Give your patients another reason to choose your services.

Registered with eClaims? Get your eClaims account integrated into Claim Manager for truly simple billing experience. Bill group benefits plans, provincial plans and patients with one software. For allied health professionals and optometrists in Canada.

Stamp_with_logo_horz_big-200   Three lifesaving reasons to do all your billing in one place.

Literally. Get your life back.

Three reasons to bill group benefits plans with Claim Manager.

1. Bill group benefits and public plans at the same time

Include B.C. insurance plans in your billing.

 

 Claim Manager

 Other Software

 
  • MSP
  • ICBC
  • WorkSafeBC
  • Sun Life Financial
  • Standard Life Assurance Company of Canada
  • Johnson Inc.
  • Cowan Insurance Group
  • Industrial Alliance
  • Chambers of Commerce Group Insurance Plan
  • Desjardins Insurance
  • Manulife Financial
  • Great-West Life
  • Maximum Benefit or Johnston Group

2. Coordinate group benefits with provincial plans

Check provincial benefits to comply with coordination of benefits rules.

 

 Claim Manager

 Other Software

 
  • Coordinate MSP and group benefits

Instant check of MSP benefit is built into every claim. The group benefits claim is decreased by its amount.

  • Coordinate ICBC and group benefits

Each ICBC claim is validated. Any balance not covered by the claim is billed to the group benefits plan.

3. Bill many payees at once

No need to switch between software when billing multiple payees.

 

 Claim Manager

 Other Software

 
  • Bill several payees in one transaction

Bill MSP fee to MSP, the balance to the group benefits plan and the remainder to the patient – all in one transaction.

  • Get aggregate income reports

Keep all transactions in one database. Prepare income reports across all payees and any time periods.

  • Bill all payees with one software

Bill MSP, WorkSafeBC, ICBC, extended health plans and patients with one software.

  • Bill several payees at once

Bill MSP fee to MSP, the balance to the private plan and the remainder to the patient – all in one transaction.

  • Get aggregate income reports

Keep all transactions in one database. Prepare income reports across all payees and any time periods.

  • HEALTH CARE SERVICE: EXAMPLE

    Service fee $100.00 = MSP benefits $23.00 + group benefits $70.00 + out-of-pocket $7.00

  • OPTOMETRY SERVICE: EXAMPLE

    Service fee $100 = MSP benefits $46.17 + group benefits $43.06 + out-of-pocket $10.77

  • PHYSIOTHERAPY SERVICE: EXAMPLE

    Service fee $100 = ICBC benefits $25.20 + group benefits $59.84 + out-of-pocket $14.96

SO SIMPLE

You can do your billing yourself.

Try it today. Limited time offer.

14-DAY FREE TRIAL!

Need more reasons to join Claim Manager?

Claim Manager autocompletes the claim.

Simply check it and fill in any gaps.

Auto-fill patient profile

Use patient lookup instead of filling profile by hand – even for occasional patients.

 

 Claim Manager

 Other Software

 
  • Select from the clinic’s index

Fill in the patient and insurance-holder profiles using the patient lookup.

  • Select from the MSP Index

Fill in profiles of new patients using the MSP integration lookup.

  • Handle spelling mismatch

Auto-fill the right spelling when it differs on public and private plans.

Auto-fill service details

Don’t bother entering service details into the claims.

 

 Claim Manager

 Other Software

 
  • Default service

Use default initial service to auto-fill the first claim of a new patient.

  • Predictive autocomplete

Use predictive auto-complete to fill in the service details for return patients.

  • Custom price list

Use service lookup to change the service details with one click.

Auto-fill authorization forms

Print ready-to-sign authorization forms.

 

 Claim Manager

 Other Software

 
  • Electronic Transmission Authorization form

A patient must sign the ETA form for every insurer. CM alerts you and completes the form.

  • Benefits Assignment form

A patient must sign the BA form to decrease the upfront payment. CM alerts you and completes the form.

Claim Manager preserves your data.

Access your data at any time.

Your data is stored while you need it.

 

 Claim Manager

 Other Software

 
  • Preserved insurance accounts

Do not ask your patients to repeatedly show their insurance cards. Store insurance accounts in Claim Manager.

  • Detailed explanations of benefits

Need to address inquiries or solve disputes? Access explanations of benefits at any time.

  • Complete billing history

Access complete billing history to reconcile payments, prepare income reports or comply with audits.

CM turns predetermination requests into claims.

