Claims processing for TPAs and TPPs
Adjudication & claims management made simple with AdjudiCare
Benefit from an effective and cost-efficient adjudication and claims payment product. With AdjudiCare you can:
Help identify fraud
Our patented Optical Character Recognition (OCR) technology flags suspicious healthcare claims for review.
Customize AdjudiCare to suit your needs
No matter how many plan designs, funding arrangements or organizations you work with, our claims processing software can handle your adjudication process.
Offer your clients proven claims management
Streamline the adjudication process and make electronic claims processing and payment more efficient with our health and dental claims software.
What you’ll love about it
Process claims more efficiently
- Handle both fully-insured and self-insured plans with the same software
- Possibility to process e-health and e-dental claims instantly*
- Allow end-users to electronically submit health and dental claims
- Enable healthcare providers including physiotherapists, chiropractors, opticians and optometrists across Canada, and eligible massage therapists, naturopathic doctors and acupuncturists to submit claims on behalf of their patients
- Control the claims process from end-to-end with powerful software
- Reduce your carbon footprint by processing claims electronically
Tailor AdjudiCare to your needs
- Easily add a Health Care Spending Account or a Cost Plus plan to a traditional health and dental plan
- Provide transparency and hands-on access to plan members and plan administrators through an online claims access portal
- Offer a fully branded and customizable benefits platform to your clients through a plan member mobile app and web portal
- Give administrators easy access to up-to-the-minute coverage status and pertinent member details, with employee claims filtered by category, benefit type, service date and payment details
Manage, adjudicate and pay out claims, quickly and simply
Streamline the adjudication process for electronic drug, dental and extended healthcare claims while building your brand. AdjudiCare ensures that claims are adjudicated and paid quickly, allowing flexibility and transparent disclosure on the benefit plan.
Here’s what AdjudiCare can do for you
Streamline claims processing
With AdjudiCare, plan members can submit electronic claims through our intuitive mobile app or web portal, and healthcare providers can submit claims on behalf of their patients. Our rules-based engine allows for claims to be adjudicated and paid in real-time*.
Provide clients with customized service
Access plan and sponsor members details, including current coverage with one click. Compile reports to easily analyze claims history and provide clients with tailored advice and efficient service.
Accommodate multiple plan designs
AdjudiCare can adapt to different business needs, including various plan designs, funding arrangements or number of organizations you work with. It can be adjusted for coverage of First Nations and Inuit plan members, Health Care Spending Accounts and more.
More solutions for TPAs and TPPs
My health benefits
Provide plan members with access to their benefit plan information and allow them to submit claims via their mobile device or desktop computer.
Transmit claims information from the point-of-sale to the TELUS Health adjudication engine and back to the healthcare provider, even if you’re not using a TELUS Health solution.
All features, functions, eligible professions and related benefits are inherent to the AdjudiCare system, but may not be supported by all participating insurers.
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