This resource has been developed to assist MTAM members with understanding direct billing best practices, help them develop their own policies for how to manage direct billing for their clients and answer some common direct billing FAQs.

What is Direct Billing? It is an arrangement between a health insurance provider and medical facility/healthcare practitioner, where the facility/practitioner sends the receipt for services directly to the client’s health insurance company. 

What is Assignment of Benefits? Assignment of benefits is an arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a massage therapist or other healthcare practitioner/medical facility.

Note ~ Not all health benefit plans allow for direct billing and assignment of benefits. You must confirm this directly with the insurance provider.

What is Coordination of Benefits (COB): This is the process of determining which of two or more insurance policies will have the primary responsibility of processing/paying a claim and the extent to which the other policies will contribute.

Each health insurance provider has their own requirements for how COB is handled. COB is most easily managed if the client has more than one plan with the same health benefit provider. 

Example - The client has 80% coverage through their own Blue Cross plan as well as 20%  coverage through their spouse’s Blue Cross plan. 

For ease of managing direct billing claims, MTAM recommends that you do not offer to co-ordinate benefits unless all of the client’s plans are with the same insurance provider.

What is an Insurance deductible? The deductible is the amount of money the client will pay for a treatment before their insurance coverage kicks in and the insurance company starts reimbursing the client or RMT/healthcare facility. When the client has a deductible, they have to pay the deductible before a claim gets paid in many circumstances.

Example - A client is having their first massage of the year and their $25 deductible has not yet been paid to the insurance provider. If the RMT direct bills for that treatment, the insurance provider will deduct $25 from the amount that is reimbursed to the RMT on that claim. The RMT should collect $25 from the client in advance to cover the amount that will be deducted from the claim.
 

Direct billing is a benefit / value-added service to your clients. 

Offering direct billing is a great way to build your massage therapy practice. It makes it easier for clients to access their massage therapy benefits, pay less up front/out of pocket and/or makes is easier for them to be reimbursed by their insurance company. 

However, it is an optional service. You do not have to offer direct billing in your practice. Many RMTs have run a successful practice without ever offering to direct bill.
 
Before you begin offering direct billing for your clients, MTAM recommends that you follow these best practices.

1. Have a policy in place for your direct billing procedure. Your policy should cover but is not limited to the following:

  • When will you direct bill for a client? Example - We will not direct bill on the client’s first appointment unless all insurance plan details can be confirmed prior to the first treatment. If all insurance plan details cannot be confirmed before the first appointment, information will be collected and authorization completed for direct billing to begin for the client’s next appointment.
     
  • What is your policy if a claim is denied for any reason? Example - If a claim is denied for any reason or coverage has run out, the outstanding balance will be charged to the client’s credit card number on file.
     
  • How will you communicate the policy to clients? Example - Client reads and signs the direct billing authorization form which indicates they are aware of the clinic policies for direct billing, payments and denied claims.
     
  • Will you accept mulitiple insurance plans for the same client (Co-ordination of benefits)? Example - We will only co-ordinate benefits/direct bill to multiple plans if the client has more than one plan with the same health insurance provider.
     
  • What insurance plans will you accept? Example - We will only direct bill to specified insurance companies. Many RMTs limit their direct billing to Blue Cross and Great West Life through Telus online due the ease of the billing and reimbursement process.

Note ~ Charging clients an administrative fee for direct billing is not permitted by Telus eClaims. See FAQs for details.

2. Make sure the client is aware of their responsibilities if a claim is denied or their coverage runs out.  

  • Ensure client's have completed any required authorization forms and have been made aware of your direct billing policy in the event their claim is denied.

3. Have a procedure for when a client nears the end of their coverage.

  • Will you track how much coverage the client has used or is it their responsibility?
  • Does your online charting and billing program track this for you?
  • Does your client see you exclusively or do they see RMTs in other clinics? You may need to confirm remaining coverage directly with the insurer.

4. Check your client's policy details prior to accepting direct billing requests. The details can vary from insurer to insurer.

Telus eClaims allows you to do an online predetermination request to see if a claim can be submitted however it’s often better to contact the specific insurance provider directly to confirm all plan details. Contact information for Telus insurance providers is listed below.

Blue Cross allows you to check a client’s coverage online very quickly however, occasionally you may need to confirm some details through a phone call to Blue Cross.

