Getting started

You can register for eClaims at telushealth.co/eclaims. Once your credentials are verified and you are accepted, TELUS Health provides you with all of the login information needed to access the eClaims service. Once you have logged in to the portal and set up your profile, you can use the same login credentials to access eClaims via the mobile app or the integration in your practice management software.

Before you start using the eClaims application, you need to:

Set up a bank account, as described in Managing banking information.

Add your users, as described in Managing users.

Add your providers, as described in Adding/associating providers.

Note: Providers and users are not always the same. Users are people who have access to use eClaims and submit claims on providers’ behalf. They can be clinic owners, receptionists, or billing administrators. Providers are healthcare practitioners who treat patients. They may also have user access to eClaims if they submit claims themselves.

For information on adding a location, or making changes to your name and contact information, roles and licenses, address and hours for your registered service location or business, business name, and contact information, see Make changes to your business profile.

Submitting claims

You can submit predeterminations to check coverage, and you can submit claims after the patient received their treatment. A real-time response is generated from the insurer.

Note: It is important to submit the payment request before the patient leaves so that you can provide the patient with his insurance company’s response. Many Insurers limit the number of days you have to submit a payment request; if you delay the submission, the insurance company could reject the request.

Note: No surcharges or administration fees may be levied to plan members or patients for submitting their claim through the Provider Portal. You must not charge a fee of any kind, including increasing the dollar amount of the claim being submitted or adding a separate fee over and above the claim amount for services rendered.

Separate claims must be submitted for each patient. If you have multiple patients within the same family, for example, you can print and save the insurer’s response, and then create a separate claim for a different family member. In such cases, eClaims will prepopulate certain fields.

Claims should be submitted while the patient is in your office at the time the service is provided. The insurance company will return a response immediately, which you can view, print, or email. You must give a copy to your patient. If you are using the eClaims mobile app, you can email the response directly to your client.

Depending on the insurer, an explanation of benefits could be returned. You have up to 31 days from the date the services were rendered to submit the claim but the sooner the claim is submitted, the faster the payment will be issued by the insurance company. You and your patient will know right away what the insurance company covers and you can then request the balance, if any, from your patient before they leave the office.

Claim processing

Claims are usually processed automatically on the day they are submitted; however, at certain times, depending on the insurer, claims cannot be adjudicated in real time. If this is the case, you will receive an acknowledgement advising you that the claim has been received and accepted for further processing. eClaims will not show an updated status for the acknowledged/pended claims; please contact the insurer after 48 hours to confirm the status or paid amount. Note that some insurers will automatically change the payee from the provider to the recipient member. To avoid this, you can void an acknowledged claim, collect the full amount from your client and resubmit with payment to the recipient member.

Notifications

The eClaims application may occasionally display notifications to you about the eClaims system or your insurer. You can view them by clicking the Notifications button in the banner at the top of the page.

This image shows the Notifications page.

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