Overview of Direct Billing Services

Registering with Extended Health Care (EHC) insurance providers or third-party benefits claims management services is an important first step to receive reimbursement by benefits providers.

Whether you choose to offer direct billing services or have patients submit their own insurance claims, most EHC insurance providers will require certain basic information about you, such as your College of Chiropractors of Ontario (CCO) registration number, as well as the address of clinic(s) where you provide privately funded services.

What to know before you get started

Whether you are setting up your own practice or joining an existing clinic, there are some questions you will need to answer before you register. If you are joining an existing clinic, discuss these questions with the clinic owner or manager.

If setting up your own practice, consult an experienced chiropractor or trusted mentor when making these decisions:

• Will you be registering as an individual professional, or as an organization?
• Will your patients submit their own claims, or will you/your clinic direct bill on behalf of patients?
• If using direct billing, will your patients pay for services and be reimbursed for services/products by their EHC insurance provider? Or will the insurer reimburse you/your clinic directly?
• If you/your clinic will be reimbursed directly, what are the details of the account to which those reimbursements should be directed (bank account number, bank number and transit number of the bank)?

Keep in mind that the registration process may take up to three to four weeks to complete, depending on the direct billing service provider. Once you have registered with providers for direct billing, you may also need to obtain consent from your patients to direct bill on their behalf. For example, Telus Health requires patients to complete this consent form before their health care professional can submit claims electronically on their behalf.

Some services permit the Coordination of benefits, while others do not (see Ready to Register?! section below for further details). Co-ordination of benefits happens when employees (plan members) and/or their dependents are eligible for benefits under more than one private health care plan. In such instances, insurers will decide among themselves which plan will be the first payor, and which will be the subsequent payor(s) of benefits. In situations where you or your administrative staff cannot directly bill the second plan, your patient will need to do so themselves.

Only insured products and services can be submitted for direct billing. When a patient is using a Health Spending Account (HSA) to pay for products or services, they must submit their own receipts for reimbursement. One exception is when your patient uses their HSA to cover a portion of the costs of a visit that is not covered by the insurers’ Reasonable and Customary fees. In those instances, some insurers have the option to have additional amounts automatically deducted from the Plan member’s HSA.

Have your patients check their member portal or contact their insurer directly for more information on this option.

Pro Tip: Banking fees

It is also important to note financial institutions charge different rates depending on the volume of transactions, such as deposits and withdrawals, passing through your accounts. These rates often differ based on whether you are using a personal or business account, and whether you have a banking fee plan that allows for a high volume of transactions. If the fee plan associated with the account you’re using for direct deposits is charged on a per-transaction basis, this can add up very quickly. We advise you to contact your financial institution to set up a fee plan that is appropriate to your needs given the increased volume of transactions that will result from enrolling in direct deposit services.

Ready to Register?!

Some insurance providers have their own portals for registering, whereas others use the services of third-party benefits and claims management providers. Our Ready to Register?! chart provides details about which benefits management services include which EHC insurers, as well as information and links, to assist you in registering.