Prompt claims adjudication is dependent upon our system containing accurate and current member and dependent information, as provided by you and your members to GroupHEALTH. Inaccurate information may create delays or result in claims being denied. GroupHEALTH offers several features to make claims submission quick and easy:
ClaimSecure Member eProfile™
ClaimSecure members are encouraged to create their own eProfile™ account, which can be found via ClaimSecure’s website: www.claimsecure.com. eProfile™ allows members to submit certain claims electronically, view claims history and balances (if applicable), and print pre-populated claims forms. eProfile™ also has a Mobile App available for smart-phones and tablets. GroupHEALTH can pay eligible Health, Dental, Health Spending Account and Wellness Account claims by electronic funds transfer (EFT), directly to a member’s personal bank account. It is the member’s responsibility to set up and activate Direct Deposit via eProfile™.
You may assist a member with set-up, but once established, no one but the member can view or change the banking information, for security reasons. Direct Deposit is required for eProfile™ claim submission and PhotoClaims. The eProfile™ Mobile App allows most iPhone, Android, and BlackBerry users to submit claims electronically by smart-phone or tablet. The PhotoClaims feature allows employees to submit a picture of receipts to support their claim. Find more information on our website.
Pay-Direct Prescription Drugs
The Pay-Direct drug system allows Canadian pharmacies to submit prescription drug claims electronically and instantly, eliminating the use of claim forms.
Electronic Data Interchange (EDI)
EDI allows dentists to submit Basic Dental claims electronically on behalf of their patients. EDI claims are received instantly and processed quickly.
Health and Dental Claim forms can be printed from WEBS™, your ClaimSecure eProfile™ or www.grouphealth.ca. Pre-populated claim forms can be printed under eProfile™.