Do twice the work in half the time.

Create a predetermination request (PDR) and a claim with one form.

 

 Claim Manager

 Other Software

 
  • A PDR is a claim sidekick

Each claim comes with a PDR if supported. Get an estimate of benefits before billing.

  • Convert PDRs into claims

Convert the approved PDR into a claim for instant processing instead of creating a new claim.

  • Convert PDRs into invoices

Convert the declined PDR into a patient invoice instead of creating it from scratch.

Spend time on what you love. Leave billing to us.

SO SIMPLE

You can do your billing yourself.

Try it today. Limited time offer.

14-DAY FREE TRIAL!

F.A.Q. About eClaims Integration

Read this section if you have more questions about eClaims and Claim Manager integration.

Claim Manager and eClaims

Do you remember the times when only Canadian dentists could bill group benefits plans electronically? Your patients had to do it themselves. By mail! A new standard of customer care was brought about by TELUS Health. It introduced eClaims, a Canada-wide electronic group-insurance-billing system for health care practitioners. eClaims enabled physiotherapists, acupuncturists, massage therapists, chiropractors and other providers to submit private insurance claims on their patients’ behalf.
eClaims uses the eClaims Switch Web service. The Switch service is an engine that passes encoded information between healthcare practitioners and private insurance companies. Practitioners submit their patients’ claims, called Payment Requests, and insurance companies return their payment decisions, called Explanations of Benefits. All communication is done in real time.
eClaims Switch Web service is a black box that does not have a user interface. It operates with encoded data that is not legible for humans. People need a user interface to communicate with eClaims Swtich Web service. Practitioners can select software with the best user interface. The choice of that software is important because the set of its features will determine the convenience of group benefits billing and payment reconciliation for the clinic’s staff.
eClaims portal by TELUS Health provides a basic user interface to eClaims Switch Web service. The eClaims portal consists of a set of webpages for data entry and review that retains records for a limited time. All entered data is eventually purged because eClaims is not connected to any practice management software. A more advanced and convenient user interface is provided by Claim Manager. Claim Manager seamlessly integrates group benefits billing into your practice management software and uses its information to auto-complete your claims. It also stores all group benefits claims and explanations of benefits in your practice management software so that you can prepare your financial statements and analyze your revenues at any time. The integration with your practice management software allows Claim Manager to provide features that are not available in a stand-alone billing applications such as eClaims.
The patients love when you deal with their insurance, but the health care providers see it as extra work and no pay. Integration of group benefits billing into your practice management software eliminates that extra work. When you are using a stand-alone group benefits software, such as eClaims, you have to log in and enter patients’ information and service details. Then you have to switch to your other billing software and do it all over to issue a patient invoice or create a provincial insurance claim. Doing all your billing in your practice management software eliminates repetitive work and keeps you and your patients happy.
Many patients are covered by both provincial and group benefits plans with balance paid by the patient, so one service might require up to three billing transactions. Creating such transactions individually is like servicing three different patients. To save your time on such patients, use Claim Manager. Claim Manager will bill all three payees in one transaction, rolling over the balance among payees until it is paid in full.
Why Claim Manager is worth every penny
  • Features
  • Claim Manager
  • Other Software
  • Coordination of Benefits with Provincial plans
  • In BC
  • No
  • Practice Management Software
  • Yes
  • No
  • Data retention
  • All data
  • A maximum of 2 months of data: current month + 1 month prior; data purged at the beginning of each month
  • Search for a patient
  • Any time
  • Only during data retention
  • Search for a transaction
  • Any time
  • Only during data retention
  • View transaction details
  • Any time
  • Only on the day it was created; only summary view is available next day; no view is available after data retention period.
  • Saving Payment and Predetermination requests as drafts for submission at later time
  • Yes
  • Only until the end of the day
  • Predetermination responses are stored and turned into claims
  • Yes
  • No
  • Income reports for custom time periods
  • Yes
  • No
  • Payment reconciliation reports for custom periods
  • Yes
  • No
  • Patient billing history reports for custom periods
  • Yes
  • No
  • Claim autocomplete
  • Yes
  • No
TH_signature_en_rgbClaim Manager integration is tested and approved by TELUS Health.

Coordination of Benefits

If the patient is covered by multiple insurance plans, the benefits must be coordinated between them.

