Electronic processing allows drug claims to be managed at the pharmacy prescription counter. We offer electronic transmission and real-time adjudication of drug claims with our Pay-direct and Deferred Payment services.

Pay-Direct

This plan provides a full service solution to plan sponsors and their members at point-of-sale. It comes complete with drug plan cost control and a range of reporting solutions to enhance claims analysis and support plan management decisions.

Plan members visit the pharmacy and present their Assure® drug card along with their prescription. The claim information is transmitted electronically to TELUS Health Solutions for adjudication. The pharmacist receives the results in real-time indicating the portion of the payment the plan member owes. The plan member need only pay this amount at the point of sale.

Deferred Payment

This plan provides many of the advantages of the Pay-direct Plan while offering plan sponsors the ability to defer the timing of payment claims. Plan members visit the pharmacy and present their Assure® drug card along with their prescription. The claim information is transmitted electronically to TELUS Health Solutions for adjudication. The pharmacist receives the results in real-time indicating the portion of the payment the plan member owes. The plan member is then required to pay the full amount at the point of sale. The plan member is reimbursed by cheque or electronic funds transfer once the time and/or dollar threshold is reached.

Deferred payment represents the natural evolution for a plan sponsor wanting to switch from paper claims processing to an electronic solution. It provides all the benefits of the Pay-direct service at a minimal increase to the drug plan cost when compared to paper processing. This service means no claims forms to validate manually, no employee complaints about claim status thus eliminating the administrative procedures related to submissions and follow-up of claims with insurance carriers.

Paper Reimbursement

We recognize that not everyone is at the same stage in the adoption of electronic claims. That's why we offer full outsourcing support, covering end-to-end processing, adjudication and payment of paper claims. We work in partnership with insurers, plan sponsors and their employees to migrate from more costly and cumbersome paper claims to an electronic claims program.