Create and Modify Extended Health Care Claim Forms

This article will help you create, modify, and print Extended Health claim forms available in Universal Office. It covers the form types listed below.

Note: Some of these claim forms may also require you to specify the coordination of benefits.

Available Extended Health Claim Form Types

• Assumption Life
• Benefit Plan Administrators Ltd.
• Blue Cross Subscriber Form
• Blue Cross Member Form
• Canada Life
• Chambers
• Claim Secure
• Commercial Workers Benefit Trust Fund
• Co-operators
• Cowan
• D.A. Townley
• Desjardins
• Empire Life
• Equitable Life
• Great-West Life
• Green Shield (EHS Claim Submission Form)
• Green Shield (Claim Form For Related Health Professional Services)
• Green Shield (Claim Form For Custom Foot Orthotics)
• Industrial Alliance
• International Union of Operating Engineers Local 793
• Johnson Inc.
• Liberty Health
• Locals 1 & 2: SEIU Benefit Trust Fund
• Local 46: UA Toronto Benefit Plans
• Local 75: Health & Welfare Trust of the Hotel Employees, Restaurant Employees Union
• Local 793: International Union of Operating Engineers
• Manion, Wilkins & Associate Ltd.
• Manion, Wilkins & Associate Ltd. (Teamsters Local 419 Benefits – General)
• Manion, Wilkins & Associate Ltd. (Teamsters Local 419 Benefits – Vision)
• Manulife Affinity Markets
• Manulife Financial
• Maximum Benefit
• National Life
• NexgenRx
• OTIP
• RWAM
• SSQ Financial Group
• Standard Life: Medical Paramedical
• Sun Life Financial
• The Benefits Trust
• Wawanesa

Before you proceed, you may want to have the extended health Insurer Information recorded for the patient with EHC coverage.

To perform the following procedures, open the Patient Manager and select the patient from the list on the left.

Create EHC Claim Form

1. Open an MVA or EHC Case and click the Documents tab.
2. While in the Documents tab, click [New Document] on the toolbar, then choose the appropriate claim form from the Template type drop-down list (leave the options at their defaults).
3. Click Open.
   The Claim Form Editor opens.
4. Verify the Document Date.
5. Click the numbered links on the left side of the screen to open, review, and complete each section of the Extended Health claim form.
6. Click Save & Close.

Modify an EHC Claim Form

Note: This can be done only for EHC claim forms with the status of Created.

1. While in the Documents tab, double-click on an EHC claim form.
   The form opens for editing.
2. Make the necessary changes, then click Save & Close.

Delete an EHC Claim Form

Note: This can be done only for EHC claim forms with the status of Created.

1. While in the Documents tab, select an EHC claim form, then click [Delete Document] on the toolbar.
   Note: You may be prompted to enter a password.
2. Click Yes when prompted.

Preview and Print an EHC Claim Form

1. While modifying an EHC claim form, click Preview.
   The form opens for previewing.
2. Click [Print] on the toolbar.
3. Choose the desired printer from the list, then click Print.

Tip: While previewing, you can also export the document to PDF by clicking [Export to PDF] on the toolbar.