TELUS Health eClaims statuses
Updated this week

The CHR uses statuses to indicate where your eClaim currently is in the claim process. Some statuses are available before you submit an eClaim, and others after you have submitted the claim.

When you create an eClaim in the CHR, the claim status is always Draft. When you are ready to submit the claim to your patient’s insurance company, you select the status to Submit Claim or Submit Predetermination.

When you submit a claim, a response is returned immediately with three different statuses:

  • A summary status in a banner that appears at the top of the Edit Insured Payment window.

  • A claim status below the summary status.

  • Billing item statuses in the billing item section of the claim.

Below are descriptions of the eClaim statuses (and billing item statuses) that you can see after you've submitted a claim.

Predetermination and submitted claims

When you send a predetermination or you submit a claim and the insurer processes it, it is returned with a summary status and claim status of either accepted, rejected, or pending.

Summary status

Claim status

Billing item status

Description

Predetermination accepted or

Claim accepted

Banner colour is green.

Predetermination accepted or

Claim accepted

If you sent the claim for predetermination, the billing item status is Pred.

If you submitted the claim, the billing item status is:
- Paid if the paid amount is more or equal to the billed amount.

- Partial if the paid amount is less than the billed amount.

The insurer is able to process the claim in real time and provides you with an answer regarding what portion of the service is covered.

You receive an explanation of benefits that details how much the insurer will pay for each line and pay in total.

Predetermination rejected or

Claim rejected

Banner colour is red.

Predetermination rejected or

Claim rejected

Refused

The insurer rejects the predetermination or if you submitted the claim and the insurer pays no portion of the claim.

This may be related to the patient’s demographic information, their insurance coverage, or the services submitted.

Predetermination pending or

Claim pending

Banner colour is blue.

Predetermination pending or

Claim pending

Held

If you sent a predetermination, the claim could not be processed immediately.

If you submitted the claim, the insurance company successfully received the claim, but does not process the claim in real time and cannot determine how much of the claim will be paid.

No further response from the insurer will be returned electronically.

From here, you can:

  • Contact the insurer directly, act on the issue accordingly, and update the claim manually, or

  • Wait for the insurer to make payment and mark the bill as Completed.

  • Write off the balance and mark the bill as Completed, or

  • Void the claim and re-submit the claim and under Payable to, select Insured Member. Ask the patient to make payment and mark the bill as Completed.

Problem encountered

Banner colour is red.

Attention required

Sent

There was a system problem while submitting the predetermination, or the insurance company may have encountered a problem while processing it.

The predetermination or submitted claim could therefore not be processed.

Make the appropriate corrections and re-submit the predetermination or claim. Click the Status field, select Submit Predetermination or Submit from the list, and click Save.

Predetermination timeout or

Timeout

Banner colour is red.

Predetermination timeout or

Claim Timeout

The predetermination or submitted claim could not be processed because there was a problem connecting to this insurer in the alloted time.

To attempt to submit the predetermination again, click Try again.

Canceled claims

You can cancel a claim and a response is returned from the insurer.

Summary status

Claim status

Billing item status

Description

Claim voided

Banner colour is red.

Claim voided

Sent

The claim (payment request) was successfully canceled.

No explanation of benefits is returned.

Void request declined

Banner colour is red.

Void request declined

This status is generated when the claim (payment request) could not be voided, i.e. your request to cancel the claim was declined by the insurer.

No explanation of benefits is returned

Void timeout

Banner colour is red.

Timeout

This status is generated when your request to cancel the claim could not be processed because there was a problem connecting to this insurer in the allotted time. To attempt to cancel the request, click Try again.

Updated September 18, 2023

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