BPA
 What are the hours of adjudication?
What are the hours of adjudication?
                                                At this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. Therefore, claim submission is only available with the option “payable to” the patient. Please ensure you collect the full treatment amount from your clients covered by this insurer.
 Once an Acknowledgement is generated, what is the time frame for receiving a response?
Once an Acknowledgement is generated, what is the time frame for receiving a response?
                                                A response following a claim acknowledgement is usually processed within a week. Predeterminations and rejected claims are mailed to providers daily, and cheques along with explanation of benefit statements for payable claims are mailed on the 1st and 15th of each month.
 Does the insurer accept predetermination requests that are submitted electronically?
Does the insurer accept predetermination requests that are submitted electronically?
                                                At this time, this payer is not providing real-time adjudication, so all predetermination requests will come back with a “claim pending” response.
 Is payment to provider (benefit assignment) possible?
Is payment to provider (benefit assignment) possible?
                                                Payments for select vision care services that are submitted from the Provider Portal or the eClaims integrated Practice Management software can be assigned to vision care providers (opticians and optometrists). Payments for all other types of services, as well as payments for claims submitted from the mobile app, must be assigned to insured members.
 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: How will payment be handled for claims submitted using eClaims? Would it be possible to set up a direct deposit option for payments?
                                                For vision claims submitted via the Provider Portal or eClaims integrated Practice Management software, if the payment is assigned to the provider, then the client does not pay. In all other cases, payment must be collected from the client for services rendered. The insurer will reimburse its members directly 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?
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)?
Can claims for the same service be submitted twice in the same day (e.g. for the same service on two different body parts, or for the same service provided in the morning and in the evening of the same day)?
                                                Only one treatment per day for the same procedure code is eligible.
 What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?
What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?
                                                - 
                                                            Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine) 
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                                                            Athletic therapists 
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                                                            Chiropodists 
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                                                            Chiropractors 
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                                                            Dietitians 
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                                                            Massage therapists 
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                                                            Naturopathic doctors 
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                                                            Occupational therapists 
- 
                                                            Opticians 
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                                                            Optometrists 
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                                                            Osteopaths 
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                                                            Physiotherapists 
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                                                            Podiatrists 
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                                                            Psychologists 
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                                                            Psychotherapists 
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                                                            Social workers 
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                                                            Speech-language pathologists 
