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Telus: Reviewing Adjudication of Claim

When submitting through TELUS e-Claims, the adjudication will be instant. Use this guide to help you determine the status of the submitted invoice. You can also hover over any symbol in InnoCare Software to see what it means.

You will know that the claim has been successfully submitted when you see one of the following symbols.  Also, the Payer Ref # column will populate on the claim line with a number.

  Approved - The transfer has been approved by the e-Claims Payer.

  • Confirm that the Explanation of Benefits (EOB) is accurate. No further action required, wait for payment from the applicable Payer

  Partially approved pending - The transfer has been partially approved by the e-Claims Payer and waiting to be paid.

  • Double check EOB to determine how much was approved.  Get Co-Pay from client

  Denied - The transfer has been denied/rejected by the e-Claims payer

  • Check the EOB to see why the claim was denied. Depending on the response:
    • Fix error and resubmit through e-Claims
    • Have client pay full balance and submit on their own
    • Have client pay full balance if payment plan has expired
    • Contact InnoCare Software Support if you cannot determine reason for denial

  Submitted EDI - The e-Claim has been created, not paid and successfully submitted to the e-Claim Payer

  • This status is similar to “Pending Further Processing” on the TELUS Portal
  • Let the client know that they may receive payment directly and to forward it to the clinic if received.  Then, await payment from either the insurance company or the client.

 

 

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