eClaims Frequently Asked Questions

About eClaims and TELUS Health

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 portal. Once you have logged in to the portal and set up your profile, you can use the same login credentials to access eClaims via the mobile app. Simply download the app from the Apple or Android stores.

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.

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

You can use the eClaims mobile app to submit claims from the mobile device that you have on your person, rather than having to go in front of a computer screen. During this process, you can hand your device to your patient so that they can provide consent to receive responses by email, rather than having to print responses and have them manually signed.

You will need to complete infrequent tasks operations, such as profile changes, updates to banking information, and adding users and providers, from the eClaims portal. You cannot view or submit predeterminations from the eClaims app.

Registration

Canada Life
Manulife Financial
Sun Life Financial
BPA
Canadian Construction Workers Union
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

Accessing eClaims

From your mobile device, launch the Apple or Google App marketplace. From there, search for and download the “TELUS Health eClaims” app (it’s free).

The administrator user for your profile will need to accept new terms and conditions to allow all users to access the app. The administrator user can accept them once they downloaded the app. The administrator user for your profile might have decided to block users from accessing the app. The administrator user can grant access to the app using the “User Access & Permissions” tool in the portal.

If you enter the incorrect password for your account 5 times in a row, your account will be locked.

If you’ve been locked out of the Provider Portal, please wait 15 minutes. Then open a new browser session and re-enter your existing password. If you are still not ableunable to access your account, please call us at 1-866-240-7492.

If you’ve been locked out of the eClaims app, you must call TELUS Health to have it unlocked.

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.

There are two potential reasons:

If you have not logged into eClaims within the past 30 days, you will not be able to use biometrics to log in; you will need to enter your username and password. Once you have logged in with your password, you will be able to use biometrics again.
If you just changed your password inthe eClaims portal and then you opened the eClaims app, you will have to enter the new password, even if you have biometrics enabled. Once you have logged in with your new password, you will be able to use biometrics again.

Training and support material

Profile updates and user access & permissions

Please note that if you would like to add additional associate providers you will need to do this from the “User Access & Permissions” link in the portal. Only user administrators can add other users. You can create the usernames of the new users to be associated to your profile. The users’ credentials are emailed to them.

You must add users from the Provider Portal. These changes cannot be done in the mobile app.

To create a new user:

Log into the eClaims Provider Portal
Click on the “User Access & Permissions” link on the main screen
Click the "New user" button
Fill in the required fields with the appropriate information (especially the email address field)
In the role section, select the role that the user should be granted to have. Please note: if eClaims submission is selected, then a work location must also be selected to proceed
Click the "Create" button
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.

You must add healthcare providers from the Provider Portal.

Login to the eClaims Provider Portal
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.

You must edit users from the Provider Portal. Only users with user administrator access can modify existing users.

To modify an existing user:

Log into the eClaims Provider Portal.
In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.
From the available results, click the username of the user that you want to modify.
Update the required field(s) and/or role access.
Click the “Submit” button.
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.

You must deactivate users from the Provider Portal. Only users with user administrator access can modify existing users.

To deactivate a user:

Log into the eClaims Provider Portal.
In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.
From the available results, click the username of the user that you would like to deactivate.
In the “Status” field, use the drop-down list to select “Inactive”.
Click the “Submit” button.
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.

You must delete users from the Provider Portal. Only users with user administrator access can modify existing users.

To delete a user permanently:

Log into the eClaims Provider Portal.
In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.
From the available results, locate the user to delete and click the trash button.
Review the warning message. Deletions are permanent.
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.

You must set up user access from the Provider Portal. Only users with user administrator access can modify existing users.

To provide another user with "User Admin" access:

Log into the eClaims Provider Portal.
In the User Access & Permissions screen, enter the first or last name of the user and click the “Filter” button.
From the available results, click the username of the user to whom you want to provide user administrator access.
Select the “User Administrator” check box.
Click the “Submit” button
Click the “Done” button

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

You must add locations from the Provider Portal.

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.

Click the “Forgot/reset my password” link in the Provider Portal login screen, or the “Forgot your password” link in the eClaims mobile app 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 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 to, as long as it has not been used on another eClaims user profile.

To avoid this issue please make sure that everyone using eClaims in your practice creates their own user account. Leverage the “User Access & Permissions” tool in the portal to do so.

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:

Log into the eClaims portal.
Click "Other Profile Updates".
Click "Clinic", then click "Manage Providers and their roles for eClaims".

You may have multiple accounts for the Provider Portal that you want to combine. For example, perhaps you registered with the Provider Portal twice, first with your birth name and then later with your married name, or perhaps you registered your clinic twice under different clinics. Once merged, key information from both accounts, such as your roles, service locations (independent providers) and provider list (organizations), will be combined and available under the merged account. Both sets of login credentials will continue to work and both sets of IDs and associated billing history are retained.

If you would like to merge your two accounts, follow these steps:

Log in to the eClaims portal.
Click "Merge accounts".
You will need the username, password and TELUS Provider IDs for both accounts that you want to merge. Your TELUS Provider ID was included in your welcome package. It is also displayed in the top right-hand corner of the provider portal homepage.
You will also need the Merge Administrator role for both accounts. For information on roles, see How do I add additional users?

Claim submission

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 or email. You must give a copy to your patient. If you are using the eClaims mobile app, you can email the response directly to your client.