In many cases you’ll be able to confirm plan details without the client being present in the clinic. However, some insurers insist that the client is present in the office before giving out the plan details.

Questions to ask the insurance provider…

A. Is a doctors note/valid prescription required?    
B. Does the policy allow for direct billing?  
C. Does the policy allow for assignments of benefits directly to the provider or must the payment go to the client?
D. What is the $ amount of coverage per year?  
E. What is the % of coverage per treatment?  
F. Is there a limit on the $ amount of coverage per treatment?  What is the limit?
G. Is there a deductible on the plan? 
H. Has the deductible been paid?  
I. Is there any coverage remaining on the plan? How much?
J. What are start/end dates on the plan (calendar year, other)? 
 

Direct Billing FAQs

Q. The clinic I work at handles the direct billing for me. Is there anything else I need to do?

A. YesEven though the clinic has someone who administers direct billing claims on your behalf, you should be able to access the records of any claims being made with your name and MTAM number on them. This will help you verify when claims were submitted and payments are made, and help prevent fraudulent billings. The RMT’s name and MTAM number are on the claims - therefore in the case of an audit, it is the RMT who will have to verify that a treatment took place and potentially have to repay the insurer for any claims that can't be verified.


Q. I’d like to start offering direct billing for my clients. How do I start?

A. The first step is to create your policy for how you’ll administer direct billing claims. (See #1)
Once you have a policy in place, register for direct billing with the appropriate insurance providers/Telus. Contact information for many insurance providers is listed below.


Q. Wow - it seems like direct billing will take a lot of time and effort to administer! Can I charge a fee to the client to cover the additional time it takes out of my day?


A
. While we understand that it takes some time to administer direct billing for your clients, charging a fee for this service is not permitted by some insurance providers and highly discouraged by others.

Telus eClaims which is the umbrella group that administers online insurance claims for several insurance providers does not allow healthcare providers to charge a fee to their clients.

As eClaims is a free service to providers and as per the Telus provider agreement section 2.0 accepted by the provider, Claims submitted for adjudication by TELUS shall not exceed the lowest amount that Provider would have charged to a cash paying customer or another private sector third party payer. If any providers would surcharge (e.g. not limited to: administrative work, time, etc.…) this would be considered a breach of the agreement and would result in immediate termination of the provider's ability to use eClaims.

Furthermore, a provider in breach of the TELUS agreement would fall at high risk of being audited by TELUS and/or the insurers.

Telus hosted a free eClaims information webinar for MTAM members on October 4, 2018. The presentation has been made available for those who may have missed it.

Webinar: Direct billing made easy with eClaims


Q. If I can't charge a fee for direct billing, how can I make sure I'm compensated for the time it takes to administer and manage my direct billing claims?

A. When setting your treatment fees, you should include all of your costs, including any administrative time you spend managing your practice (bookkeeping, charting, laundry, and direct billing etc).

If you're not including of all of these costs into your fees, you may not be charging enough per treatment and should consider a fee increase to adequately cover the costs of running your practice.

For more information on how to raise your fees sensibly and fairly, see How to Raise your Fees or login to the member portal and click on the Business Tips & Practice Advice tab.
 

Insurance Provider General Contact Information

Telus eClaims insurers
Chamber of Commerce Group Insurance 1-800-665-3365 
CINUP 1-800-665-1234 
Cowan 1-888-509-7797 
Desjardins Insurance 1-800-463-7843 
First Canadian 1-866-212-5644 
Great-West Life 1-800-957-9777 
GroupHEALTH 1-833-344-6944 
GroupSource 1-888-547-6947 
Industrial Alliance 1-877-422-6487 
Johnson Inc. 1-866-773-5467 
Johnston Group Inc. 1-800-893-7587 
Manion 1-866-532-8999 
Manulife Financial 1-866-407-7878 
Maximum Benefit 1-800-893-7587 
Sun Life Financial 1-855-301-4786 

Manitoba Blue Cross
Phone: 204-775-0151 | Fax:  204-772-1231 
Provider Relations Management 
Email: aimee.peters@mb.bluecross.ca

Green Shield 
Register for direct billing https://www.providerconnect.ca/AccessMgmt/Public/AccountRegistration.aspx
General Informaton https://www.providerconnect.ca