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What types of paramedical claims can be submitted by Providers?
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| RWAM's Provider Claims Services supports Physiotherapist, Massage Therapist, Chiropractor, Acupuncturist, Naturopath, Podiatrist, Chiropodist, Speech Therapist, Osteopath, Optical, Social Worker (MSW), and Psychologist / Psychotherapist claims at this time. |
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Can the Provider determine the patient's eligibility for coverage?
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| No, RWAM's Provider Claims Services website does not allow the Provider to determine a patient's eligibility for coverage. Plan Members should refer to their Group Benefits Booklet for details of paramedical coverage included in their plan. If there are any questions regarding coverage Plan Members should speak with their Plan Administrator, or contact RWAM. |
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How does Coordination of Benefits work with RWAM's Provider Claims Services?
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| Claims must be submitted first to the primary plan under which the patient is covered, then to the secondary plan. If RWAM is the primary plan for the patient, the Provider may submit the claim via RWAM's Provider Claims Services. |
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What information will a Plan Member receive regarding claims submitted on their behalf by the Provider?
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| Plan Members will receive an Explanation of Benefits for all claims submitted by a Provider. The Explanation of Benefits details the patient's name, service description, submitted claim amount, and information regarding the benefit eligibility / amount paid, along with any comments / explanations pertaining to the adjudication of the benefit. |
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Who receives the approved claim payment when the Provider submits a claim?
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| Claim payments can be assigned directly to the Provider, as long as the insured's Group Benefit Plan allows for assignment. Or, the Provider may choose to have any approved claim payment paid to the insured Plan Member. The Provider indicates who is to receive payment on the claim submission screen. |
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How long will it take to receive payment for claims submitted directly by the Provider?
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Claims submitted directly by the Provider using the RWAM Provider Claims Services website are adjudicated in real-time. Providers will receive confirmation of the disposition of the claim immediately upon submitting the claim.
For claim payments assigned directly to the Provider, once the claim has been adjudicated and approved a cheque is mailed out within 2 business days. An Explanation of Benefits will be sent to the Provider and also to the Plan Member.
For claims being paid to the Plan Member, if the Plan Member has enrolled for direct deposit, the approved claim payment will be deposited to the Plan Member's bank account within the next few business days*, and an Explanation of Benefits will be sent to the Plan Member. For Plan Members not participating in direct deposit, the claim cheque and Explanation of Benefits are usually mailed out within 2 business days after the claim has been approved.
*Exact timing of the bank account deposit is dependent in part on the financial institution.
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Can assigned payments be deposited directly to the Provider's bank account?
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| No, RWAM does not deposit assigned payments directly to the Provider's bank account. |
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Can clinic staff submit claims on behalf of multiple Providers?
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| Yes. First, all participating Providers must register individually on RWAM's Provider Claims Services website and obtain unique Provider IDs. Next, the clinic staff member registers on RWAM's Provider Claims Services website and enters the unique Provider IDs for those Providers. |
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How do Healthcare Providers submit claims?
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| Providers must register on RWAM's Provider Claims Services website. Once registration is complete claims can be submitted via the website. |
