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Pended and On Hold Submissions with TELUS eClaims: Paid to Clinic

  1. Insurance Billing (Canada)
  2. Pended and On Hold Submissions with TELUS eClaims: Paid to Clinic

    3. 4 min read
    Practice Plan Thrive Plan
Staff Access Level: Administrative/All Billing, or higher
Jane Plan: Practice, Thrive, or Legacy
Add-on Required: Yes, Insurance Add-on (or Legacy Insurance Plan)
Integration: TELUS eClaims
Geography:Canada 🇨🇦

Getting Started

Before you get started, make sure you have the following ready:

  • The insurer’s final decision - Pended and on-hold claims don’t update automatically in Jane, and you won’t receive a notification through Jane when the insurer reaches a decision. Contact the insurer directly to confirm the outcome before proceeding.
  • The Explanation of Benefits (EOB) - The EOB sometimes includes the insurer’s expected assessment timeframe and contact information. If no timeframe is provided, contact the insurer within 24 to 48 hours of the original submission.

Instructions

This guide covers what to do when a TELUS eClaims submission is on hold because the clinic received the insurer’s payment directly. If the patient received the payment instead, refer to our guide on Pended and On Hold Submissions with TELUS eClaims: Paid to Insured Member/Patient.

Here’s how to resolve the submission. Pick one of the two options below to close out the insurer invoice in Jane.

đź“Ł Heads up: Once you disable electronic submission, the original submission and EOB are no longer accessible in Jane. Download and save a copy of the EOB before continuing.

  1. Go to the Patient’s Profile > Billing
  2. Find the invoice with the On-Hold tag and click View.
  3. Download and save a copy of the EOB to the patient’s file area.
  4. Scroll down to the Insurance section, click the black dropdown arrow, and select Disable Electronic Submission.
  5. Click the dropdown arrow next to the line item and choose one of the following, depending on whether you need to track payment details:
    • Select Pay & Approve if the full amount of the invoice is covered and you don’t need to record the payment method, date, or reference number.
    • Select Record Payment in Detail if you need to record the payment method, date, or reference number, or if the insurer paid less than the full amount.

If you selected Pay & Approve, no further steps are required. If you selected Record Payment in Detail, continue to the steps below.

Recording an Insurer Payment in Detail

  1. Select the payment method and enter the amount the insurer paid.
  2. Click Apply to apply the payment to the invoice.
  3. If a balance remains, click Bill $ to Patient to bill the remaining amount to the patient.

What to Expect

If you selected Pay & Approve, the claim moves to the Approved folder. Jane does not record the payment method, date, or reference number for this action.

If you used Record Payment in Detail, the invoice shows the insurer’s payment applied, including the payment method and amount you entered, along with any remaining balance billed to the patient.

Important Notes

  • Insurers typically don’t return adjudications for pended or on-hold claims through the TELUS eClaims integration, so these claims require manual follow-up with the insurer.
  • Once Disable Electronic Submission is selected, the original submission and EOB are no longer accessible in Jane. There is no way to restore this record after the fact.