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Pended and On Hold Submissions with TELUS eClaims: Paid to Insured Member/Patient

  1. Insurance Billing (Canada)
  2. Pended and On Hold Submissions with TELUS eClaims: Paid to Insured Member/Patient

    3. 4 min read
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 patient received the insurer’s payment directly. If the clinic received the payment instead, refer to our guide on Pended and On Hold Submissions with TELUS eClaims: Paid to Clinic.

When this happens, Jane automatically switches the visit to Patient Pre-Pay, putting the full balance on the patient to pay up front.

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

Option A: Pay & Approve Pre-Pay Invoice

Use this option when the insurer paid the patient directly, and the clinic does not need to record a payment in Jane.

  1. From the Submitted folder, the Patient’s Profile, or the Insurer Invoices area, click the black dropdown arrow next to the word View within that line item.
  2. Select Pay & Approve.

What to expect

  • Jane does not record a payment to the clinic.
  • The claim moves to the Approved folder.
  • No insurer payment appears in your reporting.
  • The original EOB remains attached to the visit.

Option B: Remove Claim from the Visit

📣 Heads up: Choosing Remove Policy removes access to the original submission and EOB in Jane. Save a copy of the EOB first if you’ll use this option.

Use this option to remove the insurer claim entirely and treat the visit as fully private.

  1. Go to the Patient’s Profile > Billing > click View on the line item with the On-Hold tag
  2. Click the dropdown arrow to the right of the blue insurance policy information
  3. Select Remove Policy.

What to expect

  • The insurer claim is removed from the visit.
  • The visit becomes a fully private visit, with no insurer claim attached.
  • The original submission and EOB are no longer accessible in Jane (make sure you’ve saved a copy if you need it).

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.