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Submitting Claims and Eligibility Checks Through the TELUS eClaims Integration

Now that you have TELUS eClaims integrated with your Jane account, it’s time for the fun part – submitting claims!

This guide document is full of valuable information to get you up and running with TELUS eClaims as smoothly as possible. Please read it carefully, and then feel free to jump to each section below to brush up on anything you may have missed.

If you haven’t quite found what you were looking for, please visit our TELUS eClaims FAQ and Troubleshooting Guide.

Have you previously been tracking your TELUS eClaims submissions in Jane, but submitting them through the eClaims portal outside of Jane? If so, please visit this guide document to get started setting up the integration.

 


How to Create a New TELUS eClaims Insurer

*and transition existing insurers and patient insurance policies so they can be used with the new integration.

 

 

If you are just getting started with insurance billing in Jane, you’ll need to start by creating insurers for each of the TELUS eClaims eligible insurers you submit to.

To add a new TELUS insurer head to Settings > Insurers, select “New Insurer” and add a new TELUS eClaims insurer.

Give the insurer a name and then select the appropriate TELUS supported insurer from the “Electronic Submission Insurer” drop-down list, review the default settings, and hit “Save”.

 


How to Create a New TELUS eClaims Policy and Add it to a Visit

 

 

From your main schedule, if you click on an appointment, you’ll see an option under Insurance Info section to Add a Policy.

If the patient does not already have a TELUS eClaims policy set up, select “Add New Policy”.

A list of available insurers will pop up for you to select from. Here, you’ll select the appropriate TELUS eClaims supported insurer.

You will need to enter the patient’s Member ID and Policy number.

Then, set the appropriate Patient Relationship to Insured. If you select any option other than “Self”, you’ll also need to enter the insured member’s first name, last name, and date of birth. The other “Sex” and “Address” fields in this section are optional.

Next, if applicable, select whether the patient’s condition is the result of a workplace accident or auto accident. If the patient’s injury is the result of an accident, you will also need to set an injury date.

Note that the “Accident Type” selection can be left blank if the question does not apply to the patient.

Finally, if applicable in the patient’s case, enter the Referring Physician’s details.

Within the claim, you are no longer able to indicate % Coverage, Eligible Amount, or Max Amount because you will not need these fields. As soon as the claim has been successfully submitted and TELUS confirms the exact amount that will be paid by the insurer, Jane will take care of updating the amount covered for any given visit and will pass any applicable balance off to the patient.

When all the details have been entered, hit “Save”.

After saving the claim, you should now see the claim attached to the appointment, and you can add the applicable billing code.

 


Billing Codes

 

 

There are specific billing codes that you will need to use to submit your claims through TELUS eClaims.

Billing codes will be available when submitting a claim based on the discipline the treatment is assigned to (and the category the discipline is assigned to).

The billing code selected needs to match the type of appointment and service you’re billing for. So for example, if the patient received a 60 Minute Registered Massage Therapy treatment, and it was not their first visit, you would use 1.xx.12.JJ.

The necessary TELUS eClaims billing codes will have been pre-loaded into Jane for you but you can always review the available billing codes in your account. Head on over to Settings > Billing Codes to view these.

PRO TIP: Not sure what billing code you need to use? Hit the space bar on your keyboard while in the billing code field and you can browse the selection of codes applicable to that appointment.

 


Enabling/Disabling Electronic Submissions

 

 

Once you have upgraded an insurer, you will be able to Enable Electronic Submission for any given policy under that insurer that has already been added to an appointment.

Click the drop-down menu next to the policy in the Insurance Info section of the appointment panel, or in the purchase window, and choose “Enable Electronic Submission” to be able to send the claim through the eClaims integration.

If you have already added insurance policies to patient’s upcoming appointments prior to setting up your eClaims integration and upgrading your insurers, you will need to enable electronic submission on those visits. Anytime you add a policy fresh to an appointment going forward, the default submission mode will be electronic.

You’ll be able to easily tell if a claim is enabled for electronic submission by whether or not you see a “Check Eligibility” or “Submit” button under the Insurance Info section of the appointment panel and whether or not you see the coverage detail fields.

Here is what a claim looks like when electronic submission is disabled:

And this is what a claim looks like when electronic submission is enabled:

If you ever need to submit a claim by paper or through the TELUS eClaims portal, you can disable electronic submission in the same way by accessing the drop-down menu next to the policy on the appointment, and select “Disable Electronic Submission” and this will tell Jane to treat that claims like any other paper submission.

 


Submitting an Eligibility Check

 

 

Before a patient’s appointment, you will be able to preview their coverage by submitting an Eligibility Check (referred to as a predetermination request in the TELUS eClaims portal).

An eligibility check relates only to services that have not yet been rendered and is a way to see the amount that the insurer would pay if these services were provided on that same day.

Please note that the following list of insurance companies do not accept eligibility checks:

  • Cowan
  • Desjardins Insurance
  • GMS Carrier 49
  • GMS Carrier 50
  • Industrial Alliance
  • Johnson Inc.
  • Manulife Financial
  • Sun Life Financial

You can check a patient’s eligibility before or after an appointment has been arrived.

