Simply Benefits
What are the hours of adjudication?
8AM-5PM (PST) Monday-Friday
Once an Acknowledgement is generated, what is the time frame for receiving a response?
If a claim Acknowledgement is generated instead of an EOB response we typically take 48 hours to adjudicate and return an EOB to the provider.
How will payment be handled for claims submitted using eClaims?
Payments will be handled via Electronic Fund Transfer (EFT).
Is coordination of benefits possible in cases where the patient has both primary and secondary coverage with the same insurer?
Not at this time.
What do I enter in the Policy / Group and Member ID / Certificate fields? Where do I find this information for my patient?
“Group No.” is the Policy number, and “Certificate No.” is the Member ID. These are found on the patient’s Benefits Card, aka “MyCard”.
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
What expense types can be submitted electronically, and which specialized healthcare provider roles does the system support?
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Acupuncturists
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Chiropractors
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Chiropodists
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Dietitians
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Massage therapists
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Naturopathic doctors
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Occupational therapists
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Osteopaths
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Physiotherapists
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Podiatrists
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Psychologists
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Social workers
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Speech-language pathologists
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Vision care providers (opticians and optometrists)