After you create an eClaim in the Collaborative Health Record (CHR), you can submit it to the patient's insurance company on their behalf.
If you want to know the amount payable by your patient’s insurer before you deliver a service, you can first send it to their primary insurer for assessment. You'll immediately get a response from the insurer and from there you can submit the claim for payment.
If your claim is not ready to be submitted to the patient's primary insurer, and you still want to modify it later, keep it in the Draft status.
1. Click to open the eClaim from:
The Edit Insured Payments window appears.
2. Click the Status field.
To submit the claim for assessment, select Submit Predetermination from the list.
To submit the claim for payment, select Submit Claim from the list.
3. Click Save. If the CHR doesn't identify any errors, the claim is submitted to the patient’s insurer for assessment or payment.
4. A claim processing window appears and a response is returned with:
A banner that appears at the top of the Edit Insured Payment window with a summary status.
A changed claim status below the summary status.
Changed billing item statuses.
For more information on responses, refer to TELUS Health eClaims statuses.
5. Click the summary status banner to view more information about the claim.
Refer to the below table for a detailed description of the fields:
CHR summary status
The summary status appears in a green, red, blue or grey banner.
For more information on the statuses, refer to TELUS Health eClaims statuses.
A TELUS Health eClaims-generated ID that you can reference if you need to contact TELUS Health eClaims.
Claim submission date
The date you submitted the claim.
Additional comments added per status and appear in a grey banner.
The insurance company’s general notes on the claim, for example, details on how the insurer processed the claim.
There is generally a note on how to contact the insurance company.
Insurer claim ID
The insurer's claim ID that you can reference if you or the patient need to contact the insurer.
Insurer response (PDF)
When the insurer has assessed a predetermination or a payment request, they send a response in PDF format. It provides the actual results of the assessment, including what amounts, if any, will be paid by the insurer.
To view the PDF, click View.
To send it to the patient, click Share at the bottom of the PDF.
The PDF is automatically saved in the Patient Files section of the patient’s chart under the TELUS eClaims tab.
6. If the submitted predetermination was accepted and you delivered the applicable services, you can submit the claim.
7. If the insurer pays you partially or pays the patient, record this in the CHR. Refer to Recording eClaims payments in the CHR.
8. If the insurer paid you the full amount, review the claim to see if there are any outstanding billing items and then change the claim status to Completed.
Created July 31, 2023