Guide to Universal eClaims

Before you can begin submitting claims through TELUS Health eClaims in Universal Office, you will have to

1. Be registered with the TELUS Provider Registry, and
2. Have access to the “Email and Banking Information” page in your online TELUS Portal.

You will want to plug that information into Universal eClaims settings to establish a connection between your Universal Office and TELUS eClaims service.

TELUS Health released step-by-step instructions on how to set up eClaims with practice management software, you can find it on Setting up eClaims with your practice management software solution on the TELUS Health website.

IMPORTANT: If not already registered, you must first do so at https://www.telushealth.co/eclaims/.

To submit claims electronically on behalf of the patient, TELUS Health eClaims requires providers to have the following two forms filled out and signed. As the service provider, you are required to keep them on file. These forms are also available on the TELUS portal.

Benefit Assignment Form

• English
• French

Authorization and Consent Form

• English
• French

The following terms and abbreviations used in Universal eClaims you should know about.

OIN
Organization Identification Number
PIN
Provider Identification Number
Provider Number
Service Location ID
TELUS Central Provider Registry
TELUS CPR
TELUS Provider Registry
WLN
Work Location Number

When you launch Universal eClaims for the first time, the system will prompt you to add facility and provider information.

There are two contract types for the TELUS Health eClaims Service: one for independent providers and the other for clinics/organizations. Depending on your business arrangements, select the one you used to register with the TELUS Provider Registry.

• Licensed providers who register as Independents will be given a Provider Number, as well as a Service Location ID.
• Clinics/organizations will be given an Organization Identification Number (AKA TELUS Health Provider Number), as well as a Service Location ID (AKA WLN).  There must be at least one licensed provider registered as an Associate Provider under this type of contract.  Each licensed associate provider who works for the clinic/organization is registered through the organization contract and will be issued Provider Identifiers. The Service Location ID will be shared by all professionals working out of the clinic/organization.

Add Company

1. Click Add Company.
2. Fill in the Organization name as registered with TELUS Provider Registry, the OIN and WLN.
   Note: Due to limitations set by TELUS eClaims API business requirements, you may not enter more than 25 characters into Organization name.
3. Click Save.

Tip: To make things more convenient, you can change the settings so that one user can submit claims as opposed to creating user profiles for every associate provider in the eClaims module. Check the Submit all claims on behalf of user registered for organization box and complete the form with the credentials provided by the TELUS Provider Registry.

Add Provider

Adding an individual provider and an associate provider is very similar, with one exception. If you checked the Submit all claims on behalf of user registered for organization box when adding a company (see above), you will not be asked to enter the username and password requested under the TELUS CPR section.

1. Click Add Provider.
2. From the Resource drop-down list, select a provider.
3. Enter the Provider Number and Service Location ID.
4. Select the Provider Type and make sure the default Licensing Body is the correct one.
5. From the License No. drop-down list, select the applicable college registration number.
   Note: The License No. list is pulled from the college registration number(s) entered for the provider registered in the Resource Manager in Universal Office.
6. Copy the Address either from the Organization or Staff fields that appear for the provider.
   Important: The provider must be present and appear word for word as registered on TELUS Provider Registry. Your claims will be rejected by the TELUS Health eClaims service even for minor discrepancies in the provider address.
7. For Individual providers, enter the Username and Password to be used to submit claims and click Save.

Note: You may add the same provider for each discipline as registered with the TELUS Provider Registry.

Users

By default, only the admin user has access to the Universal eClaims module. The admin user is assigned by the Office Admin role. To grant access to other users, you will have to add them and assign a desired role.

Add User

1. In Settings, select Users.
2. Click Add User.
3. From the UO User drop-down list, select an active Universal Office user.
4. From the Role drop-down list, select one of the available roles.
   Important: The Role will define the level of user accessibility for the eClaims module. For a breakdown of role privileges, see the table below.
5. Click Save.

Privileges \ Permission types	Viewer	Receptionist	Provider	Office Admin
Create Predetermination		✓	✓	✓
Submit Predetermination		✓	✓	✓
Delete Draft		✓		✓
Create Claim		✓	✓	✓
Submit Claim		✓	✓	✓
Preview	✓	✓	✓	✓
Void Claim		✓		✓
Edit Memo		✓	✓	✓
Preview Document Audit Log		✓		✓
Preview Module Audit Log				✓
Configure Providers				✓
Manage Users				✓

Edit User Role

1. In Settings, select Users.
2. Double-click on a username or click Edit.
3. Change user Role, then click Save.

Delete User

In order to delete a user, you must first clear the Enabled box.

1. In Settings, select Users.
2. Double-click on a username or click Edit.
3. Clear the Enabled box, then click Save.
   Note: The option to remove a user appears.
4. Click Remove.
5. Click Yes when prompted.

