November 26, 2018
On Nov. 30, 2018, Great-West Life will upgrade their dental claims system and process claims with CDAnet version 4. Two important benefits of this upgrade are:
- Predeterminations will be processed immediately when possible.
- Coordination of Benefits will be accepted. This means when Great-West Life is the secondary claims processor you can send the secondary benefit claim right away.
Action required
On or shortly after Dec. 1, 2018, change the settings in your practice management system for Great-West Life (carrier ID 000011) to CDAnet Version 4 using the TELUS B network, and enable the supported messages shown below.
Change details
- Claims must be submitted as CDAnet version 4 (NEW)
- The network is changing to TELUS Group B (NEW)
- The following messages will be supported:
- Claim (01)
- Coordination of Benefits claim (COB) (07) (NEW)
- Claim Acknowledgement (11)
- Claim Explanation of Benefits (EOB) (21)
- Claim Reversal (02)
- Claim Reversal Response (12)
- Predetermination (03)
- Predetermination Acknowledgement (13)
- Predetermination Explanation of Benefits (EOB) (23) (NEW)
Processing details
Claims, reversals and predeterminations will be processed in real time and, when possible, with an electronic Explanation of Benefits. If an acknowledgement is received, Great-West Life will adjudicate the claim and notify plan members and dentists just like the current process. To allow for more electronic claim submissions, the age limit will be extended from 8 to 31 days.
When Great-West Life is both primary and secondary claims processor:
- If the primary claim returns an Explanation of Benefits, then the secondary claim can be sent with the new COB message, which may return either an EOB or an acknowledgement. If Great-West Life has already processed the secondary claim, an Explanation of Benefits with the message “claim was previously assessed” will be returned and no further action is required.
- If the primary claim returns an Acknowledgement, both the primary and secondary claims will be processed as long as the secondary plan details are included on the claim. There is no need to send a paper or electronic claim for the secondary claim.
When Great- West Life is the secondary carrier and different from the primary carrier:
- A COB 07 claim transaction can be sent to Great-West Life. Great-West Life will accept explanation of benefits (EOBs) from carriers using CDAnet version 2 and 4.
Payments will continue to be issued as they are now. If a payment indicates it should be issued to a “billing” dentist who is different from the payee on file, one of the following messages will be displayed: “Payment will be issued to the payee we have on file.” or “Le paiement sera émis à l’ordre du destinataire nommé dans nos dossiers.”
Click here to learn more about Great-West Life’s claims payment processes.
As of Nov. 10, plan member files will no longer be updated with the address submitted on claims and predeterminations; the claims and predeterminations will be processed as usual. Plan members should continue to give address changes or other updates directly to Great-West Life or their plan sponsors.
Further help
For more information about these changes, contact Great-West Life at 1-800-957-9777. For assistance adjusting your practice management software, contact your software vendor.