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 the 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 acknowledgement advising you that the claim has been received and accepted for further processing. eClaims 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 recipient member. To avoid this, you can void an acknowledged claim, collect the full amount from your client and resubmit with payment to the recipient member.

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.

In the portal, this can be done by selecting “Predetermination Request” rather than “Payment Request” when you first start a transaction. 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, and online predetermination requests are not supported by all participating insurance companies.

Predeterminations are not available in the eClaims mobile app. 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.

Desjardins is in the process of changing their claim processing system for 2021. For some policies/groups, they will be able to process claims in real time and allow the payment to go to the providers or clinics/organizations. For others, the claims will continue to be accepted but they will be processed at a later time. These claims will result in acknowledgments (claim pending), and the payments will go to the insured members. The TELUS Health Provider Portal will allow you to select “Payable to Provider or Clinic/Organization” if the new Desjardins claims processing system is processing the claims for the policy/group of the patient. By the end of 2021, Desjardins will be able to process claims in real time and allow payments to go to the provider or clinic/organization for all groups.

A saved/draft transaction can only be completed on the same day it was initially saved. These transactions may be found under “Today’s transactions” in the eClaims portal, or in the Claims section of the Drafts tab in the eClaims mobile app. Please print or download a PDF version of the explanation of benefits from the eClaims portal, or save or email it from the eClaims mobile app, on the day of submission. The saved/draft claim will be archived at midnight eastern time.

From the eClaims web portal, you may view previously submitted transactions for the current month as well as the previous month. Simply go to the “Past Transactions” section, where you can search among the available transactions. The information contained in the “Past Transactions” section is a summary of the claim to help you balance your account. You will not be able to access the explanation of benefits starting the day after the claim is submitted. To request a copy of the explanation of benefits after it is archived, please contact the insurer directly.

From the eClaims mobile app, you can view transactions submitted within the current and previous months. To do so, click the “View submitted claims” link on the home screen. The claims are grouped by the date that they were submitted, and sorted from most to least recent.

You can use filters in the top right-hand corner of the screen to facilitate your search.

Desjardins is in the process of changing their claim processing system for 2021. For some policies/groups, they will be able to process claims in real time and allow the payment to go to the providers or clinics/organizations. For others, the claims will continue to be accepted but they will be processed at a later time. These claims will result in acknowledgments (claim pending), and the payments will go to the insured members. By 2021, Desjardins will be able to process claims in real time/automatically and allow payments to go to the provider or clinic/organization for all groups.

The sender address is the name of the independent provider or organization name, but the email address is a no-reply email address from the TELUS Health server.

The email identifies the patient’s name and the name of the healthcare provider, the date that the patient authorized the provider to submit a claim on their behalf, the amount and percentage of the claim that was covered, and the cost of the treatment. It invites the patient to open the attached claim response or visit their insurer’s web portal or mobile app for more information, and to address any further questions to their insurer.

Virtual services

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.

Personal protective equipment (PPE)

Voiding a claim

If the request was submitted that day, you can void or cancel it. From the eClaims portal, locate it from the “Today’s transactions” section, then click the “Void” button. From the eClaims mobile app home screen, click the “View submitted claims” link, then select the claim and click 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 be cancelled.

Coordination of benefits (primary and secondary coverage)

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.

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.

Insurer’s responses and eClaims messages

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.

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.

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.

Insurer-specific (grouped by questions)

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.

RWAM: To contact RWAM, dial 1-877-888-7926.

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.

Union Benefits; To contact Union Benefits, dial 1-800-265-2568 from 9 a.m. to 5 p.m., Monday to Thursday, and from 9 a.m. to 4 p.m. on Friday.

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.

RWAM: Claims are processed daily, from 6 a.m. to midnight ET.

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.

Union Benefits: Claims are processed 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.

RWAM: Following a claim acknowledgement, RWAM usually processes the response within 5 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.

Union Benefits: Responses for predeterminations are provided in one to four weeks.
Responses for rejected claims, payments and explanations of benefits (EOB) are provided within 2 to 3 business days.

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.

RWAM: Yes, electronic predetermination requests are accepted.

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.

Union Benefits: Yes.

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.

RWAM: Yes.

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.

Union Benefits: Yes.

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.

RWAM: Healthcare professionals and clinics are paid by Electronic Funds Transfer (EFT) on the day following the approval. Payments are issued every business day. It is possible to set up direct deposit for payments. Payment statements are mailed along with cheques and send by email when electronic payment is set up.

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.

Union Benefits: Healthcare professionals and clinics are paid by cheque every 2 to 3 business days. Payment statements are enclosed with the cheques.

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.

RWAM: No, coordination of benefits is not supported.

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.

Union Benefits: No, coordination of benefits is not supported.

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.

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

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.

Union Benefits: 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

RWAM: Expenses for the following specialized healthcare providers are supported:

Acupuncturists
Chiropodists
Chiropractors
Dietitians
Massage therapists
Naturopathic doctors
Opticians
Optometrists
Physical Rehabilitation Therapists (Québec only)
Physiotherapists
Podiatrists
Psychologists
Speech-Language Pathologists

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

Union Benefits: The following healthcare professionals are supported by this insurer:

Acupuncturists
Chiropodists
Chiropractors
Dieticians
Massage Therapists
Naturopathic Doctors
Opticians
Optometrists
Physical Rehabilitation Therapists
Physiotherapists
Podiatrists
Psychologists
Speech-Language Pathologists

Insurer-specific (grouped by insurer)

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.