Note: In most cases, it’s enough to disable a user to prevent him or her from entering the system. Users whose access has been revoked will not be able to access the eClaims module.

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.

The TELUS Health eClaims platform allows you to withdraw claims submitted within the same day. If you manage to void the claim, it’s as if you’ve never submitted it.

Note: The void feature is part of the TELUS Health eClaims platform; however, it may not be supported by all participating insurers.

Void a Claim

1. In the Adjudicated queue, double-click on a claim that was submitted today.
2. Click [Void] on the toolbar.
3. Specify the reason for voiding it by choosing from one of the available two options in the drop-down list and click Void.

If successful, the system will change the status of the claim to Void and add a VOID watermark.

Resubmit Claim

One of features that make Universal’s eClaims unique is the option that allows you to re-submit a voided claim after making changes. Let’s see how it’s done.

1. While a Void claim is open, click [Save as draft] on the toolbar.
   Note: The system will save the claim as draft and allow the user to start editing.
2. Review the claim and make changes.
3. Click [Submit] on the toolbar.

The TELUS Health eClaims platform allows you to request a “pre-approval” from a participating insurer electronically. This pre-approval is called a Predetermination Request.

Note: The Predetermination request feature is part of the TELUS Health eClaims platform; however, it may not be supported by all participating insurers.

Create and Submit a Predetermination

1. Click New Predetermination.
   Tip: The system will prompt to search 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 Predetermination form prepopulated with information already entered in Universal Office pulling all details from the patient’s case.
3. Review the form for accuracy.
4. Click Select Provider.
5. Select a provider and click Save.
6. Click Add item and select an item from a drop-down list.
7. You may change item Description, Code, Quantity, Minutes (if applicable), 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.
8. Click [Submit] on the toolbar.
   Note: In case you are not ready to submit, click [Save draft] on the toolbar. You will find the Predetermination in the Drafts queue.

The system will display a progress bar to communicate Predetermination request submission.

Print and Email Response

Once the Predetermination Request 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 predetermination request was saved as draft to its final state, the system logs every action taken.

1. Open a predetermination request 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 Predetermination Request.
2. Make changes to the Predetermination, then click [Save draft] or [Submit] buttons on the toolbar.

Delete Draft

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

 

In this article, we will cover two search functionalities: searching claims and predetermination requests and searching an Audit Trail.

Search eClaims

You can search claims and predetermination requests for TELUS Health eClaims throughout all queues in Universal eClaims. You have the options to search by:

• Patient First Name,
• Patient Last Name,
• Invoice (or Claim) number, and
• Predetermination request number.

1. To start, make sure any one of the queues (e.g. Drafts, Adjudicated) is selected.
2. Start entering search criteria.
   Note: The system will display the results as you enter your search criteria.

Search an Audit Trail

Every action taken within the Universal eClaims module is recorded and can be found in the Audit Trail section of the module. The system keeps the last 30,000 records. The older records are deleted when the number of total records exceeds 30,000. Only authorized users have access to the Audit Trail.

You can search Audit Trail records by No/ID and Username.

1. Select Audit trail.
2. Start entering search criteria (e.g. admin).
   Note: The system will display the results as you enter your search criteria.

The batch billing feature in the Universal eClaims module allows you to submit hundreds of EHC claims at once.

Before submitting claims in a batch, one or more unbilled charges must exist in the patient file.

1. Click New and select Batch.
   Note: By default, all patients who have participating eClaims insurers as their primary EHC, and have unbilled services for the past 31 days will be displayed.
2. Use the following options to customize the batch:
   • To show unbilled claims for a specific date range, select from the Date range of services, From and To calendar date pickers.
     Important: You may not submit claims for services dated in the future or that are older than 31 days
   • To filter the list by a specific extended health insurer, select an insurance company from the Filter by insurer drop-down list and click Search.
3. Check the box beside the patient’s name to bill for or check the Select all box.
   Note: If any unbilled claims have invalid or missing information, an exclamation mark will appear. Hover your mouse over it to display error information.
4. Click [Submit] on the toolbar, then click Accept when prompted to agree to the Terms and Conditions for all claims in the batch.
   Note: The system will display a progress bar to communicate each claim submission one after the other until all claims in the batch have been submitted. Once completed, the submission results will be displayed. If any submissions failed, click Preview Summary to view submission errors or warnings.
5. Click Close to view batch details and to Print Results.

All submitted batches are stored and can be managed in the Batch Billing queue.

Universal eClaims simplifies EHC billing with the Payment Distribution feature which automatically records payments in a patient’s account activity based on the adjudication response.

1. In the eClaims portal go to the Settings then Payment Distribution
2. Toggle “Auto Payment Distribution” to ON
3. In the drop-down select the payment method to be used

Tip: To add a new payment method see Add and Manage Payment Methods.