A practitioner must bill the provincial insurance plan before billing the group benefits plan. For an MSP Premium Assistant patient, for example, a practitioner must bill $23 to MSP and the remainder to the group insurance. Each claim contains a mandatory field, where practitioners must indicate if the provincial health care plan is exhausted. Therefore, billing of the provincial plan is an integral part of private insurance billing. Claim Manager verifies MSP eligibility for each patient before creating a group insurance claim.
Currently eClaims only allows you to bill the primary group insurer, with the secondary insurance information being included in the claim. That informs the primary insurer about the need to coordinate the benefits with the secondary insurer. If your patients participate in two insurance plans, they have to submit the claim to the secondary insurer themselves. They might be asked to enclose the explanation of benefits provided by the primary insurer.
If the patient has a group insurance, ICBC may refuse to pay for the treatments until the patient exhausts the group insurance coverage. Section 88 (6) of Part 7 of the Regulation reads that ICBC “is not liable for any expenses paid or payable to or recoverable by the insured under a medical, surgical, dental or hospital plan or law, or paid or payable by another insurer.” However, ICBC adjusters rarely enforce this condition, so most practitioners can successfully collect ICBC benefits before billing group insurance plans. The practice in B.C. is to bill the service to ICBC first and the balance, if any, to the group benefits plan. In your group benefits claim indicate that the claim is related to the motor-vehicle accident. After the patient settles the claim with ICBC, the patient might be required to reimburse the group benefits plan for the benefits paid in relation to that claim.
You must enroll in eClaims to have it integrated in Claim Manager.

Enroll with eClaims Today

Not enrolled with eClaims? Do it today. Share the benefits of technological progress with your patients.

Some insurance companies provide an estimate of benefits on a practitioner’s request. Such a request is called a predetermination request. The predetermination response shows the amount of benefits that would be paid if the service were to occur on the date of request. Predetermination request allows patients to estimate the out-of-pocket expense for their services. Practitioners can use the requests to help patients to budget for their treatment plans.
eClaims Switch Web service allows for real time communication between practitioners and group insurance plans. Payment and predetermination requests are submitted immediately at the point-of-sale. When supported by the insurer, the payment response (called the Explanation of Benefits) is also provided immediately.
If an immediate explanation of benefits is not supported, the insurer provides an immediate Acknowledgement response to confirm the receipt of the claim. The Explanation of Benefits is sent to the payee at a later date by regular mail. The acknowledgment creates uncertainty because the amount of benefits is not declared. We recommend that you indicate the patient as the payee of the benefits in such claims and bill the full amount to the patient. The patient will collect whatever is paid by the plan.
Some group insurance plans accept the assignment of insurance benefits to practitioners. That means that they will make payments directly to the practitioners to reduce the patients’ out-of-pocket expenses at the point-of-sale. With an assignment of insurance benefits, the patient only pays the amount not covered by the group insurance.
Some private insurance companies transfer money directly to the practitioner’s bank account when the payment is done under an assignment of benefits request. Direct bank deposit allows for faster payments and tighter monetary controls.

GST and billing of private insurers for RMTs

What registered massage therapists need to know about GST and billing of private insurance plans.

Unlike MSP benefits, health care benefits provided by private insurance companies are not exempt from GST for massage therapy services. Massage therapists must apply GST to the full amount of the service fee. If the service costs $100, GST of 5% is $5. The total charge is $105.
What amount is submitted to a private insurance plan when a registered massage therapist submits a claim on the patient’s behalf: before or after the GST? The correct answer is after. If the service fee is $100 and GST is $5, bill $105 to a private insurance plans.
When the massage therapy service is partially covered by a private insurance plan, the remaining balance already includes the GST that is due to be collected from the patient. For example, if you billed $105 to the private plan (GST is included) and received $80 as a benefit payment, bill $25 to the patient, out of which 5% is GST.
If the service is paid in full by a private insurance plan, the payment already includes GST of 5%.
How to correctly account for GST on the patient’s private invoice. There are two ways to do so if the fee is over $30.
  • First, state the amount of GST as a separate line before showing the total charge. For example,

Service fee $100 GST $5 Total $105

  • Second, include the phrase “GST of 5% is included in the price”. For example,

Service fee $105 GST of 5% is included in the price.

Don’t forget to indicate your GST number on the receipt.
This page is for your information only. Please take care to verify all tax related information as the laws can change. With any questions call CRA GST support line at 1-800-959-8287.

SO SIMPLE

You can do your billing yourself.

Try it today. Limited time offer.

14-DAY FREE TRIAL!