Equitable
What are the hours of adjudication?
Claims adjudication is available 24 hours a day, seven days a week, except during maintenance windows.
How long does it take to receive a response when an Acknowledgement is generated?
Providers will receive immediate confirmation about whether a claim was approved or rejected. For claims that require additional information and are under review, we typically respond within 2 to 5 business days. We will send any response or payment associated with the claim directly to the plan member.
What is the frequency of payment? If direct deposit can be set up, is a payment statement issued?
How is the statement delivered?
We will make direct deposit payments daily based on the account information that was provided at time of registration for TELUS eClaims. We will not make direct deposit payments for claims that are selected for review. For these claims, the provider should collect payment directly from the patient. We will send any response or payment associated with the claim directly to the plan member. We do not provide a reconciliation statement for direct deposit payments. However providers / practitioners can access their submission history through the TELUS eClaims portal.
Co-ordination of benefits: Can I coordinate benefits if my patient has both primary and secondary coverage with the same insurance company?
Automatic co-ordination of benefits is not available. Providers can submit the claim under the primary plan first. Once we provide confirmation about the claim decision, providers may then submit the balance separately under the secondary plan.
What do I enter in the Policy / Group and Member ID / Certificate fields? Where do I find this information for my patient?
Please see the sample card shown below:
Can I submit for the same service twice in one day (e.g. same service on two different body parts or the same service in the same day – morning and evening)?
Yes
What type of expenses can be submitted electronically? Which specialized healthcare provider roles are supported?
Expenses for the following specialized healthcare providers are supported:
-
Acupuncturists
-
Chiropractors
-
Chiropodists
-
Counsellors
-
Massage therapists
-
Naturopathic doctors
-
Opticians
-
Optometrists
-
Osteopaths
-
Physiotherapists
-
Physiotherapist technologists
-
Podiatrists
-
Psychologists
-
Psychotherapists
-
Speech language pathologists
Does Equitable support payment reconciliation?
Yes, electronic statements are posted on the eClaims portal the same day as the payment. Statements are available for payments made Monday to Friday.