TELUS eClaims - Submitting claims or predeterminations

Submitting claims or predeterminations

To see which information you will need to extract from the eClaims Provider Portal, please visit this link.

To submit claims or predeterminations, you must use invoice details. If the invoice is a quote, the TELUS Action menu will offer to submit a predetermination. If the invoice is in billing mode, the TELUS Action menu will propose you to submit claims.

* It is important that the date on the invoice is the same as the day you make the claim or predetermination.

When you click on any of the actions, a window will appear in which you will be asked to fill in some information.

  1. Choose the patient's insurance profile (click here to learn how to set up patient insurance profiles)
  2. Select on behalf of who the payment will be made
    1. On behalf of the insured person if you wish to charge the full amount to the patient.
    2. On behalf of the provider if you want the payment to be forwarded to you and only charge the deductible to the patient
  3. Fill in the questionnaire and accept the terms and conditions.
  4. Click on “Confirm and submit

The system will forward the request to TELUS eClaims who will then forward it to the appropriate insurer.

Once the insurer has responded to the request, it will be forwarded to Medexa and a response will be posted. Normally, it takes a few seconds to proceed.

The response can have several statuses:

  • Green status: There will be a refund, either to the provider or to the insured depending on what you have chosen.
    • To the provider: this will create a pending payment from the insurer in the pending payments section of the left side TELUS menu.
  • Yellow status: the claim will be processed to a later date
  • Red status: it will be refused and the system will show you the reasons.
  • Error: the information submitted is invalid, or the insurer does not recognize the policy.
    • In that case, send a report to Medexa and send an email to support@medexa.com to advise us.

If the response is not sufficient and you submitted the claim on the same day, you have the option to cancel the claim.

For example, if the amount is undefined and you wish to make a claim payable to the insured rather than to the provider.

From the response window, you also have the possibility to print it to give it to the patient.