Submitting claims to TELUS eClaims requires a 'Managing patient invoices' permission on your account. You can check with the clinic manager to see if you have such permission.
Submitting a claim
From the patient invoice page, on the right-hand side, click on New claim.
When creating a new claim, if you select that the insurance payment is payable to the Service provider, you will be asked to select one of your payment methods. We recommend setting up a dedicated payment method for TELUS eClaims.
In the popup form, complete the required information. Once the basic information has been added to the claim page, you can add all the services/products that are part of this claim.
Click on Add an item, and fill out the popup form with:
- The associated line item from the invoice;
- The service/product type;
- The quantity: this value should be in minutes for services and the number of items for a product;
- The price/cost of the service or product.
Once all the items have been added and you are ready to submit the predetermination claim to TELUS, check that you agree to the terms and conditions and that you obtained the authorization and consent from the patient, and then click on Submit to TELUS eClaims.
This will submit the claim to TELUS, and within a few seconds, the insurer's response will be displayed.
What happens when a claim is accepted?
When a claim is submitted and accepted, a response containing an Explanation of Benefits (EOB) is returned.
The Explanation of Benefits will include a summary of the services submitted (box #1 in the image below), and how much is eligible to be covered by the insurer (box #2 in the image below).
When you initialize a claim through Embodia, in the popup form you can specify who the claim should be "payable to". There are two options:
The service provider
If you specified that the claim should be paid to the service provider, Embodia will automatically attach a new payment to the patient invoice with the full eligible amount returned in the EOB.
If the eligible amount does not cover the full amount submitted, you should collect the remaining amount from the patient using one of your payment methods and manually attach a payment to the invoice.
The insured member
If you specified that the claim should be paid to the insured member, Embodia will not attach a payment to the patient invoice. As this eligible amount will be paid directly to the insured member, you should collect the full amount from the patient using one of your payment methods and manually attach a payment to the invoice.
Nullifying a claim
If you have submitted a claim to TELUS eClaims successfully, a nullify request may be submitted if you determine that the claim was submitted in error and must be canceled. You can do so on Embodia only if the claim was submitted during the current business day.
If an insurer has fully adjudicated a claim and issued payment for it, you or the insured party should take appropriate action to return the funds to the insurer. These arrangements are strictly manual and fall outside of Embodia and the TELUS eClaims Service.
To nullify a claim, on the claim page, click on the button 'Nullify this claim' directly under the response from the insurer.
In the popup form, select the reason for nullifying the claim. Once the nullify request is submitted, a nullify result is returned to confirm or deny that the claim was successfully nullified.
When and how should I expect payment for a claim?
The payment method and date for claims submitted through TELUS eClaims vary from insurer to insurer. Please refer to the Insurer payment guide for more information. This document also lists the contact information that you can use to enquire about payments.