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:
myGroupHEALTH Member Portal and Mobile App
myGroupHEALTH members are encouraged to login to their member portal via: www.mygrouphealth.ca. The myGroupHEALTH portal allows members to submit claims electronically, view claim history and view Benefits Handbooks and forms. myGroupHEALTH also has a Mobile App available for smart-phones and tablets. myGroupHEALTH 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 their portal profile.
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 online claim submission.
Using the “Submit Claim” option is the quickest way to get reimbursed, but the submission process might take a bit more time. In this option, you enter all the details of your claim and click submit, making it quicker for the claims adjudicator to process your claim and pay you.
With “Submit a Photo”, making a claim is as quick as taking a photo. Simply upload a document or photo of your claim receipt, select the benefit category, and click submit! This is the quickest way to submit your receipts on-the-go, but requires a bit more time to adjudicate.
The myGroupHEALTH Mobile App allows most iPhone, Android, and BlackBerry users to submit claims electronically by smart-phone or tablet.
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 myGroupHEALTH Member Portal, or www.grouphealth.ca.