Great-West Provider eClaims service expanded

The following is a communique from Great-West Life, regarding their eClaims service.

Great-West expands its Provider eClaims service

This fall, Great-West Life will enhance its popular Provider eClaims network by adding three more paramedical services. Providers of massage therapy, naturopathic services and acupuncture may soon be eligible to join the network and submit electronic claims to Great-West on behalf of your plan members.

Great-West launched Provider eClaims in 2010 with chiropractic, physiotherapy and visioncare providers. Already, more than 10,000 providers across Canada have signed on and more than 175,000 claims have been processed using the network. The service allows automatic adjudication of claims at the point of sale, with checks on coverage, type of expense claimed and provider eligibility. Plan members get immediate notice of the result of initial adjudication with no need to complete forms or wait for reimbursement.

Provider regulation and registration

Providers of the new service types will become eligible to take part in Provider eClaims in two phases:

• Phase 1 – providers who are formally regulated through a regulating body
• Phase 2 – providers who are informally regulated through other provider associations

Regulation of these provider types varies by province. Our approach is to work with the provider associations for massage therapists, acupuncturists and naturopaths first in the provinces where a regulatory body exists. A regulatory body is a non-governmental organization that regulates an occupation for the government. These organizations establish educational criteria and rules for their members.

Great-West is working with TELUS Health Solutions on this initiative. TELUS is handling registration of formally regulated providers across Canada for the remainder of 2012 and into 2013.

Following a registration period for formally regulated providers, we’ll implement Phase 2 of this enhanced service by engaging provider associations where there is currently no provincial regulation in place. The intent is to work with provider associations whose standards meet the criteria deemed acceptable by Great-West. To be approved as part of
the Provider eClaims network, providers must conform to strict rules and guidelines, similar to those in place for formally regulated providers. We view approved membership in Provider eClaims as a privilege, and will continue to work with TELUS to ensure Provider eClaims members meet our high standards.

For more information

We will provide further updates as we continue to roll out the new Provider eClaims services. In the meantime, please contact your Great-West group representative if you have any questions.