LiUNA Local 183
How do I contact the insurance company?
1 416-240-2103
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. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient.
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 a predetermination request 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. This payer expects to have real-time adjudication available in 2020. We will communicate this change when it occurs.
Is payment to provider (benefit assignment) possible?
No, the payment is limited 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?
Providers are paid by cheque every 2 weeks and payment statements are mailed along with cheques. Please note that at this time, this payer is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient.
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)?
No, 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?
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Acupuncturists (Only allowed if the acupuncturist is registered with the College of Traditional Chinese Medicine.)
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Chiropodists
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Chiropractors
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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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Physiotherapy technologists
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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 therapists
Does LiUNA Local 183 provide real-time adjudication?
At this time, LiUNA Local 183 is not providing real-time adjudication, so all claim requests will come back with a “claim pending” response. We recommend submitting the claim and selecting “payable to” the patient as well as collecting the full treatment amount from your patient.