Claims may be submitted in the following manners. You may also submit claims through your mobile app or member portal if your benefit plan allows.
Mail: #50, 12221 44 Street SE | Calgary, AB | T2Z 4H3
Each benefit plan will have different requirements for medical & dental services. Generally, we recommend any service over $500 be sent to us for pre-approval to confirm coverage and the amount. For specific requirements regarding your plan please contact us.
If you have not provided your banking information a cheque and benefit statement will be mailed to your home address. Otherwise, we will direct deposit your reimbursement into the bank account of your choice. By choosing direct deposit you will not have a statement mailed to you but they are available through your member portal.
If you provide a receipt showing the exchange rate charged, you will be reimbursed based on that amount. If you do not have a receipt that shows the exchange rate used, we will use the exchange rate as of market closing on the date of service.
When submitting your claims you should send them to the primary carrier first (i.e. you send your claims to Health Risk and your spouse’s claims go to their insurance carrier). If any portion of the claim is not reimbursed by the primary carrier, then the claim should be forwarded to the other insurance company with the original Explanation of Benefits (EOB) and copies of the receipts. Children’s claims will be reimbursed under the parent whose date of birth (month and day) falls first in the year, If the parents have the same date of birth then the claims will be based on alphabetical order of the parent’s first name.
If Health Risk is the second payer then a copy of the original receipt along with the Explanation of Benefits from the primary payer is required. If the EOB is for a Dental claim, the EOB should contain procedure codes, tooth codes, tooth surfaces and provider information; If the EOB does not contain this information please submit a copy of the standard dental claim form along with the EOB.
Effective 2010, cosmetic procedures are no longer eligible. Expenses must be for diagnostic, therapeutic or rehabilitative services. Some cosmetic procedures qualify if required for medical or reconstructive purposes and must be so stated in writing by your medical practitioner. Expenses incurred for purely cosmetic procedures are not eligible medical expenses.
Most plans will allow your dentist to submit claims to us electronically. Our dental carrier number is 628151 (AutoBen) using the NDC Network v.4. For assistance submitting electronic claims please contact the Adjudicare Customer Support Line at 1-877-944-7100.
We will also pay dental claims on assignment if that is an option your dental office provides. Please have your dental office call us for confirmation of coverage and whether your plan allows electronic claim submissions.