency of payment? Payment is sent within 3 and 10 business days, by either cheque or EFT (direct deposit).

If direct deposit can be set up, is a payment statement issued? At this time, payment statements are sent by mail. In 2020, electronic payment statements will be available.

Co-ordination of Benefits: Can I coordinate benefits if my patient has both primary and secondary coverage with the same insurance company? No

What do I enter in the Policy and Member ID fields? Where do I find the Policy and Member ID for my patient? TELUS AdjudiCare is aggregated and used by many different small insurers. As a result, this varies by each insurer under TELUS AdjudiCare. The cards generally follow the format below and use these titles for the ID numbers shown. Most of these cards will include reference to “TELUS AdjudiCare” (as shown in the sample below).

Can I submit for the same service twice in one day (e.g. same service on two different body parts or the same service in the same day – morning and evening)? Only one treatment per day for the same procedure code is eligible.

What type of expenses can be submitted electronically? Which specialized healthcare provider roles are supported? Expenses for the following specialized healthcare providers are supported:

• Acupuncturist

• Chiropractor

• Chiropodist

• Dietitian

• Massage therapist

• Naturopathic doctor

• Optician

• Optometrist

• Physical Rehabilitation Therapist

• Physiotherapist

• Podiatrist

• Psychologist

• Dietitian

• Speech Therapist

If you are waiting on an outstanding payment or have other payment inquiries, please contact the affected insurer. Refer to the Insurer-specific section to consult all of the insurers’ contact information.

Depending on the insurance company’s preference, you may receive a cheque or an Electronic Fund Transfer (or direct deposit) payment.

Once you are registered and have access to the provider portal, you will have to register for direct deposit in order to benefit from using eClaims.

Yes, benefit assignment is possible. The payment can be assigned to the provider or to the organization (clinic) the provider works for.

Note: In some cases, the insurance company or patient's coverage does not permit the provider or provider's organization to be paid.

Payment is made directly by the insurance company. Please refer to the insurer-specific toolkits on the eClaims resources page for further information or contact the insurer directly.

Contact the affected insurer for questions or issues pertaining to:

• Payment, payment statement, direct deposits

• The insurer’s portal or website

• Specific claim responses

• If you are able to submit to many insurers except one and want to know why, please contact them directly

Refer to the Insurer-specific section to consult all of the insurers’ contact information.

In the eClaims mobile app, you can contact the insurer directly by selecting “Insurer” from the footer and tapping on the phone number to call them directly from your mobile device.

Contact TELUS for questions or issues pertaining to:

• Registration

• Portal login, navigation or error messages

• Provider or clinic profile change requests

• Technical issues with the portal

To contact us, dial 1-866-240-7492.

It is important to receive consent from the insurance policy holder in order to submit your patient’s healthcare payment request or predetermination electronically. This document should be printed, signed and kept on file for seven years. A new signature is required whenever the information collected on the form changes. To access the form, click here.

To change the user’s portal language (from English to French or vice-versa) go to the Welcome page, click the “Update my security profile information” link. Enter your username and password. From the “Preferred language” drop-down list, select a language, then click the “Submit” button.

Your feedback is greatly appreciated and enables us to improve the quality of our service. Please email us at provider.mgmt@telus.com.

A claim should be submitted only after you have rendered services to your patient. Some insurers allow the submission of a predetermination request before services are rendered, for the purpose of estimating a patient’s coverage level. For insurers who do not offer a predetermination option, it is strictly prohibited to submit a claim prior to providing services to the patient.

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eClaims is a value-added service that is meant to be free of charge for both you and your clients. No additional fee of any kind, e.g. cancellation fee, electronic billing fee or administration fee, may be billed to a plan member/patient for submitting their claim through the eClaims service. Only claim amounts for the actual services rendered may be submitted.

You can consult the eClaims terms and conditions here.