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eClaims

Welcome to your resource centre.

From learning how to submit claims and receiving payments to promoting eClaims to your patients, and getting one-on-one training – it’s all here.


Getting started.

Section 1 Become familiar with eClaims and how it can work for you.

Section 2 Get all the info you need to be ready to submit your first claim.

Section 3 Sign up for direct deposit to get paid faster and avoid unnecessary trips to the bank.

Section 4 Manage changes to your profile including new providers, new users, and address changes to ensure your profile reflects your evolving practice.

Section 5 Manage changes to your eClaims account including new users and user permissions.


Become a pro at submitting claims.

Section 6 Learn how to easily submit a new claim or a predetermination request.

Section 7 Turn a predetermination request into a claim request in just a few clicks.

Section 8 Understand the difference between an Explanation of Benefits and a Claim Acknowledgement response.

Section 9 Learn all you need to know about predetermination requests and insurer responses to them.

Section 10 Void submitted claims if you need to change your payment preference or if it was entered by mistake.

Understanding insurer responses

Understanding insurer responses

When you submit a claim, you can receive one of three responses from the insurer. Here are our recommendations for each type of response:

  • An “Explanation of Benefits” means the claim was processed.
    • It provides the response to your claim (accepted or rejected), and the amount that will be paid by the insurer.
    • Based on the amount that will be paid and who the payment recipient is, you will know what outstanding amount is owed by your client.
  • If the insurance company has received the claim request but is unable to process it, a Claim Acknowledgement is generated.
    • When you receive an acknowledgement or “Claim pending” response, we recommend you void the claim, collect the full amount owed from your client and either provide them with a receipt so they can submit the claim themselves or resubmit the claim and select “Payable to: patient” to avoid any payment follow-ups on your end.
  • Error means that either the eClaims system or the insurer’s adjudication engine is not functioning properly at the time you submitted.
    • When you receive an error message, we recommend you collect the full amount owed from your client and provide them with a receipt so they can submit the claim themselves.

We recommend you save a copy of the insurer’s response right away as it is only available on the day the request was submitted.

FAQs

Have a question about submitting claims?

Check out our FAQs


Understanding the payment process.

Jennifer Hancock, Student Optician

As the statements of payment arrive, they should be reconciled as soon as possible. You want to process claims and reconcile payments quickly because you do not want anything to expire.

Jennifer Hancock, Student Optician
Cowan’s Optical
Mount Pearl, Newfoundland

Jennifer Hancock, Student Optician

The instant insurer response helps you deal with any issues with the patient in front of you which saves you a lot of hassle and frustration.

Christina Worm, RMT
Rejuvenating Massage Therapy
Oakbank, Manitoba

Jennifer Hancock, Student Optician

We keep separate folders for each insurance company. We have a spreadsheet to record appointment dates, patient names, and what was paid based on the eClaims portal.

Dr. Donald R. Earle, DC
Bay Roberts Spine Clinic Inc.
Bay Roberts, Newfoundland

Jennifer Hancock, Student Optician

I recommend processing the claim when the patient is in the office in case there are any problems.

Lucas, Optometric Assistant & Office Manager
Goemans Optometry
Guelph, Ontario

5 ways to ease payment reconciliation

5 ways to ease payment reconciliation

Reconciling claim refunds from all participating eClaims insurers can be a challenge. We’ve shared some helpful payment reconciliation tips from providers, but here are some additional recommendations that we think you would find useful:

  • Submit claims right away - immediately after the treatment while the client is still with you.
  • Print or save all Explanation of Benefits statements so you can refer back to them during reconciliation, if need be.
  • Leverage the Past Transactions tab in the eClaims portal to download transactions from the past 31 days - this is your starting point for easy reconciliation.
  • Plan reconciliation activities in your agenda - integrate eClaims reconciliation into your monthly bookkeeping activities (make sure you do it at least every 30 days).
  • Download the eClaims insurer payment guide for a snapshot on payment details and contact information for each insurer. Payment questions should always be directed to the insurers.

Want to know when a payment will be issued or what the payment method will be?

Insurer payment guide

Ease payment reconciliation by tracking payments in one place.

Payment reconciliation template


Insurer toolkits & contact information.

Make sure to visit our insurer-specific FAQ before calling.

Promote eClaims to your clients.

Now that you offer eClaims as a value-added service to your patients, let them know!

Click here for details

Webinars

Full video 5 tips to help you get more out of eClaims.

Full video Payment reconciliation : tips to optimize the process.

Getting started
Submitting claims
Payment information
Insurer information
Promote eClaims
Tools & resources
Webinars

Getting started Submitting claims Payment information Insurer information Promote eClaims Tools & resources Webinars

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