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eClaims Frequently Asked Questions

About eClaims and TELUS Health

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TELUS Health is a leader in Telehomecare, electronic medical and health records, consumer health, benefits management and pharmacy management. Our solutions give health authorities, providers, patients and consumers the power to turn information into better health outcomes.

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Providers who would like to register for eClaims do not have to be TELUS Mobility customers nor do the plan members.

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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.

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You can register for eClaims at telushealth.co/eclaims. TELUS 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.

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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.

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  • 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
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eClaims is free for healthcare providers and their patients.

 

Registration

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  • Great-West Life
  • Manulife Financial
  • Sun Life Financial
  • Chambers of Commerce Group Insurance Plan
  • CINUP
  • ClaimSecure
  • Cowan Insurance Group (managed by Express Scripts Canada)
  • Desjardins Insurance
  • First Canadian
  • GroupHEALTH
  • GroupSource
  • Industrial Alliance
  • Johnson Inc.
  • Johnston Group
  • Manion
  • Maximum Benefit
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  • Acupuncturists
  • Chiropodists
  • Chiropractors
  • Massage Therapists
  • Naturopathic doctors (Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario, Saskatchewan)
  • Physical Rehabilitation Therapist
  • Physiotherapists
  • Podiatrists
  • Psychologists
  • Vision care providers (Opticians and Optometrists)
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Following registration, processing may take up to 3 weeks. 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.

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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.

 

Accessing the eClaims portal

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

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

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Please send an email to provider.mgmt@telus.com

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Please send an email to provider.mgmt@telus.com

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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.

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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 login 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.

Profile updates and user management

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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.

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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.

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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.

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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.

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To create a new user:

  1. Click on User Management 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 Create button
  7. Click Done button

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

Please refer to the Provider Portal User Management Guide for additional details.

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To modify an existing user:

  1. In the User Management screen, enter the first or last name of the user and click Filter
  2. From the available results, click on the username of the user that you want to modify
  3. Update the required field(s) and/or role access
  4. Click Submit button
  5. Click Done button

Please refer to the Provider Portal User Management Guide for additional details.

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To deactivate a user:

  1. In the User Management screen, enter the first or last name of the user and click Filter
  2. From the available results, click on the username of the user that you would like to deactivate
  3. In the Status field, use drop down menu to select “Inactive”
  4. Click Submit button
  5. Click Done button

Please refer to the Provider Portal User Management Guide for additional details.

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To delete a user permanently:

  1. In the User Management screen, enter the first or last name of the user and click Filter
  2. From the available results, locate the user to delete and click the garbage icon
  3. Review the warning message since once the user is deleted it will be permanent
  4. Click Delete button

Please refer to the Provider Portal User Management Guide for additional details.

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To provide another user with “User Admin access”:

  1. In the User Management screen, enter the first or last name of the user and click Filter
  2. From the available results, click on the username of the user that you want to provide “User Admin” access to
  3. Check the box next to the “User Administrator” role
  4. Click Submit button
  5. Click Done button

Please refer to the Provider Portal User Management Guide for additional details.

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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.

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Once you log into the provider portal using your username and password, you will notice there is a section called My Profile. Click on 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.

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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.

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To change the account type, you must first deactivate your existing account. To do so, 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. Then, you must re-register for eClaims as an organization. Register.

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

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If you have forgotten your password, click on Forgot/reset my password from the login screen and you will be prompted to answer your personal security questions to reset your password. Click on Update my security profile information if you want to change your security questions.

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

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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.

 

Claim submission

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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.

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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. In which case you will receive an acknowledgment advising you that the claim has been received and accepted for further processing.

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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 pre-populate certain fields.

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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.

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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.

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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.

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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.

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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.

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

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

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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.

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

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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.

 

Voiding a claim

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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.

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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.

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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.

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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.

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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.

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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’s notes” section.

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The void function is not available on Manulife claims.

Coordination of benefits (primary and secondary coverage)

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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.

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

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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.

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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 mother’s policy as secondary.
 

Insurer’s responses and portal messages

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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.

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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’s notes section.

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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.

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If the ‘Payable to’ field of the Acknowledgement indicates that payment will be made to the “Insured member,” you should request full payment from your patient as all insurer payments will be sent directly to the insured member.

If the “Payable to” field on the response is blank, you can either:

  • Wait for the insurer’s final response before requesting payment of 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, you select the “Insured member” option in the “Payable to” field. Please refer to the Insurer-Specific Information section for further details.

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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.

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Yes. All submitted claims are automatically saved in “Today’s transactions” 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 will not necessarily be saved, depending on the cause of the error.

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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.

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The full original request and response are available only on the day the request was submitted. As of the next day, only a summary view of the request and response are available in the “Past transactions” section.

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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’s notes” section in the box where the error message is displayed – it should provide further details on the error. If the “Insurer’s 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 question)

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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.

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.

Great-West Life Assurance Company For questions regarding a response to a claim submitted to Great-West Life Assurance Company, please call 1-800-957-9777.

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.

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.

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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.

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.

Great-West Life Assurance Company The Great-West Life Assurance Company system can respond with payment details from 6:30 a.m. to 10:00 p.m. EST from Monday through Saturday. The system will be available on most statutory holidays, except when the holiday falls on a Sunday. Outside this period, only an Acknowledgement will be generated.

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.

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.

