Published on April 2, 2008
World Access FAQ Session: World Access FAQ Session Presented To: University of Windsor Agenda : Agenda Who is World Access Assistance Procedure Claims Procedure Tips Questions World Access Corporate Structure: World Access Corporate Structure NYSE “AZ” Paris, France Canadian Operations: Canadian Operations World Access Canada Canadian Operations (World Access Canada): Canadian Operations (World Access Canada) 24/7/365 Kitchener, Ontario Approx 250+ employees 50 experienced claim adjusters 15 medical case management nurses Multilingual response – 17 languages Green Shield Member Services: Green Shield Member Services Pre-trip assistance Emergency Medical Assistance Emergency Message Centre Emergency Cash Transfer Emergency Legal Referral Lost Document Assistance Emergency Translation Services Medical Case Management Emergency Evacuation Cashless Medical Services Claims Payment Recovery – GHIP submission Co-ordination of Benefits Member Cases: Member Cases Member calls WA – needing to seek treatment WA offers referral WA makes billing arrangements with provider WA medically monitors case – approval for any investigative/invasive treatment WA assists member to get back to Canada if necessary/appropriate Claims come directly to WA – negotiated and paid GHIP Recovery done by WA Coordination with other insurance done by WA Assistance Services: Assistance Services Pre-trip and Emergency Pre-Trip Preparation: Pre-Trip Preparation Pack your Green Shield wallet card with the World Access Emergency phone number on it and your WAC booklet WAC booklet can be downloaded by visiting: www.uwindsor.ca/hr - then by choosing “Benefits” If you will be travelling outside of North America call World Access for the international dialing codes required to call Canada from your destination Inquire if there any Canadian Travel Advisory’s for your destination Country Ask any benefit questions prior to leaving To confirm coverage you need to verify with Green Shield directly Medical Emergency: Medical Emergency Evaluate your emergency If immediate medical assistance is needed then call for an ambulance (911 where applicable) Once at the hospital call World Access to open a case or have a family member call on your behalf If immediate attention isn’t needed call World Access to open a case prior to seeking medical treatment Why contact World Access?: Why contact World Access? Assist in finding an appropriate level of medical care – clinic, hospital When possible World Access will arrange billing prior to your visit Able to inform clinic/hospital you are coming in prior to visit Provided a case number to reference your emergency Medically manage the case to ensure procedures and practices are eligible for coverage One City in Africa, Two Hospitals: One City in Africa, Two Hospitals Thanks to thorough provider credentialing, World Access knows to choose Hospital B. Case Opening: Case Opening 10-15 minutes to open Requires full details (OHIP number, Green Shield Number, date of birth, contact numbers, etc) Privacy statements will be advised Investigative and Intrusive Procedures must be approved in advance World Access will monitor your case with hospital staff to ensure procedures are eligible Call 1-800-936-6226 or 519-742-3556 to open a case Claims Procedure: Claims Procedure Submitting Claims: Submitting Claims Claim forms will be sent to home address Advise if you wish them sent elsewhere at case opening Forms available on the Green Shield Website Submit claim forms, medical documents and all original bills to World Access Keep copies of the bills for yourself Mail forms to P.O Box 277, Waterloo, N2J 4A4 Inquiries Regarding Your Claim : Inquiries Regarding Your Claim Call 1-800-363-1835 Email [email protected] Claim Submission Tips: Claim Submission Tips Delays occur when further documents or information is needed 3 most common delays: claim forms, medical records, improper bills If you are in a hospital obtain a discharge summary before leaving if possible Requirements from the Canadian Government for reimbursement: Original Itemized Bills HCFA or UB92 bill if in USA When a Claim is Processed: When a Claim is Processed World Access will negotiate the bill with the provider to obtain preferred rates If payment of the claims are outstanding cheques will be issued directly to the provider You will receive an Explanation of Benefits advising of any discounts and total payment issued. If you have paid the claim payment will be issued by cheque to your home address Proof of payment should be submitted to World Access with your claim Received Partial Reimbursement: Received Partial Reimbursement Items may not have been covered under the policy Items might have been covered under your regular Green Shield Plan and forwarded to Green Shield directly for processing (ex. Extended Healthcare Benefits) Some bills processed while others still awaiting documentation (ex. Proper bills) Questions call 1-800-363-1835 Received a Bill from a Collection Agency?: Received a Bill from a Collection Agency? Billing departments are not always located within the medical facility Payment issued but reminder invoice sent before reaching billing service Bill may have never been submitted to World Access Verify amount of bill to your Explanation of benefits Call 1-800-363-1835 immediately World Access will contact the collection agency and provider to rectify the situation Questions? : Questions? Adjournment: Adjournment Thank you for your time.