If you’ve used the TELUS eClaims portal in the past, you’re likely familiar with those “pending” responses where additional processing time is needed. You will see these pending/on hold claims in Jane as well, and you’ll find that payment may go to the clinic or to the insured member for these submissions.
In the case that a submission comes back as on hold or pending, these claims won’t update automatically to a “paid” or “rejected” status. When Jane gets an EOB, typically it will specify who can expect to be reimbursed, the clinic or the patient. Let’s go over how to manage these for each situation :)
Paid to Clinic
If the clinic ends up receiving the payment you’ll be able to manually record the amount received once you get that information in your statement from the insurer:
In the event where the insurer does not pay the full cost of the visit you can specify the actual amount paid in the first step of receiving the payment and on the second step this will only partially pay the invoice:
Then Jane will give you the option to bill the remaining balance to the patient:
Paid to Insured Member/Patient
If the patient is the one who receives the payment in the end and this is specified in the EOB that Jane receives - Jane will actually update the insurance mode on the visit to be Patient Pre-Pay which will automatically push the full balance of the visit to the patient to pay up front.
For dealing with the insurer invoice, clinics will typically mark the claim as “Paid & Approved” once the patient has been paid by insurance. Or some clinics will just mark it as “Paid & Approved” right away if they are confident that the patient will receive the payment.
To mark the claim as “Paid & Approved”, you can do so from the Submitted folder, the patient’s profile or the insurer invoices area by clicking the black arrow next to the line item and select the Pay & Approve option:
When you select this option, Jane won’t actually record a real payment from insurance so you won’t see these payments on any of your reporting. Instead, she will just move it to the Approved folder.
You can also choose to completely remove the claim from the appointment which will turn it into a fully private visit since you will not be receiving anything from the insurer yourselves. With this option you would lose the record of your original submission though.