To check a patient’s eligibility, first, make sure that you have added the appropriate billing code. If the appointment is not arrived yet, then click the “Check Eligibility” button. If the appointment has been arrived, the button will read “Submit” instead.

In the Claim Preview window, verify that all the information is correct and that you have answered the “Where was the service rendered?” question. Then, you’re ready to click the “Check Eligibility for 1 Claim” button.

Jane then communicates with TELUS and the insurer in real-time, and you’ll see a response come through in a few seconds.

You’ll see right away how much the insurer would cover if these services were provided on the same day, and you will also be able to print or download the Explanation of Benefits if necessary.

Once an eligibility check has been done you’ll also be able to see at a quick glance what the status (Approved, Rejected, On Hold) of that check was and how long ago it was done from the “Insurance Info” section of the appointment panel.

To see the full details of the eligibility check, like how much was approved and/or any notes just click “View Details”.

It is important to remember that an eligibility check is valid only for services rendered on the same day the check was performed. This means that an eligibility check done a day or more in advance of the actual appointment may not accurately reflect coverage amounts at the time of service.

 


Submitting a Claim

 

 

In order to submit a claim for services that have been rendered, you’ll first need to mark the appointment as Arrived.

Next, ensure that you have added the appropriate billing code based on the services being provided.

Once you’ve done that click the “Submit” button within the claim under the Insurance Info section.

In the Submit Claims window, verify that all the information is correct. If you’ve missed any details, like adding a billing code or selecting the insured member in the policy settings, Jane will alert you and give you a quick link to where you need to make any adjustments.

At the bottom of the page, answer the “Where was the service rendered?” question to specify whether the treatments were performed in person at the clinic, in person at the patient’s location, or virtually.

Finally, double-check that you have agreed to the Terms & Conditions, and if applicable to you, check the “Provincial insurance exhausted” field. Note that this option will only be visible for physiotherapy treatments.

 


Provincial Insurance Exhausted Field (Physiotherapists Only)

Certain provinces do not allow patients to submit healthcare expenses covered by provincial plans to a private healthcare insurance company until their provincial coverage has been completely exhausted.

Check this box ONLY if:

  • this applies in your province, and
  • it applies to the services rendered, and
  • the patient’s provincial coverage has been exhausted.

If any of the above criteria are not true, leave this field unchecked.

When everything looks good, you’re ready click the “Generate Submission for 1 Claim” button, and off it goes!

Jane then communicates with TELUS and the insurer in real-time. You’ll see a response come through in a few seconds.

You’ll see right away how much the insurer will be covering and be able to print the Explanation of Benefits form.

The Explanation of Benefits (EOB) is a response generated by the insurer when it has fully processed the claim submission. This statement will provide the detailed results of the adjudication, including the amount payable by the insurer, if applicable.

Note that if you do not print the EOB right away, you can always access it again at a later date by viewing the submission.

Depending on the amount the insurer will be paying, Jane will adjust the invoices to pass any remaining balance off to the patient, and the insurer invoice will also be updated appropriately.

If that all looks good, you can close that window using the X in the top right-hand corner and proceed with collecting any applicable patient payments using the Pay button.

Voila! You’ve now successfully submitted a claim from your Jane account directly to TELUS eClaims.

If you’ve chosen to set up your integration to automatically Pay & Approve claims once a response has been received from TELUS, you won’t need to do anything further with the claim.

If you’ve chosen to set your integration to leave the claims marked as submitted so that payment can be manually applied, you can refer to this guide document that reviews Receiving an Insurer Payment.

In the event that a claim submission was made accidentally and you need to void the submission, this can also be done directly from Jane. Check out our guide on Reversing a TELUS eClaims Submission for more details.

 


Common Responses & Error Messages

 

 

Claim Acknowledgment – A Claim Acknowledgement is a response generated when the insurer has received the submission but is unable to process it. This can be due to making a submission outside the insurer’s real-time adjudication hours or the insurer not supporting real-time adjudication at all (e.g. Desjardins Insurance). When a Claim Acknowledgement is received in Jane, the status of the invoice will be changed to On-Hold.

In these cases, the final adjudication results will be provided by the insurer at a later time by other means, depending on the insurer’s preferred method. This means that the claim submission status will not update in Jane automatically. You will need to contact the insurer to confirm the status of the submission and manually record any payment details in Jane.

Key204 – The policy or group number is missing, invalid, or not found.

You may get a Key204 message in the case where the patient, certificate, or policy was not found in the insurer’s database. Double-check the policy or group numbers, as well as the member ID or certificate number from the patient’s benefits card.

NL37 – the insurer does not allow electronic submissions for this policy or group.

There might be a restriction on the patient’s plan to not allow electronic submission or allow the provider to receive payment on the member’s behalf. In these cases, have the patient contact the insurer or their plan administrator directly to confirm and if possible, to remove the restriction.

NL20 - the Provider (Author) is invalid; not registered for TELUS eClaims or is unauthorized for the User

This error means that the provider details (usually license ID) configured in the integration set up in Jane do not match what TELUS had on file. If you receive this error please contact TELUS to verify and make any changes to the provider License IDs they have on file for you.

For more help understanding insurer responses, error messages and for other eClaims resources please check out the TELUS eClaims Resource Centre.