Got clients with two insurance policies? You’re in the right place! This guide breaks down navigating secondary claims and coordination of benefits for all the different integrated insurers in Canada.
Note📝: This guide walks through secondary claims for Canadian clinics. If you’re across the pond and looking to bill secondary claims, check out this guide on 🇺🇸 Billing Secondary Claims Insurance Claims for more details!
Secondary insurance can get a bit tricky when using the integrations. This essentially comes down to the fact that every insurance company does things a little bit differently, which means not all systems communicate the information that other systems need for secondary policies, and therefore not every integration can be used to submit secondary policies.
Let’s dive into how these claims would look for each insurer. You can use the links below to skip ahead to the insurer or section you’re most interested in.
Telus eClaims
Currently, only primary policies can be submitted using the Telus integration. Submitting secondary policies in the integration isn’t recommended because there isn’t currently a way to communicate details about the primary policy’s coverage details, which the secondary insurer would need to approve the claim.
A note from Telus eClaims…
“Providers should only submit to the primary and have the patient submit manually to their secondary insurer. The only 2 insurance companies that accept secondary coverage (ie. coordination of benefits) are Canada Life and ClaimSecure and only if both primary and secondary are under the same company. For example, if both primary and secondary policies are with Canada Life, the provider submits only one claim with the information of both policies. The provider will only receive a real-time response for the primary, therefore the patient must pay the difference. The secondary coverage is handled manually and payment will always go to the patient, in this case the patient doesn’t need to submit manually.”
You can still track secondary Telus claims in Jane, but you’ll want to track them manually without using the integration by submitting them on the Telus eClaims portal directly.
To view and update this setting, you’ll start by heading over to the appointment on the Schedule and selecting the insured appointment. Next, within the Appointment Panel, you can scroll down to the Insurance Info section, click on the black dropdown arrow and select Disable Electronic Submission.
For more details on how to disable this feature, you can check out this guide doc on Disabling Electronic Submission on Telus claims.
Pacific Blue Cross
If you have a patient who is covered under two different Pacific Blue Cross policies, it is important to ensure that the secondary Pacific Blue Cross policy is not already added to the appointment at the time of submission. Pacific Blue Cross only requires that the primary policy is added to the visit.
If there is a coordination of benefits, Pacific Blue Cross will communicate that to Jane and the secondary coverage details will automatically be added to the appointment without you needing to do anything special. Neat, eh?
Teleplan
At the moment, secondary submissions through the Teleplan integration are not supported. Any secondary coverages would have to be billed outside of Jane, then manually recorded later on.
Here’s a guide that walks through how you can record these claims: Working with Claim Submissions and Online Insurer Portals
Mismatching Insurer Mode Types
Lastly, in order for secondary policies to work in Jane, both the primary and secondary policies have to be Collect from Insurer or both have to be Patient Pre-Pay. It isn’t possible to mix and match insurance mode types on a single visit in Jane at the moment.
This means if a patient’s policies are structured where one will pay the clinic and the other will pay the patient, one of the policies won’t be recorded accurately, which could affect the clinic’s financial reports.
In cases where a patient’s primary policy is Payable to Patient and their secondary policy is Collect from Insurer (or vice versa), we would highly recommend only submitting to the primary policy and having the patient submit to their secondary policy on their own.
As always, if you have any additional questions or concerns, you can contact our support team and we’ll be happy to help 💙