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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.

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.

Great-West Life Assurance Company Up to 5 business days.

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.

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.

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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.

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.

Great-West Life Assurance Company Yes.

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.

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.

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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.

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.

Great-West Life Assurance Company Great-West Life Assurance Company allows benefit assignment, unless prohibited by the insured member’s policy. In such cases, it will be noted in the electronic response.

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.

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.

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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?”

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.

Great-West Life Assurance Company Great-West 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.

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.

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.

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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.

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.

Great-West Life Assurance Company If your patient holds both primary and secondary coverage with the Great-West Life Assurance Company, the provider must complete both the primary and secondary coverage sections of the patient’s claim. Great-West 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 Great-West 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.

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

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.

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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.

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.

Great-West Life Assurance Company Claims must be submitted manually to Great-West Life Assurance Company.

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.

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.

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

  • Acupuncturist
  • Chiropractor
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist

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

  • Acupuncturist
  • Chiropractor
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist

ClaimSecure 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)

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 providers (Optician and Optometrist)

The patient must manually submit all other extended healthcare claims.

Desjardins Insurance All healthcare provider disciplines are accepted.

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

  • Acupuncturist
  • Chiropractor
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist

Great-West Life Assurance Company All eClaims-eligible healthcare provider disciplines are supported except for massage therapy in Quebec.

GroupHEALTH All eClaims-eligible healthcare provider disciplines are supported.

GroupSource All eClaims-eligible healthcare provider disciplines are supported.

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

  • Acupuncturist
  • Chiropractor
  • Massage therapist
  • Naturopathic doctor
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
  • Vision care providers (Optician and Optometrist)

Fees are accepted provided the practitioner is licensed by the appropriate provincial or federal organization to practice 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 providers (Optician and Optometrist)

Manion All eClaims-eligible healthcare provider disciplines are supported.

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
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist

Sun Life Financial 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.

 

Insurer-specific (grouped by insurer)

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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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)
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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.

Will the insurer accept a predetermination request that is submitted electronically? No.

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

Payment: How will payment be handled for claims submitted via the portal? 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.

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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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.

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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
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How do I contact the insurance company? For questions regarding a response to a claim submitted to Great-West Life Assurance Company, please call 1-800-957-9777.

What are the hours of adjudication? The Great-West Life Assurance Company system can respond with payment details from 6:30 a.m. to 10:00 p.m. EST from Monday through Saturday. The system will be available on most statutory holidays, except when the holiday falls on a Sunday. 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 5 business days.

Will the insurer accept a predetermination request that is submitted electronically? Yes.

Is payment to provider (benefit assignment) possible? Great-West Life Assurance Company 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 via the portal? Would it be possible to set up a direct deposit option for payments? Great-West 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 the Great-West Life Assurance Company, the provider must complete both the primary and secondary coverage sections of the patient’s claim. Great-West 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 Great-West 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 Great-West Life Assurance Company.

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.

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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 provider (benefit assignment) possible? Yes.

Payment: How will payment be handled for claims submitted via the portal? 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.

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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.

Will the insurer accept a predetermination requires that is submitted electronically? Yes, predetermination requests are accepted.

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

Payment: How will payment be handled for claims submitted via the portal? 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.

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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.

Will the insurer accept a predetermination request that is submitted electronically? Electronic submissions of predetermination requests are not currently accepted.

Is payment to 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 via the portal? 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
  • Massage therapist
  • Naturopathic doctor
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
  • Vision care providers (Optician and Optometrist)

Fees are accepted provided the practitioner is licensed by the appropriate provincial or federal organization to practice 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.

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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.

Will the insurer accept a predetermination request that is submitted electronically? No, electronic submissions of predetermination requests are not accepted.

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

Payment: How will payment be handled for claims submitted via the portal? 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)
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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.

Will the insurer accept a predetermination requires that is submitted electronically? Yes, predetermination requests are accepted.

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

Payment: How will payment be handled for claims submitted via the portal? 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.

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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.

Will the insurer accept a predetermination request that is submitted electronically? No.

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

Payment: How will payment be handled for claims submitted via the portal? 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, and Chiropodists.

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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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
  • Massage therapist
  • Naturopathic doctor
  • Optician
  • Optometrist
  • Physical Rehabilitation Therapist
  • Physiotherapist
  • Podiatrist
  • Psychologist
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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.

Will the insurer accept a predetermination request that is 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 via the portal? 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.

Payment

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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.

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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.

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Payment is made directly by the insurance company. TELUS does not currently bulk or bundle multiple payments to a provider on behalf of participating insurance companies.

General questions

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It is important to ask your patient or, in the case of minor, his/her parent/guardian, for permission to submit the patient’s healthcare payment request or predetermination electronically.

This document should be printed, signed and kept on file. A new signature is required whenever the information collected on the form changes.

To access the form, click on the Authorization Forms tab in the portal.

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It is important that your patient or his/her parent/guardian sign the Benefit Assignment form when payment is assigned to your practice. This ensures that both your patient and/or the patient’s insurer understand how payment is assigned and that all appropriate authorizations have been received.

This document should be printed, signed and kept on file. A new signature is required whenever the information collected on the form changes.

To access the form, click on the Authorization Forms tab in the portal.

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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.

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

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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 Provider Portal. Only claim amounts for the actual services rendered may be submitted.

 

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