Skip to main content
  1. Guides
  2. Practice Management on Embo...
  3. What happens when a claim i...

Practice Management on Embodia - Part 3: Billing

TELUS eClaims
Video tutorial: Direct Billing with Embodia (How to submit an eClaim)
Introduction
Enabling and adding your TELUS eClaims credentials
What kind of response can I expect?
Obtaining patient's authorization and consent
Predetermination claim - not associated with an invoice
Predetermination claim - associated with an invoice
Submitting a claim
What happens when a claim is accepted?
Nullifying a claim
Storing patient policy details
When and how should I expect payment for a claim?

When a claim is submitted and accepted, a response containing an Explanation of Benefits (EOB) is returned.

The Explanation of Benefits will include a summary of the services submitted (box #1 in the image below), and how much is eligible to be covered by the insurer (box #2 in the image below). 

Sample of claim submitted to TELUS eClaims on Embodia

 

When you initialize a claim through Embodia, in the popup form you can specify who the claim should be "payable to". There are two options:

 

The service provider

If you specified that the claim should be paid to the service provider, Embodia will automatically attach a new payment to the patient invoice with the full eligible amount returned in the EOB.

If the eligible amount does not cover the full amount submitted, you should collect the remaining amount from the patient using one of your payment methods and manually attach a payment to the invoice.

 

The insured member

If you specified that the claim should be paid to the insured member, Embodia will not attach a payment to the patient invoice. As this eligible amount will be paid directly to the insured member, you should collect the full amount from the patient using one of your payment methods and manually attach a payment to the invoice.

Back
© 2024 Embodia