Search ClaimSecure Search ClaimSecure Change Language to French Français Home Claims Management Health and Dental Claims Management Fast, Reliable Health and Dental Claims Management When it comes to health and dental claims management, ClaimSecure matches reach and rigour with speed of service. Our real-time adjudication system is connected to 99% of all licensed pharmacies and 80% of licensed dentists across Canada. To ensure accuracy, our system performs more than 100 checks and edits on all electronically transmitted claims before they are accepted, adjusted or rejected, and adjudication results are immediately transmitted back to both claimants and service providers in real time. When it comes to offering convenience and efficiency, we take the lead. In the case of extended health care (EHC) claims – including vision care, major medical, hospital and out of country and travel assistance benefits -- we adjudicate, process and pay eligible claims within five business days of receipt, which leads to happy plan members – and happy plan members are happy employees. Key Features National Coverage - No matter where in Canada plan members may be, ClaimSecure has them covered for health and dental. Rigorous Standards – Our drug and dental claims management system is designed to ensure that member/dependant eligibility, therapeutic choice, procedure code eligibility and cost containment measures are strictly adhered to. Furthermore, ClaimSecure has developed extensive auditing procedures and guidelines that help protect clients from fraudulent claims and/or abnormally high healthcare provider service fees. Speed and Functionality – For drug and dental claims, our state-of-the-art adjudication system allows for electronic claims submission directly by the health service provider. Patient history is reviewed and claims are approved, adjusted or declined online in real time within mere seconds. All transaction data is then stored in our central data warehouse for reporting, invoicing and analytics. How’s that for offering peace of mind? Flexible Plan Design Options Choose a standard plan design or create a customized program to ensure your organization’s unique needs are met. Drug Claims : Generic substitution Preferred provider network Tiered co-payment: brand vs. generic; government vs. private; pharmacy chain Therapeutic price substitution Managed cost formularies Deductibles and maximums Coordination of benefits – private and provincial Dental Claims : Pay member or pay provider claims payment options Tiered co-insurance per benefit class (e.g. 100% basic, 80% major restorative, 50% orthodontics) Co-insurance plus calendar, policy or lifetime maximum per benefit class (e.g. 100% periodontics to maximum of $500/year) Annual or per-claim deductibles Maximums: Annual Per certificate Per individual Per benefit class (e.g. endodontics) Coordination of benefits EHC Claims : Tiered co-insurance per benefit class (e.g. 100% Hospital, 80% Major Medical) Co-insurance plus calendar maximum per benefit class – dollar or frequency (e.g. 100% Paramedical to maximum of $500 per year or 12 visits per year) Dollar maximums: Lifetime or Annual (per certificate, individual or benefit class) Benefit entitlement age maximums (for students, employees, retirees) Pay member/provider capabilities Usual and customary price verification Coordination of benefits – private and provincial (e.g. Assistive Devices Program) Front-end deductibles SiteMap Claims Management Health and Dental Health Service Spending Account (HSSA) Cost Plus Plan Management Consulting Planning Activation Account Management Analytics Auditing Invoicing and Billing Risk Management Stop-Loss Coverage Travel Coverage eProfile™ Services Login Member Plan Administrator Videos Cost Containment Services Clinical Services Plan Design Provider Relations RxAdvantage™ Services Canada Life What's New? Drug Reviews eNews Downloads Accessibility Privacy Legal About Us Contact Us Careers © 2021 ClaimSecure Inc. All rights reserved.