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OutSmart Guide

Telus Health Insurance Integration

OutSmart integrates with Telus Health eClaims so practitioners can submit insurance claims and predeterminations directly from invoices. The integration has four setup steps and one billing flow:

  1. The office owner links the office’s eClaims Location details.
  2. Each practitioner links their personal eClaims Profile.
  3. Products and services that are insurable get tagged with a matching Telus Service code.
  4. When billing an invoice, practitioners submit a predetermination or claim from the Insurance section on the invoice.

You’ll need active Telus Health eClaims credentials before you start. Telus provides both the Location and Profile details that get entered into OutSmart.

Useful Telus Resources

Step 1 — Link the Office’s eClaims Location (Office Owner Only)

Only the office owner can add the Location details. Telus Health provides these to the office.

  1. Open your Office Details page.
  2. Open the Remote Services tab.
  3. Fill in the Location details from Telus and save.

Once the Location is in, individual practitioners can add their own Profile (next step).

Step 2 — Link Each Practitioner’s eClaims Profile

Each practitioner who wants to submit claims links their own Telus credentials into their profile. The Location must be set up first or the Add Telus Profile button isn’t available.

  1. Open your own Profile page.
  2. Open the Remote Services tab.
  3. Click Add Telus Profile.
  4. Fill in the Profile details from Telus and save.

You can edit or delete your Profile at any time from the same tab.

Step 3 — Tag Products and Services as Insurable

Each product or service that can be claimed against insurance needs to be tagged with the matching Telus service code. This is set on the product itself, in the dispensary.

  1. Open your Dispensary.
  2. Open the Product List.
  3. Click + New Product to add a new product, or click an existing product to edit it.
  4. Find the Telus Service field on the product form.
  5. Choose the matching service from the dropdown.
  6. Save.

The list of available Telus services in the dropdown depends on the role you entered in your eClaims Profile — only services valid for that practitioner role appear.

Submitting a Predetermination or Claim

When billing a patient, insurable items on the invoice can be submitted to the patient’s insurance provider. Two kinds of submission are available:

SubmissionWhat it does
PredeterminationA simulated request — Telus forecasts the likely outcome without filing an actual claim. Useful when you want to confirm coverage before billing.
ClaimAn official claim filed with the patient’s insurance provider.

The setup is the same for both; the final button differs.

  1. Create the invoice the way you normally would — either a blank invoice or one prefilled from a calendar appointment.
  2. Below the invoice’s line items and totals, look for the Insurance section.
  3. Add the insurable items to the invoice. Insurable items are visually tagged in the product or service dropdown.
  4. Choose the patient’s insurance provider from the dropdown.
  5. If the visit relates to an accident, check the accident checkbox, pick the accident type, and enter the date of the accident.

Then either submit a predetermination or submit a claim:

Submit a predetermination

  1. Click Submit Predetermination.
  2. Read the Terms and Conditions and check I agree.
  3. Click Send Request.

Submit a claim

  1. Click Submit Claim.
  2. Read the Terms and Conditions and check I agree.
  3. Decide whether the Customer will pay in full and check or uncheck the box:
    • Checked — the patient pays the invoice out of pocket, so the patient is the payee of the claim and the insurance reimbursement goes to them.
    • Unchecked — the clinic or practitioner is the payee, and the insurance reimbursement comes back to the clinic.
  4. Click Send Request.

Wait for the success message. The invoice updates with the result of the request, and a View Benefits button opens a PDF with the full Telus response details in a new window.

Cancelling a Claim

A claim can only be cancelled on the same day it was submitted. After that, Telus considers the claim filed and cancellation isn’t possible through the integration.

  1. Open the invoice with the claim on it.
  2. Open the Insurance section.
  3. Click Cancel Claim.
  4. Confirm with Yes.
  5. Click Send Request.

Wait for the success message — the claim is cancelled.