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.

Become a pro at submitting claims.

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.

“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

“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

“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

“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

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.