Create and Submit Predetermination Request to an Extended Health Insurer

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.