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Service Type Service Type Select Provider Claim Details Claim Summary
Recent Claims
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Benefit Sub Category Patient Name Submitted Paid Status Service Date Submitted Date
Claim Types
Previous
Dental
Drug
Wellness
HSA
Health
Chiropractor
Physiotherapy
Massage Therapy
Other
Health
Vision
Hospital
Recent Providers
Name Address City Province
According to our records, you do not have any recent providers on file. To add a provider to your claim, please use the Search for a Provider option.
Or
Attention: eClaim submissions must have a provider.
Click above in the search field to search and add your provider or pick a provider under recent providers. If you cannot find your provider, you will be prompted to add receipts to your eClaim to complete your submission.
Name Address City Province
Lab fees are not eligible to be submitted online; Please submit the claim by mail or fax 1-866-613-0530.
Lab fees are not eligible to be submitted online.
Please Note: There is a per claim maximum of %m for dental online claims submissions. Claims exceeding this amount will be pended for adjudicator review. All receipts must be uploaded with the claim. To access a dental claim form, visit the "Forms" library located on the Home Page or simply "click here"
You currently have {0} left in your Health Spending Account.
Balance is as of Midnight (EST). Claims processed today will be reflected on the next business day.
Service Date Patient Specialist Total Charges
Please Note: There is a per claim maximum of %m for drug online claims submissions. Claims exceeding this amount will be pended for adjudicator review. All receipts must be uploaded with the claim.
Dispense Date Patient DIN Quantity Dispensing Fee Amount
Please Note: There is a per claim maximum of %m for Extended Health Care online claims submissions. Claims exceeding this amount will be pended for adjudicator review. All receipts must be uploaded with the claim .
You currently have {0} left in your Health Spending Account.
Balance is as of Midnight (EST). Claims processed today will be reflected on the next business day.
Service Date Patient Service Amount
Please Note: You currently have {0} left in your Health Spending Account.
There is a per claim maximum of {0} for HSA online claims submissions. Claims exceeding this amount will be pended for adjudicator review. All receipts must be uploaded with the claim.
Balance is as of Midnight (EST). Claims processed today will be reflected on the next business day.
Please Note: The current balance in your Wellness account is {0}.
There is a per claim maximum of {0} for Wellness online claims submissions. Claims exceeding this amount will be pended for adjudicator review. All receipts must be uploaded with the claim.
Balance is as of Midnight (EST). Claims processed today will be reflected on the next business day.
Please remember to submit your claim for consideration under your regular Drug, Dental or Extended Health benefits first.
Service Date Patient Service Benefit Amount
Dispense Date Patient Drug Name Submitted Amount
Service Date Patient Specialist Submitted Amount
Service Date Patient Service Submitted Amount

Note

Should supporting receipt(s)/documentation be required to process your claim, you must supply an electronic copy of those receipt(s)/documentation along with the submission of your eClaim.

We cannot accept separately submitted supporting documentation arriving by fax, email or the postal system.

Note: To submit your receipts and/or documentation electronically you will need to digitize your images using a scanner or the camera feature on your cellphone.
Terms and Conditions
====================
If you have read and understood and agree to the following online claims submission Terms and Conditions, Privacy Policy and Disclaimer, then click the "I Agree" button to continue.

About these Terms and Conditions
================================
These online claims submission Terms and Conditions apply to all claims you submit of any kind for any patient or provider with our online claims submission service.

Disclaimer
==========
After you have read, understood and accept reading the disclaimer, click on one of the options at the bottom to agree or disagree. I certify that the information I will provide for this online claims submission is true and complete and that I am authorized to submit this claim. I certify that I am authorized to disclose and receive information about my spouse and/or dependents for purposes of assessing and paying a benefit if any. I acknowledge that any reimbursement of the charges and explanation of such amounts paid will be provided to the benefit plan member. I authorize ClaimSecure, healthcare professionals, insurers, administrators of government or other benefit plans, and other services providers working with ClaimSecure to exchange necessary information regarding this claim for the purpose of administering my health benefit plan. If I am submitting the personal information of my spouse and/or dependents, I acknowledge that he/she/they have reviewed and consent to the Terms and Conditions, Disclaimer and Privacy Policy (https://www.claimsecure.com/privacy/).

I understand and agree that ClaimSecure will conduct audits of claims submitted by me for purposes including, but not limited to, preventing and detecting fraud. I authorize ClaimSecure, and persons acting for ClaimSecure, to disclose this claim, or any personal information contained in this claim, to the benefit plan sponsor/employer for the purposes of reporting fraud suspicious claims. I am aware that ClaimSecure, or persons acting on its behalf, may be required or permitted by law to disclose this claim, and the information contained in this claim, to others without my knowledge or consent or the consent of the individual to whom the information relates.

By clicking the "I Agree" button you are deemed to have read, understood and agreed to all of these Terms and Conditions, and the Disclaimer and Privacy Policy.

Your responsibilities as a Plan Member
======================================
Keep your personal site identification codes confidential.
You are responsible for online claims submission using your personal identification codes.
You are responsible for continuing to accept the Terms and Conditions for use of the secured website.
You are responsible for retaining original claim receipt(s) for 12 months following the date of your online claim submission(s).
ClaimSecure reserves the right to remove your access to online claims submission without prior notice or explanation.
Your online claim and your coverage may be denied or terminated if you provide false, incomplete, or misleading information.
Any monies or overpayment that you may owe to ClaimSecure in accordance with the provisions of the Group Benefit plan will be repaid to ClaimSecure upon demand.
ClaimSecure may, at its sole discretion, and without prior notice, deduct such monies from your future claim payments.
You will access our website before submitting a claim and will use the most updated claim form, Disclaimer, Terms and Conditions and Privacy Policy available on our website.

If your claims submission(s) is selected for Audit
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Upon request, ClaimSecure may require you to provide the original claim receipt(s). You are responsible for producing and providing the original receipts to ClaimSecure within 30 days.
If you fail to provide the original claim receipt(s) to ClaimSecure, we reserve the right to remove your access to online claims submission and/or notify your plan sponsor without prior notice.

We may revise this Disclaimer from time to time, and will post the most current version on our website at (https://www.claimsecure.com/). Please check back from time to time to ensure that you are aware of any changes and are using the most recent version of the Disclaimer. We will indicate at the top of the page the date this Disclaimer was last revised. Your continued use of our services after any such changes constitutes your acceptance of the Disclaimer as revised.
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