Create and Submit a Claim to an Extended Health Insurer

Create and Submit a Claim

1. Click on New Invoice.
   Tip: The system will prompt to search for patients. By default, the system will list all patients who have a participating eClaims insurer for Primary EHC with charges that have never been invoiced. The “e” logo will appear next to patient cases with participating eClaims insurers for Primary EHC.
2. Select one of the listed patient cases (if any) or use the search box to find a patient.
   Tip: Enter a first or a last name in the search box and press Enter.
   Note: The system will open a New Claim form prepopulated with information already entered in Universal Office, pulling all details from the patient’s case.
3. Review the form for accuracy.
   Note: When a claim is submitted on behalf of a Clinic/Organization, the system will default the Payment to be issued to the Facility Name. When submitted on behalf of an individual provider, the system will default the Payment to be issued to the Provider Name.
4. Add one or more Billing Items to your claim.
   There are three ways to add Billing Items to the claim: a) Preview and transfer, b) Add item one at a time, and c) Using the Calendar date picker. Let’s look at each one in detail.

a. Preview and transfer:  When charges that were never invoiced exist in a patient’s case, the system will allow you to transfer those charges. Simply click Preview and transfer, select one or more charges (make sure the charges were billed under the same provider name), then click Apply.

b. Add item one at a time:

1. 1. Click Select Provider.
   2. Select a provider and click Save.
   3. Click Add item and select an item from a drop-down list.
   4. Make sure the Date corresponds to the actual service date.
      Note: If the service is older than 31 days, then you will have to submit it manually to the insurer as the eClaims service does not allow users to submit services older than 31 days.
   5. You may also change an item Description, Code, Quantity, Minutes (if applies), and Unit Price.
      Important: The Description that appears on the form is for your reference only. As with the HCAI submissions, the only part of the service identifier that is submitted via TELUS Health eClaims is the Service Code.
      Tip: The Minutes detail can be left blank. In that case, the item will be submitted as a procedure.

c. Using the Calendar date picker: This feature allows you to quickly add multiple Billing Items to the claim with less effort.

1. 1. Click Select Provider.
   2. Select a provider and click Save.
   3. Click the Options button next to the selected provider name to open the Calendar pane.
   4. Click Select a billing item.
   5. From Item ID drop-down, select a Billing Item and make sure the description, code, minutes, rate, and tax are accurate.
      Note: Tax is optional.
   6. Click Save.
   7. In the calendar date picker that appears below item description, select dates to add Billing Items.
      Note: The system will add a Billing Item as you double-click on each date in the calendar.
      Important: You may not submit services dated in the future or the ones that are older than 30 days.
      Tip: To remove a billing item, select the item from the list and click the Trash Can that appears on the left. Click Yes when prompted.

Click [Submit] on the toolbar.
Note: In case you are not ready to submit, click [Save draft] on the toolbar. You will find the claim in the Drafts queue.

The system will display a progress bar to communicate claim submission.

Print and Email Response

Once the claim is successfully submitted, the system will process and display the response.

1. Click [Preview Results]to view the response in print preview mode.
2. Use the [Print Results] button to send the report to your printer or click [Email] to open the eClaims Insurer Response email template with the report attached.
   Note: The eClaims Insurer Response template can be modified in eBroadcast. See the Create and Manage Email Templates article for more information.

View Log

From the moment the claim was saved as a draft to its final state, the system logs every action taken.

1. Open a claim from any one of the available queues (Drafts, Submission Failed, Submitted, Adjudicated, or Void).
2. To view the log, simply click [View log] on the toolbar.

The system will list timestamped records for each event with a username next to each record responsible for the event.

Edit Draft

1. In the Drafts queue, double-click on an existing draft claim.
2. Make changes to the claim, then click [Save draft] or [Submit] buttons on the toolbar.

Delete Draft

1. In the Drafts queue, select an existing draft claim.
2. Click [Delete] on the toolbar.
3. Click Yes when prompted.