Electronic Claims Services for Plan Members – eClaims

Great-West’s Member eClaims and Provider eClaims services provide plan members with convenience and sophisticated technology adding value to your group benefits plan.

Member eClaims

Plan members can submit claims online through GroupNet™ for Plan Members

• Your plan members can submit claims online through GroupNet for Plan Members, our secure online services.
• Member eClaims includes a variety of covered services including:

• Prescription drugs
• Dentalcare
• Visioncare
• Paramedical services

• It’s easy to use and accessible 24-7.

To use Member eClaims, your plan members must be:

• Registered on GroupNet for Plan Members.
• Signed up for Direct Deposit of claim payments and eDetails to notify them by email when a claim has been processed and that claim details are available online.

Provider eClaims

Claims submitted electronically at the point of service

• Provider eClaims is the first national eClaims service for extended healthcare providers across Canada.
• It expands convenient dental-style electronic claim submission to other healthcare provider types, including chiropractors, physiotherapists and visioncare providers.
• Provider eClaims is available at approved providers across Canada—we’re adding new providers every day.

How it works

1. A plan member receives a service at an approved provider.
2. The provider logs on to a secure site, enters the patient and claim information, and can submit a claim or verify coverage (but not plan details).
3. The claim is submitted to Great-West for automatic adjudication, with a series of checks including coverage, type of expenses and provider eligibility.
4. The provider is notified whether the claim has been approved, declined or held for review.
5. Later, the plan member receives an Explanation of Benefits providing details of the claim.

Enhanced fraud protection

We are committed to protecting your plan from benefits fraud and misuse. Member eClaims and Provider eClaims provide an opportunity for even more effective use of our cutting-edge detection and prevention technology.

• We apply all of our existing state-of-the-art safeguards to all eClaims, along with additional electronic measures.
• Submitted claims are subject to rigorous adjudication and verification through our comprehensive provider database.
• In addition to our automated detection systems, claims are randomly selected for audit.
• Increased electronic tracking also creates an easily verifiable trail of information, further protecting the benefits your plan members value.