Paramedical e-claims make life brighter for plan members

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Plan members are saying great things about their online self-serve experience on our Plan Member Services website. We listened to their feedback and as a result are expanding the e-claims functionality on Plan Member Services to include paramedical e-claims.


On October 26, 2009, e-claims will be automatically extended to include the following most popular paramedical expenses:
  • Physiotherapy
  • Massage therapy
  • Chiropractic services*
  • Chiropody
  • Podiatry services*
  • Psychology
  • Naturopathy

    * Includes x-rays

With the addition of e-claims for paramedical expenses, 95 per cent of all claims we receive are for expenses that are eligible for instant adjudication.

This also brings us one step closer to a totally paperless — and greener — medical and dental claiming experience.

Paramedical e-claims steps

Paramedical e-claims have the same look and feel as other types of e-claims. The process is based on the provider’s information. For the initial claim, the member is prompted to enter the provider’s details, which we validate, and store on our website for subsequent claims. In just a few easy steps, the claim is instantly adjudicated online, the plan member gets confirmation and payment is deposited in their bank account within 24 to 48 hours.

Audits and controls

We have implemented increased fraud management controls throughout the online claiming and adjudication process. All e-claims are subject to comprehensive and rigorous audits in addition to the limits in the benefits plan. Here are some examples:

  • When a member submits a paramedical claim, we validate whether the provider is in our national provider database. The database integrates data provided by the associations that govern each practitioner type. If the provider is not registered with their association, the claim is not eligible for online submission.
  • Each paramedical online claim submission triggers an instant automated analysis of that member’s claiming activity to detect any suspicious and potentially fraudulent behaviour.
  • During the claim adjudication process all online claims are subject to random audits, maximum amounts that can be paid for each online submission and mandatory audits for claims over certain amounts.

Communicating with plan members

We encourage you to share this member announcement with your plan members.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.