Manion has one of the most respected and experienced claims teams in the industry, supported by leading edge technology.
Major insurance companies in Canada and the U.S. have authorized our organization to pay claims on their behalf. Qualified claims adjudicators pay claims accurately and on a timely basis. All claims are processed using a web based automated claims system, which ensures consistent application of all plan rules. Our 3 day turnaround time on submitted claims is among the best in the industry!
We offer a customized benefit card which enables the insured member and their family to access instant point of sale RX adjudication, electronic dental submission, and emergency out of country contact information. Direct deposit of claims is available to plan members, as well as online access to all benefit coverage information, claims history reports, forms, and information.
Our claims services are supported by our experienced bilingual contact center agents, who have full access to our systems allowing them to quickly respond to plan member inquiries. We constantly monitor our claims turnaround times and contact center agent productivity to ensure we meet or exceed our service standard.
Managed Health Care
Manion promotes a Managed Health Care approach designed to contain costs without lowering the quality of care to plan participants. A Managed Health Care solution includes drug claims payment procedures and systems which:
- Offer the option of providing coverage (fixed or customized) based on a specific Drug Identification Number (DIN)
- Contain formulary and capped dispensing fee reimbursement.
- Provide prior authorization requirements for high cost drugs
- Provide access to a list of pharmacies and their average dispensing fees
- Offer flexible reporting to manage costs on a proactive basis
Electronic Dental Claims Submission
Manion offers Electronic Data Interchange (EDI) capability to dental offices who are part of CDAnet, the Canadian Dental Association sponsored network. This enables dental claims and estimates to be sent electronically for adjudication from the dental office to Manion. Today, three quarters of dental claims are submitted in this manner, eliminating the use of claim forms, postage, courier or fax. We partner with Emergis, a leader in this technology. The majority of dental offices subscribe to this service.
Disability Claims Management
At Manion, we treat each short and long term disability claim on an individual and personalized basis. Our disability claims personnel are comprised of individuals experienced in the insurance and medical fields. We also work closely with the insurance provider to ensure a smooth transition from STD to LTD.
Our claims management process:
- utilizes in-house resources such as Registered Nurses and Medical Review Committees
- has direct access to Medical Consultants – General Practitioners and Psychiatrists
- provides early intervention/referral to our in-house Rehabilitation Consultant
- connects to a large network of service providers across Canada
- assigns a single point of contact to provide continuity of care throughout the claim process
- establishes realistic goals and return to work dates utilizing the Rehabilitation Consultant’s expertise.
Being away from the workplace due to illness can be a significant disruption in a disabled person’s life. Manion has an in-house Rehabilitation Consultant who has established a large network of service providers to assist in the Return to Work process.
Rehabilitation Counseling provides the foundation for ongoing assistance in relation to disability and return to work issues. This can be done in conjunction with coordination of medical/physical rehabilitation so as to maximize recovery and return to work.
Life, AD&D and Waiver of Premium Claims
Manion administers all forms of Life Insurance and A.D. & D. provided within a Plan Sponsor’s program. Our focus is on assisting the insured and or beneficiary in making a complete and proper claim to the Insurer with all required documentation. We work closely with both parties to ensure claims are processed in a timely fashion.