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Direct Billing Guide
What is Direct Billing
Direct billing, also known as assignment, refers to the process wherein healthcare providers submit claims directly to insurance companies or third-party payers on behalf of patients. This system is widely used in Canada, where it streamlines the payment process for medical services covered by private insurance plans or government health programs.
Benefits of Direct Billing:
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Convenience: Patients pay little to no out-of-pocket expenses for covered services, reducing financial burdens and paperwork.
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Transparency: Direct billing promotes transparency in healthcare costs, as patients are aware of their coverage benefits and financial responsibilities upfront. We encourage patients to contact their insurance providers prior to attending their first visit at the clinic to confirm that their benefit plan qualifies for direct billing.
How Direct Billing Works
1. Eligibility Verification
Before providing services, healthcare providers verify the patient's insurance coverage and eligibility for direct billing. This involves confirming details such as the insurance plan, policy number, and coverage benefits.
2. Service Provision
Once eligibility is confirmed, the healthcare provider renders the necessary medical services to the patient.
3. Claim Submission
After the services are provided, the healthcare provider submits a claim to the patient's insurance company electronically or through traditional means. The claim includes details of the services rendered, such as diagnosis codes, procedure codes, and charges.
4. Payment Processing
Upon receiving the claim, the insurance company processes it and reimburses the healthcare provider directly for the covered services. Patients may be responsible for any deductibles, co-payments, or services not covered by their insurance plan.
Affiliated Insurers
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Alberta Blue Cross
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ARTA
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ASEBP
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BPA
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Canada Life
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Canada Life - PSHCP
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Canadian Construction Workers
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Chambers of Commerce Group Insurance
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CINUP
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Claim Secure
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Cowan
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D.A. Townley
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Desjardins Insurance
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Empire Life
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Equitable Life
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First Canadian
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GMS Carrier 49
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GMS Carrier 50
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Green Shield Canada
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GroupHEALTH
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GroupSource
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Industrial Alliance
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Johnson Inc.
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Johnston Group Inc.
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LiUNA Local 183
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LiUNA Local 506
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Manion
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Manulife Financial
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Maximum Benefit
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Medavie Blue Cross
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Medic Construction
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People Corporation
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RWAM Insurance Administrators
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SSQ Insurance
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Sun Life
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Telus Adjudicare
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The Co-operators
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Union Benefits
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UV Insurance
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Veterans Affairs Canada
