GMS Carriers 49 and 50
How do I contact the insurance company?
1-800-563-3274, Monday to Saturday 24h, Sunday between 12:00 a.m. and 7:00 a.m.
What are the hours of adjudication?
Claims are adjudicated 24 hours a day, 7 days a week, except on Sunday from 12:00 a.m. to 7:00 a.m. EST.
Once an Acknowledgement is generated, what is the time frame for receiving a response?
Claims are processed within a business day.
Does the insurer accept a predetermination request submitted electronically?
No, electronic submissions of predetermination requests are not accepted by the insurance company.
Is payment to provider (benefit assignment) possible?
Yes, assignment of payment to the provider is possible, providing the plan member’s policy enabled this feature.
Payment: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?
Payment is made by direct deposit or cheque (providers requiring cheques will incur a fee), depending on how the provider is registered with TELUS Health. Payment frequency is twice a month (on the 5th and the 20th of each month). Providers are setup with electronic statement by default. To request a paper statement, please contact the Express Scripts Canada Call Centre at 1-800-563-3274.
Coordination of benefits: Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?
No, coordination of benefits is not supported.
Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?
Yes, it is possible, if the procedure code is allowed. If not, only the first claim will be paid.
What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?
Expenses can be electronically submitted for all healthcare roles that TELUS Health currently supports, except for occupational therapists and social workers.