How To Manage Insurance via Telus Health

This page describes what is needed when managing the integration of practitioners using the system to achieve direct insurance claim submissions via Telus Health’s eClaims.

If you need to get help from Telus resources, regarding use of the claims system, please see this link: https://plus.telushealth.co/page/eclaims/resources-api/
To see the information you might need in order to set up the integration with Telus please use this link: http://page.telushealth.com/eClaims_integration_documentation.html

In This Article:

How to link your eClaims Location details

The ability to add this information is reserved for office owners. Your Location details are provided by Telus Health. This information is added to Outsmart using the step(s) below.

Navigate to the your office details page

Open the Remote Services Tab

Fill in your Location details in the form provided

How to link your eClaims Profile

Your Profile details are provided by Telus Health. This information is added to Outsmart using the step(s) below.

Navigate to your profile page

Open the Remote Services Tab

Click Add Telus Profile.
- This button is only available after you (or the office owner) has added the Location details

Fill in your Profile details in the form provided.
- The credentials here (i.e. username/password) refers to the credentials provided by Telus Health not your Outsmart credentials.

You can edit or delete your profile at any time.

How to make your Products/Services Insurable

Navigate to your dispensary
Navigate to the Product List of your dispensary

Click + New Product or edit an existing product.
If adding a new product fill in your product details as per usual. Navigate to the field Telus Service. Click the dropdown and choose from the list of Telus Health Products/Services.

The list shown is based on the role entered in your eClaims Profile

Save your changes.

How to submit a Predetermination or Claim request

When billing a patient, insurable items may be submitted to a patient’s insurance provider. There are two types of request that can be submitted

Predetermination – a simulated request sent to the patient’s insurance provider and forecast the possible outcomes.
Claim – an official claim request send to the patient’s insurance provider.

The steps to submit either request is described below.

Create an invoice in the usual manner (i.e. a completely blank invoice or from an appointment where some details are already filled in)
- The Insurance section is displayed below the invoice’s line item table and totals

Fill out the invoice in the usual manner (i.e. select patient, patient address and other details that may have not been auto populated).
Select insurable items from the product or service dropdown.
- Insurable items are tagged.

Choose patient’s insurance provider from the dropdown list.

Indicate if the visit is related to an accident by clicking the checkbox, if so choose the type of accident from the dropdown list and indicate the date of the accident.

Predetermination

To send a predetermination, click Submit Predetermination
Read the Terms and Conditions.
Check I agree.
Click Send Request

Claim

To send a claim, click Submit Claim
Read the Terms and Conditions.
Check I agree
Indicate if the Customer will pay in full by clicking checkbox (or leaving it unchecked)

Customer will pay in full

Checked – the patient will be paying invoice out of pocket. As a result, the patient will be the payee of the subsequent claim request.
Unchecked – the clinic or practitioner will be the payee of the subsequent claim request.